For the analysis, researchers examined data from 23 previously published studies with a total of more than two million stroke survivors. Overall, 5,563 people in these studies attempted suicide or died by suicide. Compared with people who had never had a stroke, those who survived a stroke were 2.11 times more likely to attempt suicide and 61 percent more likely to die by suicide, the analysis found. “Stroke survivors have physical, cognitive, and mental health consequences that may put them at a higher risk of suicide,” says the study’s lead author, Manav Vyas, MBBS, a neurologist at Sunnybrook Health Sciences Centre and an assistant professor of neurology at the University of Toronto. The first several months after a stroke may be the most crucial for monitoring mental health, the study results suggest. With each passing year after the stroke, the suicide risk declined by 3 percent, the study found. While the study wasn’t designed to determine what might cause suicide risk to spike after a stroke or decline over time, it’s possible that several factors play a role, including the severity of disability resulting from the stroke along with prior history of depression or mood disorders, Dr. Vyas says. RELATED: Telemedicine for Stroke Care and Rehabilitation

Roughly one in three stroke survivors have depression, according to a study published in the International Journal of Stroke. Even five years after a stroke, more than one in five survivors had depression, this study found. Depression is among the biggest predictors of suicide risk among stroke survivors, a separate study published in March 2017 in the Journal of Neurology, Neurosurgery, and Psychiatry suggested. In this study, almost one in eight stroke survivors had suicidal thoughts. Compared with stroke survivors who never experienced depression, people currently suffering from depression had an almost 12-fold greater risk of suicidal thoughts, and people with a history of depression had an almost 7-fold higher risk, this study found. People who had repeat strokes, or who experienced more extensive physical disabilities or cognitive deficits also had an increased risk for suicidal thoughts. “Many stroke survivors may not be able to communicate how they feel because of language deficits following stroke, and so it is important to evaluate their mood and screen for depression and suicidal thoughts,” Vyas says. RELATED: Mobile Stroke Units Lead to Faster Care, Less Disability Among Stroke Patients

Causes and Symptoms of Depression After a Stroke

A stroke can trigger chemical changes in the brain that block the ability to feel positive emotions and amplify negative feelings, according to the American Stroke Association. While suicidal thoughts are one indication of depression, the ASA notes that several other symptoms can be common among stroke survivors:

Persistent sad or anxious moodFeeling hopeless, worthless, or helplessLack of interest in hobbies or activitiesFeeling fatiguedDifficulty with concentration, memory, and decision-makingInsomniaDramatic changes in appetite or weight

Unlike some chronic diseases that lead to disabilities gradually over many months or even years, a stroke can force patients to adjust to sudden, substantial changes in their physical and mental abilities seemingly overnight. “The stress associated with that can lead to increased depression and also increased thoughts about wanting to hurt themselves or feeling like they don’t want to be around anymore,” says Anjail Sharrief, MD, MPH, the director of stroke prevention at the Institute of Stroke and Cerebrovascular Diseases at the University of Texas Health Science Center in Houston. RELATED: 8 Depression Symptoms You Shouldn’t Ignore

How Depression Treatment Can Aid Stroke Recovery

Many stroke survivors need to undergo rehabilitation to help rebuild skills compromised by the stroke. This can include speech therapy to improve communication skills, physical therapy to rebuild coordination and movement skills, and occupational therapy to help with daily activities like eating, bathing, and dressing, according to the Centers for Disease Control and Prevention (CDC). Untreated depression can make rehab harder for stroke survivors; many symptoms of depression make it challenging to complete exercises in therapy and focus on recovery. At the same time, treatment for depression can aid recovery, according to the CDC. “Recognizing that stroke may increase the risk of suicidal thoughts or suicide attempts will help stroke survivors, their families, and healthcare professionals to identify and hopefully reduce these risks,” Vyas says.