Incidence of suicide death in patients with cancer: A systematic review and meta-analysis

Suicide after colorectal cancer-a national population-based study

AIM

A cancer diagnosis is often associated with physical as well as emotional distress. Previous studies indicate a higher risk for suicide in patients diagnosed with cancer. The aim of this study was to investigate the prevalence of death by suicide in a national cohort of patients with newly diagnosed colorectal cancer compared with a matched control group to determine if patients with colorectal cancer had an increased incidence of death by suicide.

METHOD

This national Swedish cohort was retrieved from the register-based research database CRCBaSe, which includes all patients diagnosed with colorectal cancer between 1997-2006 (rectal) and 2008-2016 (colon) and six controls for each patient matched by age, sex, and county. Cause specific mortality due to suicide was modelled using Cox proportional hazards model and adjusted for known risk factors.

RESULTS

The main analysis included patients operated for colorectal cancer, 55 578 patients compared with 307 888 controls. The first year after diagnosis the hazard ratio (HR) for suicide among patients operated for colorectal cancer was 1.86 (CI: 1.18-2.95) compared to controls. Suicide was more common among men than women (HR 2.08; 1.26-3.42 vs. 1.09; 0.32-3.75). A subgroup analysis of the 9198 patients who did not undergo surgery after diagnoses found a seven-fold increase of suicide (HR 7.03; 3.10-15.91).

CONCLUSION

Suicide after surgery for colorectal cancer was almost twice as high as in the control group, mainly driven by excess mortality among men. Although the cases were few in the subgroup of nonoperated patients, the considerably higher risk of suicide indicates that more resources might be needed in this group. Evaluation of risk factors for suicide among patients with colorectal cancer should be performed for early identification of individuals at risk.

The effects of psychological interventions on suicide for cancer patients: a systematic review and network meta-analysis

Numerous psychological interventions are available for suicidal and death ideation (SDI) and suicidal behavior among cancer patients. To identify the optimal psychological interventions for reducing SDI and suicidal behavior in cancer patients. However, it remains unclear which psychological intervention is the most effective. We performed a pairwise and network meta-analysis by searching seven databases from the date of inception until 8 April 2022. An important focus of this network meta-analysis was the comparison of the effects of various psychological interventions on the reduction of SDI and suicidal behavior among cancer patients. For determining efficacy, we used standardized mean differences (SMDs) and 95% confidence intervals (CIs). Besides, a pairwise meta-analysis, inconsistency test, network meta-analysis, the surface under the cumulative rankings curve (SUCRA), comparison-adjusted funnel plot, subgroup analysis, and sensitivity analysis were also carried out. A total of 8 studies involving 1,350 patients were searched in this study. It showed that empathy therapy (SUCRA = 95.3%) has the best effect among the six interventions. Comprehensive psychological intervention (SUCRA = 77.6%) was ranked in the top two positions, followed by meaning-centered therapy (SUCRA = 40.7%). Comparison-adjusted funnel plots revealed no significant publication bias. In addition, our conclusions have not changed significantly after the sensitivity analysis. In this network meta-analysis, empathy therapy was identified as the optimal choice for reducing SDI and suicidal behaviors in cancer patients. Further multi-center and high-quality RCT studies should be conducted to make our conclusion more rigorous.

Effect of Socioeconomic Disparities on Suicide Risk in Patients With Prostate Cancer During 2005 to 2020: A Population Study

PURPOSE

To determine whether socioeconomic disparities have an impact on the likelihood of suicide among prostate cancer patients.

METHODS

Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with malignant prostate cancer between 2005 and 2020. The socioeconomic disparities of the patients were evaluated by median household income (MHI) and ethnicity. Ethnicity included Spanish-Hispanic-Latino and non-Spanish-Hispanic-Latino. A Cox proportional risk model was utilized. Using the Kaplan-Meier approach, the cumulative incidence of suicide mortality was measured.

RESULTS

A total of 857,418 US population with prostate cancer were included. In the multivariate analysis, individuals with MHI over $75,000 had a lower risk of suicide mortality than those with MHI between $54,999 and $74,999 in all patients (aHRs: 0.693, 95 CI%: 0.603-0.797). Spanish-Hispanic-Latino displayed lower overall suicide mortality in all patients (aHRs: 0.426, 95% CI: 0.323-0.561). In the subgroup analysis of different ages, individuals with MHI over $75,000 had a lower risk of suicide than those with MHI between $54,999 and $74,999 in patients 60 to 79 years (aHRs: 0.668, 95% CI: 0.562-0.794) and individuals with MHI below $54,999 had higher suicide risk than those with MHI between $54,999 and $74,999 in patients 80+ years (aHRs: 1.786, 95% CI: 1.100-2.902). Hispanic-Latino individuals had lower overall suicide mortality in 00 to 59 years (aHRs: 0.420, 95% CI: 0.240-0.734), 60 to 79 years (aHRs: 0.445, 95% CI: 0.319-0.621), 80+ years (aHRs: 0.363, 95% CI: 0.133-0.988).

CONCLUSION

Socioeconomic disparities, including MHI and ethnicity, are important factors strongly related to suicide risk in prostate cancer patients. The lower MHI individuals and non-Spanish-Hispanic-Latino individuals were associated with higher suicide risk.

To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research

Psychological variables substantially shape the risk of suicidal thoughts and behaviours (STBs). However, it is unclear to what extent they are considered in individuals with cancer. We synthesized the quantitative research landscape concerning psychological risk/protective factors of STBs in the (psycho-) oncological context. This pre-registered review (PROSPERO-ID CRD42022331484) systematically searched the databases PubMed/Medline, CINAHL, PsycInfo, Cochrane Library, and Web of Science (as well as the grey literature and preprints). Risk of bias (RoB) was estimated using the ROBINS-I tool. Of 11,159 retrieved records, 319 studies were eligible for inclusion. Of those, 163 (51.1%) had investigated psychological factors (affective: n = 155; social: n = 65; cognitive: n = 63; personality/individual differences: n = 37; life events: n = 6), in a combined 3,561,741 participants. The most common STBs were suicidal ideation (n = 107) or death wishes (n = 20) rather than behaviour (suicide deaths: n = 26; attempts: n = 14). Most studies had a serious RoB. Thus, a large body of research investigated STBs in cancer patients/survivors, but it rarely aligned with the theoretical or clinical developments in suicide research. We propose a conceptual model of STBs in cancer delineating moderation and mediation effects to advance the integration of the fields, and to inform future research and practice.

