Abstract
Purpose
The study aimed to identify differences between individuals with stroke and the general population regarding socioeconomic, mental health, and Health-related quality of life (HRQOL) factors, and associations among Suicidal ideation (SI), HRQOL, and mental health.
Methods
Data of individuals with stroke (n = 592) and without stroke (n = 23,562) aged 20 or older from the 2013–2017 Korea National Health and Nutrition Examination Survey were analyzed. Chi-square tests examined differences in socioeconomic status, mental health, and HRQOL (EQ-5D) between groups. Independent associations between each EQ-5D dimension and SI were analyzed through multivariable logistic regression.
Results
Individuals with stroke were more likely to have problems on all EQ-5D dimensions. Significant univariate associations were identified between four EQ-5D dimensions and SI among individuals with stroke. Pain/discomfort (odds ratio [OR] = 1.32; 95% confidence interval [CI], 1.01–1.75, p = 0.048) and anxiety/depression (OR = 4.66; 95% CI, 3.69–5.89, p < .0001) of the EQ-5D were associated with SI when adjusting for all socioeconomic variables; anxiety/depression (OR = 2.80; 95% CI, 2.18–3.60, p < .0001) was the only risk factor for SI after controlling for socioeconomic and mental health variables.
Conclusion
Individuals with stroke showed higher rates for problems on the EQ-5D, SI, and depression compared to the general population. They also demonstrated significant associations between SI and each EQ-5D dimension except physical activity, especially pain/discomfort and depression/anxiety. The study’s findings can be referred to when predicting suicide risk in individuals with stroke by analyzing their EQ-5D scores.
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Abbreviations
- CI:
-
Confidence interval
- HRQOL:
-
Health-related quality of life
- OR:
-
Odds ratio
- SI:
-
Suicidal ideation
References
Broussy, S., Rouanet, F., Lesaine, E., Domecq, S., Kret, M., Maugeais, M., et al. (2019). Post-stroke pathway analysis and link with one year sequelae in a French cohort of stroke patients: The PAPASePA protocol study. BMC Health Services Research, 19(1), 770. https://doi.org/10.1186/s12913-019-4522-2
Broussy, S., Saillour-Glenisson, F., García-Lorenzo, B., Rouanet, F., Lesaine, E., Maugeais, M., et al. (2019). Sequelae and quality of life in patients living at home 1 year after a stroke managed in stroke units. Frontiers in Neurology, 10, 907. https://doi.org/10.3389/fneur.2019.00907
Cumming, T. B., Churilov, L., Collier, J., Donnan, G., Ellery, F., Dewey, H., et al. (2019). Early mobilization and quality of life after stroke: Findings from AVERT. Neurology, 93(7), e717–e728. https://doi.org/10.1212/wnl.0000000000007937
Ferro, J. M., Caeiro, L., & Figueira, M. L. (2016). Neuropsychiatric sequelae of stroke. Nature Reviews Neurology, 12(5), 269–280. https://doi.org/10.1038/nrneurol.2016.46
Razmara, A., Valle, N., Markovic, D., Sanossian, N., Ovbiagele, B., Dutta, T., et al. (2017). Depression is associated with a higher risk of death among stroke survivors. Journal of Stroke and Cerebrovascular Diseases, 26(12), 2870–2879. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.07.006
Pompili, M., Venturini, P., Campi, S., Seretti, M. E., Montebovi, F., Lamis, D. A., et al. (2012). Do stroke patients have an increased risk of developing suicidal ideation or dying by suicide? An overview of the current literature. CNS Neuroscience and Therapeutics, 18(9), 711–721. https://doi.org/10.1111/j.1755-5949.2012.00364.x
Bartoli, F., Pompili, M., Lillia, N., Crocamo, C., Salemi, G., Clerici, M., et al. (2017). Rates and correlates of suicidal ideation among stroke survivors: A meta-analysis. Journal of Neurology, Neurosurgery and Psychiatry, 88(6), 498–504. https://doi.org/10.1136/jnnp-2017-315660
Joshi, P., Song, H. B., & Lee, S. A. (2017). Association of chronic disease prevalence and quality of life with suicide-related ideation and suicide attempt among Korean adults. Indian Journal of Psychiatry, 59(3), 352–358. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_282_16
Xu, H., Qin, L., Wang, J., Zhou, L., Luo, D., Hu, M., et al. (2016). A cross-sectional study on risk factors and their interactions with suicidal ideation among the elderly in rural communities of Hunan, China. British Medical Journal Open, 6(4), e010914. https://doi.org/10.1136/bmjopen-2015-010914
