Leo Sher, M.D.

A research report, “The association between heart diseases and suicide: A nationwide cohort study” has been published in the Journal of Internal Medicine online ahead of print (1). The authors examined whether people diagnosed with heart disease had an increased rate of suicide compared to individuals without heart disease. In addition, they examined whether the suicide rate varied according to time since diagnosis, number of admissions, and presence of comorbid disorders while adjusting for relevant covariates.

All 7,298,002 individuals (3,640,632 males and 3,657,370 females) aged 15 years or older listed in the Civil Registration System as living in Denmark during 1 January 1980 through 31 December 2016 were included in the study. Those turning 15 or who immigrated into the country during the observation period were included on the date of the respective events. In the multivariate model, the authors adjusted for sex, period, age group, living status, income level, diseases in the Charlson Comorbidity Index, psychiatric disorders diagnosed prior to any diagnosis of heart disease and deliberate self-harm recorded prior to any diagnosis of heart disease.

The authors found excess suicide rate ratios for the following disorders: heart failure (IRR: 1.48; 95% CI: 1.38-1.58); cardiomyopathy (IRR: 1.41; 95% CI: 1.16-1.70); acute myocardial infarction (IRR: 1.28; 95% CI: 1.21-1.36); cardiac arrest with successful resuscitation (IRR: 4.75; 95% CI: 3.57-6.33); atrial fibrillation and flutter (IRR: 1.42; 95% CI: 1.32-1.52); angina pectoris (IRR: 1.19; 95% CI: 1.12-1.26); and ventricular tachycardia (IRR: 1.53; 95% CI: 1.20-1.94). A higher rate of suicide was observed during the first 6 months after the diagnosis of heart failure, acute myocardial infarction, atrial fibrillation and flutter, and angina pectoris when compared to later. The authors also observed a dose-response relationship with respect to number of comorbid disorders as well as number of admissions for certain heart diseases.

The authors suggest that their findings support the recommendation of the American Heart Association that patients with coronary heart disease need to be screened for depression and suicidal ideation using the 9-Item Patient Health Questionnaire (PHQ-9). Detection and treatment of depression as well as reduction in psychological distress and feelings of perceived burdensomeness may help prevent suicide in patients with cardiovascular disorders.

Reference

1. Petersen B, Stenager E, Mogensen CB, Erlangsen A. The association between heart diseases and suicide: A nationwide cohort study. J Intern Med. 2020 Jan 21. doi: 10.1111/joim.13025. [Epub ahead of print]