Core and bridge symptoms of demoralization in Chinese female cancer patients: a network analysis

Objective

In this study, we explore the core and bridge symptoms of demoralization in female cancer patients in China, and provide a basis for precise psychological intervention among female cancer patients.

Methods

This study used a cross-sectional survey. Participants were recruited from three third-class hospitals in Jiangsu Province from June 2022 to June 2023 using the convenience sampling method. The severity of each symptom of demoralization was investigated in female cancer patients using the Demoralization Scale (DS). Network analysis was performed using the R language to identify core and bridge symptoms in the network and further explore some characteristic edge connections in the network.

Results

The network structure model of demoralization had strong accuracy and stability. In the network, the symptoms with the highest strength centrality were "Discouragement" (C3, strength=2.19), "No self-worth" (A3, strength=1.21), "Don't want to live" (A5, strength=1.20), "Hopeless" (D4, strength=0.81), and "Vulnerability" (B3, strength=0.74), respectively. The bridge strength analysis identified "Hopeless" (D4, bridge strength=0.92), "Discouragement" (C3, bridge strength=0.85), "No self-worth" (A3, bridge strength=0.75), "Poor spirits" (E2, bridge strength=0.71), and "Vulnerability" (B3, bridge strength=0.69) as the bridge symptoms. The strongest edge connections of all dimensions were "No self-worth" and "Worthless" (A3-E6, edge weighting=0.27), "Poor spirits" and "Loss of emotional control" (E2-D1, edge weighting=0.22), "Discouragement" and "Vulnerability" (C3-B3, edge weighting=0.14), and "Hopeless" and "No meaning of survival" (D4-A4, edge weighting=0.12).

Conclusion

"Discouragement (C3)", "No self-worth (A3)", "Hopeless (D4)", and "Vulnerability (B3)" are both core symptoms and bridge symptoms. These symptoms can not only trigger a patient's demoralization but also stimulate more severe symptom clusters through interactions. The early recognition of and intervention regarding these symptoms could be important for the prevention and treatment of demoralization among female cancer patients.

Indirect effects of health-related quality of life on suicidal ideation through psychological distress among cancer patients

The interrelationships of suicidal ideation, psychological distress, and impaired health-related quality of life (HRQoL) in cancer patients are complex and multifaceted. Limited empirical evidence exists on the indirect effects of impaired HRQoL on suicidal ideation through psychological distress among cancer patients. To fill this research gap, 250 cancer patients were recruited through a cross-sectional hospital-based research design. Structural equation model (SEM) results indicated that impaired HRQoL is a predictor of psychological distress (β = 0.153; p < 0.05), and psychological distress positively predicts suicidal ideation (β = 0.647; p < 0.000). The study found no direct effects of impaired HRQoL on suicidal ideation (β = -0.05; p = 0.223). Indirect effects of HRQoL on suicidal ideation was confirmed, showing a full-mediation effect β = 0.099 (SE = 0.048, CI = [0.030, 0.189], p < 0.05) (i.e. the pathway impaired HRQoL predict suicidal ideation is through psychological distress). Cognitive-behavioral therapy and other emotional support programs should be considered for cancer patients to mitigate psychological vulnerabilities linking impaired HRQoL to suicidal ideation.

Risk factors associated with suicidal ideation among cancer patients: a systematic review and meta-analysis

Objective

The objective of this review was to provide a comprehensive summary and analysis of the risk factors associated with suicidal ideation among cancer patients.

Methods

This review adhered to the PICO/S framework and guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework (PROSPERO CRD42023433639). We searched Web of Science, PubMed, Embase, Scopus, PsycINFO, and Cochrane Library from the establishment date of the databases until June 9, 2023 for observational studies that reveal risk factors associated with suicidal ideation among cancer patients. Software Review Manager 5 (vision 5.4) was used for Meta-analyses.

Results

4,921 studies were obtained through the search of the databases, 40 of which were eligible. Meta-analysis revealed that suicidal ideation in cancer patients was significantly associated with marital status, living alone, post-traumatic stress disorder (PTSD), panic disorder, education, psychiatric illness history, social functioning, childhood adversity experience, financial problems, pain, depression, demoralization, vomiting, residence and anxiety.

Conclusion

Being unmarried, living alone, less educated, living in rural, financial problems, pain, vomiting, PTSD, psychiatric illness history, lower social functioning, childhood adversity experience, anxiety, depression, demoralization, panic disorder were risk factors for suicidal ideation among cancer patients. This review provided evidence-based information for identifying and reducing the risk of suicide in cancer survivors.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42023433639.

The efficacy and safety of ketamine for depression in patients with cancer: A systematic review

Background

Management of depression in the oncology population includes supportive psychotherapeutic interventions with or without psychotropic medication, which take time to demonstrate effectiveness. Fast-acting interventions, like ketamine, can provide a rapid antidepressant effect; however, there has been limited research on effects of ketamine among cancer patients. The objective of this review is to provide an overview of research on the efficacy and safety of ketamine on depression in patients with cancer.

Methods

We reviewed the published literature in MEDLINE® (via PubMed®), EMBASE, and Scopus from 1 January 1982 to 20 October 2022. We screened the retrieved abstracts against inclusion criteria and conducted a full-text review of eligible studies. Following extraction of data from included studies, we used a framework analysis approach to summarize the evidence on using ketamine in patients with cancer.

Results

All 5 included studies were randomized clinical trials conducted in inpatient settings in China. In all included studies ketamine was administered intravenously. Three studies used only racemic ketamine, and two studies used both S-ketamine and racemic ketamine. All included studies reported ketamine a tolerable and effective drug to control depression symptoms.

Conclusion

Included studies showed administration of sub-anesthesia ketamine significantly improves postoperative depression among patients with cancer.

Psychosocial functioning in individuals with advanced oesophago-gastric cancer: a mixed methods systematic review

BACKGROUND

Oesophago-gastric cancer is an aggressive disease with a high rate of recurrence and mortality across the disease trajectory. Reduced psychosocial functioning has been evidenced amongst those with advanced disease, however little is known about the contributing factors. Determining these factors is an important clinical consideration to inform assessment and intervention. This review aimed to synthesise the available evidence on the psychosocial functioning of individuals with advanced oesophago-gastric cancer and their carers.

METHODS

A JBI mixed-methods systematic review. Four bibliographic databases, MEDLINE, Embase, PsycINFO, and CINAHL, were searched. Quantitative and qualitative studies were screened for inclusion and critically appraised for methodological quality. Both types of data were extracted using JBI tools for mixed-methods systematic reviews. A convergent segregated approach to synthesis and integration was used. The findings of the synthesis have been configured according to JBI methodology.

