Patients with PSD are more likely to commit suicide than patients without PSD. Suicidal thoughts may develop immediately 4 days after stroke in at risk patients with history of depression. However, whether suicidal thoughts persist after the acute event is not clear.

A retrospective review of a clinical registry from a comprehensive stroke center between 10/2018 and 3/2020. Patients were eligible if a Patient Health Questionnaire 9-Item (PHQ-9) was available. PHQ-9 greater than or equal to 5, 10, or 20 indicated the presence of mild, moderate, and severe PSD, respectively. Question 9 of the PHQ-9 screens for suicidal ideation and scores ≥ 1, 2, or 3 indicated suicidal ideation over the past 2 weeks for several days, more than half the days, and nearly every day, respectively. Descriptive statistics were generated. The Spearman rank-order correlation coefficient was used to measure the associations between clinical variables and suicidal ideation.

A total of 898 patients who had an acute (primarily ischemic or intracerebral) stroke completed a 90-day telephonic PHQ-9. The mean age (years) and NIH Stroke Scale were 64±15 and 7.4±7.3, respectively. The sample was composed of 56% men, 39% Whites, 31% Blacks, 2.6% Asians, and 10% Hispanics. Eighteen percent, 30%, and 55% scored severe, moderate, and mild on the PHQ-9, respectively. Seven percent reported suicidal ideation and 3% had significant suicidal ideation that likely required further intervention. There was a positive correlation between the Modified Rankin Score (mRS) at 7 days and suicidal ideation (spearman r_s = .184, p < .001). There was no significant correlation between 90 days mRS and PHQ-9.

Routine screening and interventions are needed for PSD and suicidal ideation in at-risk patients in the early stroke recovery period.