For Heart Attack Survivors, a Risk of Suicide?

Study findings underscore importance of depression screening, researcher says

Wednesday, December 7, 2016

WEDNESDAY, Dec. 7, 2016 (HealthDay News) -- People who've suffered a heart attack or unstable angina may face a higher-than-normal risk of suicide, a new study suggests.

Researchers in Taiwan found that patients with the heart conditions were slightly more likely to die by suicide compared to people their age who had healthy hearts. The risk was particularly elevated in the first six months after diagnosis of the heart problem.

However, experts said the findings do not prove that heart problems were the direct cause of some suicides.

Suicidal behavior is "complicated," and it's possible there are other explanations for the link with heart disease, said researcher Jung-Chen Chang. She is an assistant professor at National Taiwan University's College of Medicine.

On the other hand, it's known that depression is common among heart attack survivors and people with unstable angina -- where clogged heart arteries cause bouts of chest pain. Angina may eventually lead to a heart attack.

It's estimated that up to one-third of heart attack survivors develop some degree of depression, said clinical psychologist Barry Jacobs. He's director of behavioral sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Penn.

Jacobs said the new findings underscore the importance of screening heart disease patients for depression, which is recommended by the American Heart Association.

Jacobs, who was not involved in the study, is a spokesman for the heart association.

The findings only report heart patients' risk of suicide relative to people without heart conditions. They do not give an estimate of the absolute risk.

Suicide appears to be a "relatively" uncommon cause of death among these patients, Chang said. Still, if the risk is higher than average, it's important to know that and try to intervene, she added.

The study results were published Dec. 7 in the Journal of the American Heart Association.

The findings are based on government data for more than 41,000 Taiwanese adults who died by suicide between 2000 and 2012. These cases were compared with 164,200 adults with similar demographics.

Heart disease was more common among people who died by suicide: 2.5 percent had been diagnosed with a heart attack or unstable angina versus 1.5 percent of the comparison group, the researchers said.

In general, the study found, people with a history of depression or other psychiatric disorders were at higher suicide risk -- as were people in poor physical health. Single people were also at greater risk than those who were married.

But even when the researchers weighed those factors, heart disease was still tied to a 15 percent increase in suicide risk.

In addition, the findings showed that risk was greatest in the first six months after diagnosis, when heart disease patients had a threefold higher suicide risk versus people with healthy hearts.

That points to a particularly vulnerable period, Jacobs and Chang said.

People may still have bothersome physical symptoms in those early months, Chang noted. "It is also the most difficult time to readjust to daily life, work and social roles," she said.

Jacobs pointed out that "this gives us an even greater sense of urgency to screen people for depression soon after diagnosis."

Of course, a depression diagnosis does not mean a person is suicidal, Jacobs noted. But, he said, certain patients may be more vulnerable -- such as those who'd previously had psychiatric disorders, or those who lack support from family and friends.

Although the heart association recommends depression screening, it's not always done, according to Chang's team.

Jacobs suggested that patients talk to their primary care doctor if they think they might be depressed.

It's normal, he noted, to feel down after a heart disease diagnosis. "But there's a big difference between feeling a little sad and being so distraught that you can't get out of bed in the morning," Jacobs said.

Another red flag is losing interest in activities you once enjoyed, he added.

As for depression treatment, the options for people with heart disease are the same as for everyone else -- talk therapy, antidepressants, or both.

"Often, it comes down to patient preference," Jacobs said.

There are limitations to the current study. Besides the question of cause-and-effect, it's not clear whether the findings would be the same in countries other than Taiwan, Jacobs said.

"Suicide rates, in general, do differ across the world," he pointed out.

But the bottom line is that heart patients' mental health symptoms should be "taken seriously," Jacobs explained.

"That's the message for doctors, patients and families," he said.

SOURCES: Jung-Chen Chang, Ph.D., assistant professor, School of Nursing, College of Medicine, National Taiwan University, Taipei; Barry Jacobs, Psy.D., director, behavioral sciences, Crozer-Keystone Family Medicine Residency Program, Springfield, Penn.; Dec. 7, 2016, Journal of the American Heart Association, online

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