RESULTS

A total of 12 studies were included in this review, including 6 quantitative studies and 6 qualitative studies. The quantitative results provide preliminary indication of several physical, biological, psychological and macro-level contextual factors associated with psychosocial functioning in this clinical population. The qualitative findings shed light on a range of physical, psychosocial, and existential challenges faced by advanced oesophago-gastric cancer patients. These multiple and often persistent challenges appear to cause considerable distress; however, patients describe the importance of maintaining a sense of normality and control over their illness and its effects. Patients value continuity and structure, however many report shortcomings when accessing care. No findings reporting the experiences from the perspective of carers were found, therefore all findings represent the perspective of the patient.

CONCLUSIONS

Further high-quality research is needed to understand how best to support and manage the palliative care needs of individuals living with advanced oesophago-gastric cancer. Implications for practice are discussed, suggesting that psychosocial interventions, complex symptom management and continuity of care could improve the psychosocial functioning of individuals in this setting.

PRE-REGISTRATION

The systematic review was pre-registered at the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020181273) and the protocol can be viewed on the OSF ( http://osf.io/exuzf ).

Suicide rates among patients with first and second primary cancer

AIMS

With advancements in cancer treatments, the survival rates of patients with their first primary cancer (FPC) have increased, resulting in a rise in the number of patients with second primary cancer (SPC). However, there has been no assessment on the incidence of suicide among patients with SPC. This study assessed the occurrence of suicide among patients with SPC and compared them with that in patients with FPC.

METHODS

This was a retrospective, population-based cohort study that followed patients with FPC and SPC diagnosed from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 17 registries database between 1 January 2000 and 31 December 2019.

RESULTS

For patients with SPC, an age of 85+ years at diagnosis was associated with a higher incidence of suicide death (HR, 1.727; 95% CI, 1.075-2.774), while the suicide death was not considerably different in the chemotherapy group (P > 0.05). Female genital system cancers (HR, 3.042; 95% CI, 1.819-6.361) accounted for the highest suicide death among patients with SPC. The suicide death distribution of patients with SPC over time indicated that suicide events mainly occurred within 5 to 15 years of diagnosis. Compared with patients with FPC, patients with SPC in general had a lower risk of suicide, but increased year by year.

CONCLUSION

The risk of suicide was reduced in patients with SPC compared with patients with FPC, but increased year by year. Therefore, oncologists and related health professionals need to provide continuous psychological support to reduce the incidence of suicide. The highest suicide death was found among patients with female genital system cancer.

Risk of suicide in patients with cancer aged 75 years or more - Follow-up of over 400,000 individuals

BACKGROUND

It is well established that older patients with cancer have a significantly higher risk of suicide. However, a comprehensive understanding of the risk factors is lacking. In this study, we aimed to identify groups at an increased risk of suicide among patients aged ≥75 years with a previous cancer diagnosis.

MATERIAL AND METHODS

All Polish individuals diagnosed with cancer at the age of ≥75 years between 1 January 2009 and 31 December 2019 were included in this study. Standardized mortality ratios (SMRs) and 95 % confidence intervals (CIs) were calculated.

RESULTS

A total of 410,440 patients (211,730 men and 198,710 women) were included in this study. SMR for both sexes was 1.64 (95 % CI 1.43-1.87). When analyzed by sex, a significantly higher risk was observed only in men (SMR 1.70, 95 % CI 1.47-1.95). Among them, the risk of suicide was observed after the diagnosis of lymphoma (2.83, 1.14-5.82), lung cancer (2.63, 1.70-3.89), kidney cancer (2.16, 1.03-3.96), colorectal cancer (1.96, 1.41-2.65), urinary tract cancer (1.86, 1.22-2.70), and prostate cancer (1.40, 1.07-1.82). The highest risk of suicide in men was observed within 6 months of diagnosis (2.83, 2.11-3.71).

CONCLUSIONS

Men diagnosed with cancer at ≥75 years of age are at a higher risk of suicide than men of the same age in the general population. The observations from this study suggest which are the most vulnerable groups of elderly patients with cancer, and the time at which they should be given special support.

Oncology Providers' and Professionals' Experiences With Suicide Risk Screening Among Patients With Head and Neck Cancer: A Qualitative Study

PURPOSE

There has been limited study of the implementation of suicide risk screening for patients with head and neck cancer (HNC) as a part of routine care. To address this gap, this study assessed oncology providers' and professionals' perspectives about barriers and facilitators of implementing a suicide risk screening among patients with HNC.

MATERIALS AND METHODS

All patients with HNC with an in-person visit completed a suicide risk screening on an electronic tablet. Patients reporting passive death wish were then screened for active suicidal ideation and referred for appropriate intervention. Interviews were conducted with 25 oncology providers and professionals who played a key role in implementation including nurses, medical assistants, patient access representatives, advanced practice providers, physicians, social workers, and informatics staff. The interview guide was based on the Consolidated Framework for Implementation Research. Interviews were transcribed and analyzed for themes.

RESULTS

Participants identified multilevel implementation barriers, such as intervention level (eg, patient difficulty with using a tablet), process level (eg, limited nursing engagement), organizational level (eg, limited clinic Wi-Fi connectivity), and individual level (eg, low clinician self-efficacy for interpreting and acting upon patient-reported outcome scores). Participants noted facilitators, such as effective care coordination across nursing and social work staff and the opportunity for patients to be screened multiple times. Participants recommended strengthening patient and clinician education and providing patients with other modalities for data entry (eg, desktop computer in the waiting room).

CONCLUSION

Participants identified important intervention modifications that may be needed to optimize suicide risk screening in cancer care settings.

Suicide risk among adolescents and young adults after cancer diagnosis: analysis of 34 cancer groups from 2009 to 2019

PURPOSE

We aimed to identify granular groups with an increased risk of suicide among adolescents and young adult (AYA) patients with a previous malignant neoplasm diagnosis.

METHODS

We deployed a cohort of all cases of primary malignant neoplasms diagnosed between the 1st of January 2009 and the 31st of December 2019 among individuals aged 15-39 years registered in the Polish National Cancer Registry. To assess the risk of suicide in comparison with the general AYA population, we calculated sex-age-year standardized mortality ratios (SMR) with 95% confidence intervals (CI).

RESULTS

A total of 50,298 cancer patients (22,111 men and 28,187 women) were included in this study. The risk of suicide for AYA after cancer diagnosis was 2.39-fold higher than that for AYA in the general population (SMR 2.39, 95% CI 1.69 to 3.28). The risk in women (SMR 4.18, 95% CI 1.68 to 8.62) was higher than that in men (SMR 2.18, 95% CI 1.48 to 3.09). A significantly higher risk of suicide was observed in men with testicular cancer (SMR 2.46, 95% CI 1.37 to 4.05).

