Stroke Survivors: R U OK? and More--Conversations About Suicide

Hang with me here. It's time. I want talk about something which is taboo in most social circles. It's kind of more like a one-to-one conversation. The topic? Suicide. I know many--a husband who had a loving wife and children, three friend's nephews, a distraught colleague, and so many more who committed the end-of-life drama prematurely. 

R U OK? has an organization that addresses just that. I wrote to them and here is their reply:  

"At the moment, R U OK? operates only in Australia out of a single national office in Sydney. We are currently developing a formal international health promotion partner framework, which will follow on from an international trademarking process. This process is taking some time and isn’t finalised as yet.

"Ideally R U OK? is seeking to expand this initiative internationally with suitable organisations interested and capable of being the central point of contact and health promotion partner for the R U OK? campaign within their countries. Until this happens - anyone interested in promoting the R U OK? message, you may download and use the existing resources from the R U OK? website (www.ruok.org.au) to promote R U OK? within your internal environment only.

"Similarly, you may share existing R U OK? social media, video and other content through your own channels. The R U OK? logo is trademarked, so no changes may be made to the logo. No changes or alterations may be made to the content, unless you change language to be culturally relevant or appropriate. We also recommend that you provide links or information of localised help/health services within your region. [Sorry, Australia. Not too much here in America].

"It’s critical that any organisations or individuals understand and respect R U OK?’s positioning and role as an early intervention campaign, within the suicide prevention health promotion space."

R U OK?’s mission is a world where we’re all connected and are protected from suicide and to inspire and empower everyone to meaningfully connect with people around them and support anyone struggling with life.

R U OK offers a 4-steps plan to a conversation: 
Ask ‘R U OK?’
Listen
Encourage Action
Check-in/Follow-up

'How to Ask’ page is located at http://www.ruok.org.au/how-to-ask.

At home in America, Representative Susan Wild, a Congresswoman, gave this impassioned speech to her colleagues that cried out for more measures regarding mental health. She, and her family and friends, too, were a victim of her husband's unsuspecting suicide. 

https://www.cnn.com/videos/politics/2019/06/27/susan-wild-partner-suicide-kerry-acker-speech-sot-vpx.cnn

“Routine screening of suicidal ideation after stroke, especially targeting subjects with specific characteristics, is needed to plan pharmacological and psychosocial interventions aimed at reducing suicide risk,” Dr. Francesco Bartoli, MD, PhD, University of Milano Bicocca (Monza, Italy), and colleagues said.

But here is the twist in suicide: Stroke survivors are more than twice as likely (learned opinions say even higher) to attempt suicide within a decade of their stroke than non-stroke patients, according to a nationwide study of more than two million Taiwanese adults.

The Neurology Times write that though the illness is an immense global presence and the most common cause of disability worldwide, cultures handle stroke diagnoses in different ways, Tomor Harnod, MD, PhD, and colleagues wrote in the Journal of the American Heart Association. In developed Western countries like the U.S., stroke patients are usually highly intolerant of their disability, which has led to increased rates of suicidal ideations and attempts in those populations.

“In different countries, cultural heritage and socioeconomic status would usually influence a patient with disability thinking about a suicide attempt,” the authors wrote. “Ethnic and cultural differences from Western countries may make Asian people more tolerant of their impairment, dependence or disability in daily life than their European or American counterparts.”

The National Institutes of Health in conjunction with American Academy of Neurology completed a study that will amaze you.

Headed by Swedish researchers in the remarkably morose study entitled "Poststroke suicide attempts and completed suicides: A socioeconomic and nationwide perspective," the researchers found the following:

This nationwide cohort study included stroke patients from Riksstroke (the Swedish Stroke Register) from 2001 to 2012. We used personal identification numbers to link the Riksstroke data with other national registers. Suicide attempts were identified by a record of hospital admission for intentional self-harm (ICD-10: X60-X84), and completed suicides were identified in the national Cause of Death Register. We used multiple Cox regression [explanation: method for investigating the effect of several variables upon the time a specified event takes to happen] to analyze time from stroke onset to first suicide attempt.

RESULTS:

We observed 220,336 stroke patients with a total follow-up time of 860,713 person-years. During follow-up, there were 1,217 suicide attempts, of which 260 were fatal. This was approximately double the rate of the general Swedish population. Patients with lower education or income (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.11-1.68) for primary vs university and patients living alone (HR 1.73, 95% CI 1.52-1.97) had an increased risk of attempted suicide, and patients born outside of Europe had a lower risk compared to patients of European origin. Male sex, young age, severe stroke, and poststroke depression were other factors associated with an increased risk of attempted suicide after stroke. The risk was highest during the first 2 years after stroke.
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Here's a little-known fact: I contemplated suicide in the first 2 years after my stroke, but I couldn't move around too much to finalize and, the thing that made me ultimately NOT do it, was my boys would take it so hard. I couldn't do that to them. After the 2 years passed, I wanted to do it less and less. And now almost 10 years later? No suicide thoughts at all.

That's the thing with a stroke. You get better over time, but the waiting is abhorrent, so much so that you might think about ending it all at the beginning. But just thinking about it, if you think about suicide at all, is enough for most of us.