Association Between Aneurysmal Subarachnoid Hemorrhage and Risk of Suicide: A Systematic Review and Meta-analysis

BACKGROUND: Depression and psychosocial sequelae are common after aneurysmal subarachnoid hemorrhage (aSAH), yet the extent to which aSAH survivors are at increased risk of suicide remains unclear. This systematic review and meta-analysis evaluated whether aSAH is associated with death by suicide and sought to identify potential patient-level risk factors. METHODS: Following PRISMA guidelines, MEDLINE, Embase and PsycINFO were searched from inception until April 1, 2025, for studies reporting suicide rates in adults with aSAH. Pooled relative risks (RRs) were calculated using a simple model adjusted for age, sex, year of event and a comprehensively adjusted model for age, sex, year of event, living status, region, socioeconomic status, physical comorbidity and psychiatric hospitalization. RESULTS: Of 294 unique studies identified, 2 met the inclusion criteria, yielding 20,661 aSAH survivors. Median age was 55 years (IQR: 44-64) years, and 47.4% were male. Ninety deaths by suicide were reported. Pooled analysis demonstrated increased risk of suicide among aSAH survivors compared with non-aSAH controls in both the simple model (RR 1.79, 95% CI 1.46-2.19) and comprehensively adjusted model (RR 1.42, 95% CI 1.09-1.86). Insufficient data prevented the identification of independent patient-level risk factors for suicide. CONCLUSIONS: Survivors of aSAH have a small but significantly increased risk of death by suicide compared to the general population, although suicide remains a rare cause of death following aSAH. Clinicians involved in the subacute and long-term care of aSAH survivors should maintain awareness of this increased risk and routinely screen for depression and suicidal ideation in aSAH survivors.