Stroke survivors can face many challenges as they recover. Now, a new federal survey is showing that one out of every 12 stroke survivors has contemplated suicide or thought that he or she would be better off dead.
That's more common than what's seen in people with other health problems such as heart attacks or cancer, and it suggests that depression after stroke is more serious than many had realized.
"It was surprising" and shows a need for more treatment, said the study's leader, Dr. Amytis Towfighi of the University of Southern California in Los Angeles. "When patients have their depression treated they're more motivated to take their medication, do therapy and live a full life."
The study was discussed Thursday at an American Stroke Association conference in Honolulu.
More than 6 million Americans have had a stroke; about 800,000 occur each year in the U.S. Studies suggest that up to a third of stroke survivors develop depression, but few have looked at suicidal thoughts - one sign of how serious it is. Stroke kills about 130,000 Americans each year - about one of every 18 U.S. deaths -- according to Centers for Disease Control and Prevention.
"It's not necessarily active suicidal thoughts with a plan, but perhaps wishing you hadn't survived the event," Towfighi explained.
She used the National Health and Nutrition Surveys, a government project that gives checkups and questionnaires to a representative sample of adults. More than 17,000 people were surveyed from 2005 through 2010.
They included 678 who had suffered a stroke; 758 who had had a heart attack; 1,242 with cancer, and 1,991 with diabetes. Researchers don't know how long ago these problems occurred of if people were still being treated for them.
They were asked a question that many studies use to gauge suicidal thinking: "Over the last two weeks, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself?"
About 8 percent of stroke survivors reported such thoughts, compared to 6 percent of heart attack survivors, 5 percent of those with diabetes and 4 percent with cancer.
Suicidal thoughts were more likely in people who scored high on depression tests, were younger, overweight, less educated, poor, female or unmarried.
Another study published in December 2012 in Stroke showed that people over 65 who went through "psychosocial distress," including stress and depression, were significantly more likely to have a stroke and die from it. The most distressed subjects were 54 percent more likely to be hospitalized from having a stroke compared who were the least stressed.
Depression may develop partly because strokes damage the very thing that controls mood - the brain, said a neurologist with no role in the study, Dr. Brian Silver of Brown University and Rhode Island Hospital.
"It's not necessarily the reaction to the disease ... it's also the disease itself that is causing the depression," by releasing harmful chemicals that can trigger it, he said.
Suicidal thinking is a well-known problem, but this study "puts a number on it" and shows the need to watch for and treat it, Silver said.
On the other side of the coin, an earlier study published in September 2012 in the Journal of the American Medical Association showed that depression significantly increased the risk of having a stroke and dying from it. Depression was associated with 45 percent increased risk for stroke and a 55 percent increased chance of dying from a stroke. The authors were unsure why depression led to stroke, but they did note that depression could cause inflammation of the nervous and immune systems, as well as increases the risk for diabetes and high blood pressure. These factors could potentially increase stroke risk.