CONCLUSIONS

Polish AYA diagnosed with cancer had an almost 2.5-fold higher risk of suicide than the general AYA population. The particular risk group was men with testicular cancer within 2-3 and 5-10 years after cancer diagnosis.

IMPLICATIONS FOR CANCER SURVIVORS

To better identify patients at risk of suicide, there is a need to create or adapt screening tools, educate cancer care providers and family physicians, and integrate psychological services into select cancer care specialties.

Mental health outcomes and correlates in cancer patients entering survivorship after curative treatment

OBJECTIVE

Cancer survivors face numerous physical and mental health challenges even after treatment completion. However, few studies have examined mental health in cancer survivors who received curative treatment during the transition out of active treatment and into survivorship. The current study describes the prevalence of mental health outcomes and their correlates in cancer survivors treated with curative intent during the first year of survivorship.

METHODS

A total of 120 cancer survivors of any cancer type completed a survey that assessed depression, anxiety, death ideation, alcohol and substance use, and demographic characteristics. Data regarding cancer type and treatment were extracted from the medical record.

RESULTS

Approximately 15% of the sample reported depression symptoms. Fifteen percent also reported anxiety symptoms in the past two weeks. 10 percent of the sample reported experiencing death ideation since their treatment ended and 7.5% reported death ideation in the past two weeks. Younger age, previous psychiatric diagnosis, and current substance use were associated with reports of depression symptoms, anxiety symptoms, and death ideation.

CONCLUSION

Cancer survivors entering survivorship after curative treatment experience elevated prevalence of depressive symptoms, anxiety symptoms, and death ideation. Younger cancer survivors and those with previous psychiatric diagnoses or substance use may be at particular risk for mental health problems during the first year of survivorship. Future research should further examine modifiable risk factors for depression, anxiety, and death ideation in cancer survivors at the transition into survivorship after curative treatment in order to improve survivorship care within both oncology and primary care.

Supervised Relation Extraction Between Suicide-Related Entities and Drugs: Development and Usability Study of an Annotated PubMed Corpus

BACKGROUND

Drug-induced suicide has been debated as a crucial issue in both clinical and public health research. Published research articles contain valuable data on the drugs associated with suicidal adverse events. An automated process that extracts such information and rapidly detects drugs related to suicide risk is essential but has not been well established. Moreover, few data sets are available for training and validating classification models on drug-induced suicide.

OBJECTIVE

This study aimed to build a corpus of drug-suicide relations containing annotated entities for drugs, suicidal adverse events, and their relations. To confirm the effectiveness of the drug-suicide relation corpus, we evaluated the performance of a relation classification model using the corpus in conjunction with various embeddings.

METHODS

We collected the abstracts and titles of research articles associated with drugs and suicide from PubMed and manually annotated them along with their relations at the sentence level (adverse drug events, treatment, suicide means, or miscellaneous). To reduce the manual annotation effort, we preliminarily selected sentences with a pretrained zero-shot classifier or sentences containing only drug and suicide keywords. We trained a relation classification model using various Bidirectional Encoder Representations from Transformer embeddings with the proposed corpus. We then compared the performances of the model with different Bidirectional Encoder Representations from Transformer-based embeddings and selected the most suitable embedding for our corpus.

RESULTS

Our corpus comprised 11,894 sentences extracted from the titles and abstracts of the PubMed research articles. Each sentence was annotated with drug and suicide entities and the relationship between these 2 entities (adverse drug events, treatment, means, and miscellaneous). All of the tested relation classification models that were fine-tuned on the corpus accurately detected sentences of suicidal adverse events regardless of their pretrained type and data set properties.

CONCLUSIONS

To our knowledge, this is the first and most extensive corpus of drug-suicide relations.

A qualitative study on the perspectives and needs of oncology nurses about recognition and management of suicide risk in cancer patients

AIMS

To determine the perspectives and needs of the oncology nurses in recognising and managing the risk of suicide in cancer patients.

BACKGROUND

Cancer patients are one of the groups with a high risk of suicide. The perspectives and needs of oncology nurses regarding their recognition and management of suicide risk in such patients need to be clarified.

DESIGN AND METHODS

This qualitative descriptive study used a sample of 33 oncology nurses that were sampled by maximum variation sampling from different oncology units and hospitals. Data were collected with in-depth interviews via a semi-structured interview form and analysed with content analysis. The COREQ guideline was followed for the reporting of the study.

RESULTS

Three main themes and eight subthemes were identified, namely 'An uncertain atmosphere: sensing the risk of suicide but not seeing the picture' (Subthemes: Inability to identify suicide risk, Unclear responsibilities and Distress as a result of uncertainty), 'Efforts to give meaning to and compensate losses of patients' (Subthemes: Attributions to cancer-related losses of patients and Interventions to alleviate distress related to loss) and 'Hindrances beyond the nurse' (Subthemes: Stigma towards psychosocial problems and getting help, Disagreement with the Physician and A lack of institutional culture on suicide prevention).

CONCLUSIONS

Our study revealed that oncology nurses have insufficient knowledge and skills and unclear roles in recognising and managing suicide risk. In addition, nurses have difficulty in helping patients due to the insufficient support of team members, stigmas of patients and their relatives towards getting help, patient workloads, and inadequate institutional support in risk management. Training programmes aiming to increase nurses' awareness, knowledge and skills should be developed and embedded into current in-service education programmes and undergraduate education curricula as part of professional improvement.

RELEVANCE TO CLINICAL PRACTICE

The results of the study can contribute to planning the content and scope of suicide prevention training peculiar to oncology nursing.

Risk of Psychiatric Disorders Among Spouses of Patients With Cancer in Denmark and Sweden

IMPORTANCE

There is emerging evidence that spouses of patients with cancer may have a higher prevalence of mental illness, but these studies have been limited by pre-post designs, focus on a single mental illness, and short follow-up periods.

OBJECTIVES

To assess the overall burden of psychiatric disorders among spouses of patients with cancer vs spouses of individuals without cancer and to describe possible changes in this burden over time.

DESIGN, SETTING, AND PARTICIPANTS

This population based cohort study included spouses of patients with cancer (diagnosed 1986-2016 in Denmark and 1973-2014 in Sweden; exposed group) and spouses of individuals without cancer (unexposed group). Members of the unexposed group were individually matched to individuals in the exposed group on the year of birth, sex, and country. Spouses with and without preexisting psychiatric morbidity were analyzed separately. Data analysis was performed between May 2021 and January 2022.

