Letters

Suicide in patients with stroke

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7164.1016b (Published 10 October 1998) Cite this as: BMJ 1998;317:1016

Depression may be caused by symptoms affecting lower urinary tract

  1. K R Brittain, Research associate,
  2. C M Castleden, Professor
  1. Division of Medicine for the Elderly, University of Leicester, Leicester LE1 7RH
  2. Leicester General Hospital, Leicester LE5 4PW
  3. Guy's Hospital, London SE1 9RT

    EDITOR—In their paper on suicide in patients with stroke Stenager et al commented on the prevalence of depression after stroke.1 If the underlying causes of this depression can be elucidated and treated then the risk of suicide may be lowered.

    One such cause may be symptoms affecting the lower urinary tract (urinary incontinence, frequency, nocturia, and urgency), as self reported depression is related to such symptoms.2 A total of 3592 questionnaires that were developed for a large Medical Research Council study on incontinence in Leicestershire have been analysed. The prevalence of self reported depression increased from 15% in patients with stroke without urinary symptoms to 32% in those who had had a stroke and urinary symptoms.

    Symptoms affecting the lower urinary tract should not be discounted when assessing survivors of stroke in the community because they can be treated and hence could play an active part in reducing depression and therefore suicide.

    References

    1. 1.
    2. 2.

    Future studies should consider the role of cerebrovascular disease

    1. Rahul Rao, Senior lecturer in old age psychiatry
    1. Division of Medicine for the Elderly, University of Leicester, Leicester LE1 7RH
    2. Leicester General Hospital, Leicester LE5 4PW
    3. Guy's Hospital, London SE1 9RT

      EDITOR—The epidemiological study by Stenager et al on the risk of suicide after stroke is the first study of its kind and highlights the prime importance of detecting mood disorder in patients with stroke.1 However, the conclusion that society should take more interest in the psychosocial aspects of living with the impairment imposed by stroke underplays the role of organic brain damage imposed by cerebrovascular disease. As the prevalence of depression is higher in stroke than in disorders with a similar degree of disability,2 closer scrutiny of the brain injury may be required. Indeed, one study of suicidal ideation after stroke found anterior brain lesions to be associated with suicidal thinking immediately after a stroke.3 A possible explanation for the likely overrepresentation of suicidal thinking and completed suicide in patients with stroke is the high prevalence of lesions disrupting frontal and subcortical brain circuitry, either as lacunar infarcts or strategic cortical infarcts affecting the frontal lobe(s). Such lesions are associated with both depression4 and impulsivity.

      Although the role of disability and social disadvantage after stroke cannot be understated, the contribution of damage to specific brain areas should continue to attract research. In this way, the study of cerebrovascular disease can complement epidemiological research into sociodemographic risk factors.

      References

      1. 1.
      2. 2.
      3. 3.
      4. 4.
      5. 5.
      View Abstract