Yang, Y., Shi, Y. Z., Zhang, N., Wang, S., Ungvari, G. S., Ng, C. H., et al. (2017). Suicidal ideation at 1-year post-stroke: A nationwide survey in China. General Hospital Psychiatry, 44, 38–42. https://doi.org/10.1016/j.genhosppsych.2016.09.006
Choi, J. W., Lee, S. G., Kim, T. H., & Han, E. (2020). Poststroke suicide risk among older adults in South Korea: A retrospective longitudinal cohort study. International Journal of Geriatric Psychiatry, 35(3), 282–289. https://doi.org/10.1002/gps.5245
Yeoh, Y. S., Koh, G. C., Tan, C. S., Tu, T. M., Singh, R., Chang, H. M., et al. (2019). Health-related quality of life loss associated with first-time stroke. PLoS ONE, 14(1), e0211493. https://doi.org/10.1371/journal.pone.0211493
Chung, J. H., Kim, J. B., & Kim, J. H. (2016). Suicidal ideation and attempts in patients with stroke: A population-based study. Journal of Neurology, 263(10), 2032–2038. https://doi.org/10.1007/s00415-016-8231-z
Harnod, T., Lin, C. L., & Kao, C. H. (2018). Risk of suicide attempt in poststroke patients: A population-based cohort study. Journal of the American Heart Association. https://doi.org/10.1161/jaha.117.007830
Bang, O. Y. (2016). Considerations when subtyping ischemic stroke in Asian patients. Journal of Clinical Neurology, 12(2), 129–136. https://doi.org/10.3988/jcn.2016.12.2.129
Kim, M., & Lee, Y. H. (2018). Gender-specific factors related to suicidal ideation among community-dwelling stroke survivors: The 2013 Korean community health survey. PLoS ONE, 13(8), e0201717. https://doi.org/10.1371/journal.pone.0201717
Park, C. H. K., Lee, J. W., Lee, S. Y., Shim, S. H., Kim, S. G., Lee, J., et al. (2019). Characteristics of the “young-old” and “old-old” community-dwelling suicidal Ideators: A longitudinal 6-month follow-up study. Comprehensive Psychiatry, 89, 67–77. https://doi.org/10.1016/j.comppsych.2018.12.002
Kishi, Y., Robinson, R. G., & Kosier, J. T. (1996). Suicidal plans in patients with stroke: Comparison between acute-onset and delayed-onset suicidal plans. International Psychogeriatrics, 8(4), 623–634. https://doi.org/10.1017/s1041610296002931
Paolucci, S. (2008). Epidemiology and treatment of post-stroke depression. Neuropsychiatric Disease and Treatment, 4(1), 145–154. https://doi.org/10.2147/ndt.s2017
Ones, K., Yilmaz, E., Cetinkaya, B., & Caglar, N. (2005). Quality of life for patients poststroke and the factors affecting it. Journal of Stroke and Cerebrovascular Diseases, 14(6), 261–266. https://doi.org/10.1016/j.jstrokecerebrovasdis.2005.07.003
De Wit, L., Theuns, P., Dejaeger, E., Devos, S., Gantenbein, A. R., Kerckhofs, E., et al. (2017). Long-term impact of stroke on patients’ health-related quality of life. Disability and Rehabilitation, 39(14), 1435–1440. https://doi.org/10.1080/09638288.2016.1200676
Em, S., Bozkurt, M., Karakoç, M., Çağlayan, M., Akdeniz, D., Oktayoğlu, P., et al. (2015). Determining quality of life and associated factors in patients with stroke. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi, 61(2), 148–154. https://doi.org/10.5152/tftrd.2015.80090
Fairweather-Schmidt, A. K., Batterham, P. J., Butterworth, P., & Nada-Raja, S. (2016). The impact of suicidality on health-related quality of life: A latent growth curve analysis of community-based data. Journal of Affective Disorders, 203, 14–21. https://doi.org/10.1016/j.jad.2016.05.067
Jang, J., Jung, H. S., Wang, J., & Kim, S. (2021). Effects of health-related quality of life on suicidal ideation and depression among older Korean adults: A cross-sectional study. Psychiatry Investigation, 18(1), 31–38. https://doi.org/10.30773/pi.2020.0159
Survey, K. N. H. A. N. E. (2021). Survey overview. Retrieved May 30, 2021 from https://knhanes.kdca.go.kr/knhanes/eng/index.do
Korea centers for disease control and prevention, K. C. F. D. C. A. (2017). The third Korea National Health and Nutrition Examination Survey guide book. (Translator, Trans.). In: Book the third Korea National Health and Nutrition Examination Survey guide book. (Vol. 2014, Series the third Korea National Health and Nutrition Examination Survey guide book, Vol. Series 2014): Korea centers for disease control and prevention.