EXPOSURES

Being spouse to a patient with cancer.

MAIN OUTCOMES AND MEASURES

The main outcome was a clinical diagnosis of psychiatric disorders through hospital-based inpatient or outpatient care. Flexible parametric models and Cox models were fitted to estimate hazard ratios (HRs) with 95% CIs, adjusted for sex, age and year at cohort entry, country, household income, and cancer history.

RESULTS

Among 546 321 spouses in the exposed group and 2 731 574 in the unexposed group who had no preexisting psychiatry morbidity, 46.0% were male participants, with a median (IQR) age at cohort entry of 60 (51-68) years. During follow-up (median, 8.4 vs 7.6 years), the incidence rate of first-onset psychiatric disorders was 6.8 and 5.9 per 1000 person-years for the exposed and unexposed groups, respectively (37 830 spouses of patients with cancer [6.9%]; 153 607 of spouses of individuals without cancer [5.6%]). Risk of first-onset psychiatric disorders increased by 30% (adjusted HR, 1.30; 95% CI, 1.25-1.34) during the first year after cancer diagnosis, especially for depression (adjusted HR, 1.38; 95% CI, 1.30-1.47) and stress-related disorders (adjusted HR, 2.04; 95% CI, 1.88-2.22). Risk of first-onset psychiatric disorders increased by 14% (adjusted HR, 1.14; 95% CI, 1.13-1.16) during the entire follow-up, which was similar for substance abuse, depression, and stress-related disorders. The risk increase was more prominent among spouses of patients diagnosed with a cancer with poor prognosis (eg, pancreatic cancer: adjusted HR, 1.41; 95% CI, 1.32-1.51) or at an advanced stage (adjusted HR, 1.31; 95% CI, 1.26-1.36) and when the patient died during follow-up (adjusted HR, 1.29; 95% CI, 1.27-1.31). Among spouses with preexisting psychiatric morbidity, the risk of psychiatric disorders (first-onset or recurrent) increased by 23% during the entire follow-up (adjusted HR, 1.23; 95% CI, 1.20-1.25).

CONCLUSIONS AND RELEVANCE

In this cohort study of 2 populations in Denmark and Sweden, spouses of patients with cancer experienced increased risk of several psychiatric disorders that required hospital-based specialist care. Our results support the need for clinical awareness to prevent potential mental illness among the spouses of patients with cancer.

Suicide rates among people with serious mental illness: a systematic review and meta-analysis

BACKGROUND

People with serious mental illness are at great risk of suicide, but little is known about the suicide rates among this population. We aimed to quantify the suicide rates among people with serious mental illness (bipolar disorder, major depression, or schizophrenia).

METHODS

PubMed and Web of Science were searched to identify studies published from 1 January 1975 to 10 December 2020. We assessed English-language studies for the suicide rates among people with serious mental illness. Random-effects meta-analysis was used. Changes in follow-up time and the suicide rates were presented by a locally weighted scatter-plot smoothing (LOESS) curve. Suicide rate ratio was estimated for assessments of difference in suicide rate by sex.

RESULTS

Of 5014 identified studies, 41 were included in this analysis. The pooled suicide rate was 312.8 per 100 000 person-years (95% CI 230.3-406.8). Europe was reported to have the highest pooled suicide rate of 335.2 per 100 000 person-years (95% CI 261.5-417.6). Major depression had the highest suicide rate of 534.3 per 100 000 person-years (95% CI 30.4-1448.7). There is a downward trend in suicide rate estimates over follow-up time. Excess risk of suicide in males was found [1.90 (95% CI 1.60-2.25)]. The most common suicide method was poisoning [21.9 per 100 000 person-years (95% CI 3.7-50.4)].

CONCLUSIONS

The suicide rates among people with serious mental illness were high, highlighting the requirements for increasing psychological assessment and monitoring. Further study should focus on region and age differences in suicide among this population.

The significance of cognitive-behavioral therapy on suicide: An umbrella review

BACKGROUND

Suicide becomes a widespread public health concern. Cognitive-behavioral therapy (CBT) is used to correct negative thoughts and behaviors of patients at risk of suicide. The aim of this research is to summarize and evaluate the existing evidence to explore the impact of CBT on suicide.

METHOD

We conducted a systematic searched in PubMed, Web of Science, Cochrane database from the first available year to March 2021. The methodological quality was evaluated by AMSTAR-2 tool, and the evidence quality was evaluated by GRADE classification. We summarized all the comparative effects of CBT on suicide, and used forest plots to describe the impact of CBT on suicide related outcomes included suicidal ideation, suicide attempts. The random effects model was used to summarize data.

RESULTS

Nine systematic reviews and meta-analysis were included. Most of the systematic reviews and meta-analysis were of medium methodological and evidence quality. The impact of CBT on suicide outcomes could be divided into the following two categories: CBT reduced levels of suicidal ideation (SMD -0.28, 95 % CI -0.36 to -0.21), CBT relieved suicide attempts (RR 0.77, 95 % CI 0.69 to 0.87).

CONCLUSION

Based on the current evidence, CBT could relieve suicide, including suicide ideation, suicide attempts. CBT is scalable and cost-effective. It is helpful for health professionals to formulate personalized CBT programs, promote clinical and community applications and integrate them into comprehensive suicide interventions and prevention strategies.

Association of suicidal ideation and depression with the use of proton pump inhibitors in adults: a cross-sectional study

Proton pump inhibitors (PPIs) were found to be associated with depression. This study aimed to find the cross-sectional association between recent PPI use and suicidal ideation. Item 9 of Patient Health Questionnaire-9 (PHQ-9) of the US National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 was used to categorize whether or not the participants had suicidal ideation. The secondary outcome of this study was depression and the scores of the PHQ-9 were used as the depression diagnostic instrument. The study population included 16,881 participants who were over 20 years old. The bivariate Rao-Scott χ² test showed a significant association between PPI use and suicidal ideation (P < 0.001) and a stronger association was observed between PPIs and depression (P < 0.001). Multiple logistic regression analysis of the education, gender, race and age-adjusted model revealed that the PPI users had a 2.34 (95% CI 1.66-3.31) greater risk of having suicidal ideation than the non-PPI users. Middle-aged participants (40-49 years) showed the greatest number of differences in suicidal ideation between PPI and non-PPI users (P < 0.001). Future research should continue to consider the psychiatric effects of taking PPIs.

