Depression and suicidal ideation are common mental health problems among stroke survivors, which significantly impact their disability and mortality. The impact of stroke on the risk of suicidal ideation among individuals with depression is not well understood. The study examines whether the co-occurrence of stroke and depression increases the likelihood and severity of suicide.

The National Health and Nutrition Examination Survey 2011-2018 retrospective cross-sectional data set was used to identify participants based on the presence or absence of stroke and depression, categorizing them into four mutually exclusive groups. Socio-demographic groups were compared using weighted percentages and 95% confidence intervals. Chi-square and F-test were used to assess group differences. Multivariable logistic regression was used to examine associations between the four groups. Adjusted odds ratios (AOR) and p≤0.05 were used to determine a significant independent risk of stroke associated with depression and suicide.

Among 19,397 participants, 863 (4%) reported having suffered a stroke. Depression was reported by 154 participants (0.7%), while 586 participants (2.6%) did not have depression. The mean age of participants with stroke and depression was 59 years. Majority of participants with stroke and depression were females(64%), Non-Hispanic Whites(67.7%), with an educational level above high school(38.9%), and £ poverty line(69.8%). Stroke almost doubled the effect of suicidal ideation in individuals with depression (AOR = 1.86; 95% CI [1.21,2.85]; p = 0.005) compared to individuals with depression and no stroke. Those below the poverty line had an increased risk of developing suicidality (AOR = 1.39; 95% CI [1.11,1.74]; p = 0.005).

Stroke worsens the effects of an individual developing suicidal thoughts. Healthcare systems should integrate mental health screening procedures tailored for stroke victims, especially if they are depressed.