Balestroni, G., & Bertolotti, G. (2012). EuroQol-5D (EQ-5D): An instrument for measuring quality of life. Monaldi Archives for Chest Disease, 78(3), 155–159. https://doi.org/10.4081/monaldi.2012.121
Garratt, A., Schmidt, L., Mackintosh, A., & Fitzpatrick, R. (2002). Quality of life measurement: Bibliographic study of patient assessed health outcome measures. BMJ, 324(7351), 1417. https://doi.org/10.1136/bmj.324.7351.1417
Kim, J. H., & Kwon, J. W. (2012). The impact of health-related quality of life on suicidal ideation and suicide attempts among Korean older adults. Journal of Gerontological Nursing, 38(11), 48–59. https://doi.org/10.3928/00989134-20121003-01
Lee, Y. K., Nam, H. S., Chuang, L. H., Kim, K. Y., Yang, H. K., Kwon, I. S., et al. (2009). South Korean time trade-off values for EQ-5D health states: Modeling with observed values for 101 health states. Value Health, 12(8), 1187–1193. https://doi.org/10.1111/j.1524-4733.2009.00579.x
Jung, K. I., & Park, C. K. (2016). Mental health status and quality of life in undiagnosed glaucoma patients: A nationwide population-based study. Medicine (Baltimore), 95(19), e3523. https://doi.org/10.1097/md.0000000000003523
Min, J. (2015). Suicide behaviors and health-related quality of life: Results from the Korean community health survey of 393,073 adults. Journal of Psychiatry. https://doi.org/10.4172/Psychiatry.1000214
Dou, J., Tang, J., Lu, C. H., Jiang, E. S., & Wang, P. X. (2015). A study of suicidal ideation in acute ischemic stroke patients. Health and Quality of Life Outcomes, 13, 7. https://doi.org/10.1186/s12955-014-0198-9
Kim, S., Kim, Y., Choi, N., Seo, D., Lee, B. C., & Lee, M. (2001). Suicidal ideation of patients in the acute stage of stroke. Journal of Korean Neuropsychiatric Association, 40(2), 243–252.
Ware, J. E., Jr. (2003). Conceptualization and measurement of health-related quality of life: Comments on an evolving field. Archives of Physical Medicine and Rehabilitation, 84(4 Suppl 2), S43-51. https://doi.org/10.1053/apmr.2003.50246
van Straten, A., de Haan, R. J., Limburg, M., & van den Bos, G. A. (2000). Clinical meaning of the stroke-adapted sickness impact profile-30 and the sickness impact profile-136. Stroke, 31(11), 2610–2615. https://doi.org/10.1161/01.str.31.11.2610
Acknowledgements
We thank the Korea Centers for Disease Control and Prevention and the Ministry of Health and Welfare for providing us with the nationally representative cross-sectional survey data used in this study.
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Conceptualization: JJ, KL; Methodology: JJ, KL, SK; Formal analysis and investigation: JJ, HJ; Writing—original draft preparation: JJ; Writing—review and editing: JJ, KL, SK; Resources: JJ, HJ; Supervision: KL, SK.
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All the participants in this study provided written informed consent. All procedures performed the study were approved by the Korean Centers for Disease Control and Prevention Research Ethics Committee (IRB no. 2013-07CON-03-4C for 2013 and IRB no. 2013-12EXP-03-5C for 2014. Exemption has been granted since 2015).
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Jang, J., Jung, HS., Kim, S. et al. Associations between suicidal ideation and health-related quality of life among community-dwelling stroke survivors: 2013–2017 Korea National Health and Nutrition Examination Survey. Qual Life Res 31, 403–412 (2022). https://doi.org/10.1007/s11136-021-02960-9
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DOI: https://doi.org/10.1007/s11136-021-02960-9