Suicidal ideation in patients with cancer: Its prevalence and results of structural equation modelling

OBJECTIVE

Patients with cancer have a higher risk of suicidal ideation (SI) and suicidality than the general population. This study was designed to investigate the prevalence of SI and its association with psychosocial and sociodemographic factors and tumour entity.

METHODS

In this observational cross-sectional study, 4372 adult patients with different cancer entities were enrolled. We assessed the outcome variables (i.e. SI, depressive and anxiety symptoms, mental and physical fatigue and sociodemographic data) using self-report questionnaires. Data were analysed via descriptive statistics, binomial logistic regression and structural equation modelling (SEM).

RESULTS

Among all patients, 627 (14.3%) reported SI, of whom 12.8% reported SI on several days, 0.9% on half of the days and 0.6% nearly every day. Age, anxiety, mental fatigue and the Patient Health Questionnaire-9 items 'feeling down, depressed and hopeless', 'feeling bad about oneself' and 'slowing or agitation' were significant predictors of SI. SEM, including all significant predictors with a latent depressiveness-demoralisation variable, explained 30.3% variance of SI, showing a good fit.

CONCLUSIONS

Our results showed that a significant number of patients with cancer show SI. Future long-term studies are needed to address the differential contribution of depression and demoralisation on SI in patients with cancer.

Relationship between depressive symptoms and internet usage time among adolescents: Results from a nationwide survey

Adolescent depression is becoming a public health problem. In this study the association between depressive symptoms and internet usage time in adolescents was examined, with data collected from the China Education Tracking Survey (CEPS). The survey is publicly available and carried out nationwide. A logistic regression analysis was conducted with odds ratios (OR) and 95% confidence intervals (CI), the subgroup analysis examined the relationships between internet usage time and depressive symptoms. A total of 10,705 adolescents were involved, where 46.4% of them are caught by the internet for more than two hours per day. Adolescents keeping on the internet for 6-8 h per day were reported to have higher odds of depressive symptoms than adolescents who were free from it with the confounders of individual, family, and school adjusted, which were observed among groups with a medium family economic status without living with their father and with a sleep time less than nine hours. The results revealed that adolescents spending more time online had a higher risk of experiencing depression symptoms. This study suggested that it is helpful for mental health professionals to evaluate and develop prevention interventions for depressive symptoms in adolescents promptly through monitoring and managing online time.

Suicidal Ideation in Long-Term Adult Cancer Survivors: Findings of a Nationwide Cross-Sectional Study

BACKGROUND

Cancer survivors suffer substantial psychologic distress, but little is known about their vulnerabilities to suicidal ideation more than 5 years after diagnosis.

METHODS

We compared suicidal ideation among 1,033 adult cancer survivors, who had received a diagnosis of cancer more than 5 years previously, with that among individuals without a cancer history using nationwide survey data. Logistic regression models were used to evaluate suicidal ideation in cancer survivors.

RESULTS

Cancer survivors did not have a significantly higher suicidal ideation rate than those without a cancer history, regardless of depressive mood.

CONCLUSIONS

A cancer history of 5 years or greater is not associated with suicidal ideation.

IMPACT

A large Korean study considering depressive mood affirm no association between long-term cancer survivorship and suicidal ideation.

Relation between occupation, gender dominance in the occupation and workplace and suicide in Sweden: a longitudinal study

OBJECTIVES

To describe the association between occupations and suicide, and to explore the effect of gender dominance in the occupation and in the workplace on the risk of suicide.

DESIGN

Register-based cohort study.

PARTICIPANTS

3 318 050 workers in Sweden in 2005 and followed up until 2010. Exclusion criteria for the study were: missing information in the occupational codes, yearly income of <100 Swedish krona, missing information of the employer, death or migration, and registered occupational code reported from more than 5 years ago.

OUTCOME

Suicides occurring during 2006-2010 identified in the cause of death register by the International Classification of Diagnoses-10 codes X60-84 and Y10-34.

RESULTS

Occupations with increased suicide were life science and health professionals (OR: 2.8, 95% CI: 1.50 to 5.26) among women. In men, these were metal, machinery and related workers (OR: 1.5, 95% CI: 1.09 to 2.05) and personal and protective service workers (OR: 1.59, 95% CI: 1.14 to 2.22). In terms of gender dominance in the occupation, borderline associations with increased suicide risk were found for men in both male-dominated (OR: 1.32, 95% CI: 0.98 to 1.79) and female-dominated (OR: 1.37, 95% CI: 0.99 to 1.91) occupations. For women, borderline increased risk of suicide was found in female-dominated occupations (OR: 1.51, 95% CI: 0.95 to 2.40). Finally, men showed a borderline increased risk of suicide in female-dominated workplaces (OR: 1.31, 95% CI: 0.94 to 1.81).

CONCLUSIONS

This study found that women in the 'life science and health professionals' group and men in the 'metal, machinery and related workers' as well as 'personal and protective service workers' groups have increased incidence of suicide also when adjusting for sociodemographic characteristics, precariousness of the employment relationship, spells of unemployment, previous mental disorders and suicide attempts. Moreover, gender dominance at workplace and occupation seems to be associated with the risk of suicide among men. The results of our study are novel and are worth exploring in future qualitative studies.

Risk factor analysis and nomogram construction for predicting suicidal ideation in patients with cancer

BACKGROUND

Suicidal ideation in cancer patients is a critical challenge. At present, few studies focus on factors associated with suicidal ideation, and predictive models are still lacking. This study aimed at investigating the risk factors for suicidal ideation among cancer patients, and developed a predictive nomogram to screen high risk cancer patients for early prevention and intervention.

METHODS

A questionnaire survey was conducted among cancer patients between May 2021 and January 2022. The factors associated with suicidal ideation were used to construct a multivariate logistic regression model, which was visualized as a predictive nomogram to evaluate the risk of suicidal ideation. Areas under the curve, calibration plot, decision curve analysis, and internal and external validation were used to validate the discrimination, calibration and clinical usefulness of the model.

RESULTS

A total of 820 patients with cancer were recruited for this study and 213 (25.98%) developed suicidal ideation. Levels of demoralization, depression and cancer staging, marital status, residence, medical financial burden, and living condition were influence factors for suicidal ideation. Comparing nomogram with Self-rating Idea of Suicide Scale (SIOSS), the nomogram had a satisfactory discrimination ability with an AUC of 0.859 (95% CI: 0.827-0.890) and 0.818 (95% CI: 0.764-0.873) in the training and validation sets, respectively. The calibration plot and decision curve analysis revealed that this nomogram was in good fitness and could be beneficial in clinical applications.

CONCLUSIONS

Suicidal ideation is common in cancer patients. Levels of demoralization, depression and cancer staging were independent predictors of suicidal ideation. The nomogram is an effective and simple tool for predictive suicidal ideation in cancer patients.

Forecast of peak attainment and imminent decline after 2017 of oral cancer incidence in men in Taiwan

Oral cancer is the fourth most common cancer among men in Taiwan. The age-standardized incidence rate of oral cancer among men in Taiwan has increased since 1980 and became six times greater in 2014. To enable effective public health planning for oral cancer, research on the projection of oral cancer burden is essential. We conducted an age-period-cohort analysis on the incidence of oral cancer among men in Taiwan from 1997 to 2017 and extrapolated the trend to 2025. We found that the period trends for young adults aged between 25 and 44 have already peaked before 2017; the younger, the earlier, and then the trends declined. The cohort trends have peaked roughly at the 1972 birth cohort and then declined for all ages. Despite the increasing trend in the age-standardized incidence rate for oral cancer among men in Taiwan from 1997 to 2017, we forecast a peak attained, an imminent decline after 2017, and a decrease of 8.4% in age-standardized incidence rate from 2017 to 2025. The findings of this study contribute to developing efficient and comprehensive strategies for oral cancer prevention and control.

Suicide risk and mortality among patients with cancer

Despite substantial progress in cancer therapy in recent decades, patients with cancer remain at high suicide risk. Data from individual studies have not been comprehensively quantified and specific risk factors are ill-defined. We assessed suicide mortality risk according to cancer prognosis, stage, time since diagnosis, gender, ethnicity, marital status, year of recruitment and geographic region. We searched EMBASE, MEDLINE, PsycINFO, Web of Science, CINAHL and Google Scholar for relevant articles up to February 2021. We used a random effects model, performed meta-regression meta-analysis and assessed heterogeneity and publication bias using I², funnel plots and Egger's and Begg's tests. We performed a systematic review including 62 studies and 46,952,813 patients. To avoid patient sample overlap, the meta-analysis was performed on 28 studies, involving 22,407,690 patients with cancer. Suicide mortality was significantly increased compared with the general population (standardized mortality ratio = 1.85, 95% confidence interval = 1.55-2.20). Risk was strongly related to cancer prognosis, cancer stage, time since diagnosis and geographic region. Patients with cancer, particularly those with specific risk factors, should be closely monitored for suicidality and need specialized care to reduce short- and long-term risks of suicide.

Development and validation of a model for predicting the risk of suicide in patients with cancer

OBJECTIVE

The objective of this study was to establish a nomogram model to predict SI in patients with cancer and further evaluate its performance.

METHOD

This study was performed among 390 patients in oncology departments of Affiliated Hospital of Nantong University from April 2020 to January 2021. Of these, eligible patients who were diagnosed with cancer were split into training and validation cohorts according the ratio of 2:1 randomly. In the training cohort, multivariate regression was performed to determine the independent variables related to SI. A nomogram was built incorporating these variables. The model performance was evaluated by an independent validation cohort.

RESULTS

The prevalence of SI in patients with cancer was 22.31% and 19.23% in training and validation cohorts, respectively. The nomogram model suggested independent variables for SI, including depression, emotional function, time after diagnosis, family function and educational status. The area under the curve (AUC) was 0.93 (95%CI, 0.90-0.97) and 0.82 (95%CI, 0.74-0.90) in training and validation cohorts respectively, which indicated good discrimination of the nomogram in predicting SI in cancer patients. The p-value of the goodness of fit (GOF) test was 0.197 and 0.974 in training and validation cohorts respectively, suggesting our nomogram model has acceptable calibration power, and the calibration curves further indicated good calibration power.

CONCLUSION

In conclusion, the nomogram model for predicting individualized probability of SI could help clinical caregivers estimate the risk of SI in patients with cancer and provide appropriate management.

Subsequent risk of suicide among 9,300,812 cancer survivors in US: A population-based cohort study covering 40 years of data

BACKGROUND

Large cohort studies that estimate the variation in suicide risk among cancer patients, depending on disease type and patient characteristics, are lacking. We aimed to investigate suicide risk among patients with different cancers types in the United States (US) and to identify subsets of patients at particularly high risk.

METHODS

A total of 9,300,812 cases of cancer in the Surveillance, Epidemiology, and End Results (SEER) database that were diagnosed between 1975 and 2016 were included in the study. Standardized mortality ratio (SMR) and absolute excess risk (AER) of suicide were estimated.

FINDINGS

From the included cases, 14,423 cancer patients were identified as having died by suicide, representing 0.26% of all deaths. We found that cancer patients had a higher risk of suicide compared with the general population, which equated to 0.8 excess deaths per 10,000 person-years. Greater suicide risk was correlated with the following: specific cancer sites, male sex, American Indian/Alaskan Native ancestry, being divorced, being uninsured, distance of metastasis, aged between 60 and 69 at diagnosis, and having a more recent diagnosis. The greatest SMR and AER were found in patients with cancers of the respiratory system, followed by those of the oral cavity and pharynx, myeloma, bones and joints, digestive system, and brain and other nervous system cancers.

INTERPRETATION

Suicide risk among cancer patients varies greatly and depends on both disease type and patient characteristics. A tailored clinical management should be considered for patients at a higher risk of suicide.

FUNDING

Natural Science Foundation of China.

Exploring multiple pathways and mediation effects of urban environmental factors for suicide prevention

Public health is threatened by air pollution and high temperature, especially in urban areas and areas impacted by climate change. Well-designed urban forms have co-benefits on promoting human health and mediating atmospheric environment-related threats (e.g., high temperature and air pollution). Previous studies overlooked these mediating effects of urban form on suicide mortality. This study used partial least squares modeling and countywide data in Taiwan to identify the crucial influences and pathways of urban environment, socioeconomic status, and diseases on suicide mortality. The model considered the impact of the characteristics of urban form (i.e., urban development intensity, land mix, and urban sprawl), urban industrial status (i.e., industrial level), urban greening (i.e., green coverage), disease (i.e., important diseases morbidity of human immunodeficiency virus [HIV], cerebrovascular disease [CVD], chronic liver disease and cirrhosis [CLDC], nephritis, nephrotic syndrome and nephrosis [NNSN], malignant tumor [MT]), socioeconomic status (i.e., income level and aging population rate), and the atmospheric environment (i.e., air pollution and high temperature) on suicide mortality. Optimizing land mix and minimizing urban development intensity and urban sprawl have been found to reduce suicide mortality. The mediating effect of urban form on suicide mortality originated from air pollution and high temperature, and mediating air pollution was greater than high temperature. Furthermore, industrial level, important diseases (HIV, CVD, CLDC, NNSN, and MT) morbidity, an aging population rate, air pollution, and high temperature were associated with an increase in suicide mortality, whereas green coverage and income level were associated with a reduction in suicide rates. The findings demonstrate that appropriate urban policy and urban planning may lower suicide mortality, be useful strategies for suicide prevention, and be a foundation for building a healthy city. Moreover, this study provides clarity on the complex relationship of suicide and the urban environment while identifying crucial factors.

A Descriptive Cohort of Suicidal Cancer Patients: Analysis of the Autopsy Case Series from 1993 to 2019 in Milan (Italy)

Suicide in cancer patients has always been a subject of clinical studies, but the contribution of forensic pathology to this phenomenon is poorly reported. With the aim of at least partially filling this gap in information, at the Institute of Forensic Medicine of Milan, Italy, we assessed all suicides that occurred in cancer patients. A descriptive and retrospective analysis was carried out by examining the database of the Institute and autopsy reports. We included 288 suicide cases with proven cancer diseases. For each suicide, sex, age, country of origin, body area affected by cancer, further pathological history, medications, previous suicide attempts and suicidal communications, as well as the place where the suicide occurred, were assessed. Furthermore, from a forensic point of view, we considered the chosen suicide method and any involved means. The majority of cases were male older adults affected by lung, colon and prostate cancer. Violent suicide methods were prevalent, and the most represented suicide method was falling from height regardless of the body area affected by cancer. Such data may be of clinical use for clinicians engaged in the front lines in order to address suicide risk prevention strategies among cancer patients.

[Why do we require clinical guidelines for suicide prevention?]

Trotz der Relevanz des Themas Suizidalität und gut bekannter Risikofaktoren gibt es bisher keine deutsche Leitlinie zur Suizidalität im Erwachsenenalter. In diesem Beitrag werden zunächst die Geschichte und die Hintergründe der Arbeit mit Leitlinien beschrieben. Der aktuelle Stand der Leitlinien für psychische Erkrankungen in Deutschland wird dargestellt und auf suizidpräventive Inhalte hin untersucht. Die Notwendigkeit evidenzbasierter Suizidprävention und einer spezifischen Leitlinie zur Suizidprävention bei Erwachsenen wird diskutiert.

Nur durch gezielte Suizidpräventionsstrategien und Interventionen für die jeweiligen Risikogruppen und unter Beachtung von Alters- und Geschlechtsspezifität kann für alle Betroffenen eine flächendeckende, gut erreichbare, bedarfs- und versorgungsgerechte, finanzierbare sowie nachhaltige medizinische Versorgung auf einem hohen Niveau sichergestellt werden. Dies gilt für den ambulanten und den stationären Bereich sowie für deren Schnittstellen. Bei Suizidalität handelt es sich um ein diagnoseübergreifendes, in unterschiedlichen Versorgungskontexten auftretendes Syndrom mit komplexem Behandlungsbedarf, weshalb intersektorale und multiprofessionelle Aspekte in einer entsprechenden Leitlinie besonders zu adressieren sind. Wissenschaftliche Evidenz und interdisziplinärer Konsens unter Expertinnen und Experten zum Umgang mit suizidalem Verhalten in der medizinischen Versorgung können dazu beitragen, Morbidität und Mortalität im Zusammenhang mit Suizidalität zu reduzieren. Im August 2021 wurde die Finanzierung einer S3-Leitlinie „Umgang mit Suizidalität“ vom Innovationsfonds des Gemeinsamen Bundesausschusses bewilligt.

Disparities and inequalities in cancer care and outcomes in patients with severe mental illness: Call to action

OBJECTIVES

People with severe mental illness (SMI) are at extreme risk of being stigmatized and to receive poor quality physical care. It has been demonstrated that they have higher morbidity and poorer prognosis of several medical diseases than the general population, with an at least 10-20-year reduction in life expectancy.

METHODS

A special issue of Psycho-Oncology focusing on cancer care among patients affected by SMI was called by the Editorial Board of the journal, with the aim to explore cancer health disparities and inequalities among people with SMI, mortality from cancer, problems of communication between multidisciplinary oncology and psychiatric teams and need for more structured intervention (i.e., screening, prevention, treatment).

RESULTS

Authors from eight countries contributed. The problem of stigma and barriers to cancer care provision for patients with SMI were studied (e.g., the complex nature of SMI and healthcare providers' misunderstanding of SMI). Key barriers were related to both patients, clinicians and institutional problems, such as fragmentation of care. A higher mortality from cancer and poor knowledge about cancer risk-factors was shown in patients with SMI. Models of intervention were also proposed.

CONCLUSIONS

Several conclusions have been recommended by the authors, such as the need for guidelines and clinical procedures specific for cancer care in mental health settings; large-scale studies to address the disparities of care in people with SMI; a larger vision of psychosocial oncology as the facilitator of the liaison between oncology and psychiatry.

Cancer diagnosis and suicide outcomes: Umbrella review and methodological considerations

BACKGROUND

Suicide outcomes in cancer patients represent a major public health concern. We performed an umbrella review (UR) including all meta-analyses (MAs) and systematic reviews (SRs) published on the association between cancer and suicide outcomes.

METHODS

Eligible studies were searched in the main scientific databases up to January 23rd, 2021. Eligible MAs/SRs focused on all suicide phenotypes among cancer patients. Evidence of the association was extracted; the credibility and quality of the included studies were evaluated using ad-hoc tools, including "A MeaSurement Tool to Assess systematic Reviews-2-Revised" (AMSTAR-2-R).

RESULTS

Six MAs and 6 SRs were included. The standardized mortality ratio of suicide in cancer patients was 1.5 to 1.7-fold higher than in the general population. Risk factors for suicide outcomes among cancer patients were male sex and older age, a cancer diagnosis within the prior year, and some specific cancer sites. Among 107 associations, 90 (84.1%) were supported by high credibility of evidence (class II). However, all studies reported a large heterogeneity (I²> 50%) and the majority of them reported considerable heterogeneity (I²> 75%). All MAs used random-effects measures. All MAs but one assessed publication bias and only one disclosed it. The majority of MAs/SRs showed critically low quality based on AMSTAR-2-R.

LIMITATIONS

We could not perform additional analyses due to the limited number of MAs.

CONCLUSIONS

This UR underlines the inflated risk for suicide among cancer patients. Upcoming, well-designed studies are needed to account for a broader set of variables. Several methodological issues likewise warrant attention.

Understanding the impact of clinical characteristics and healthcare utilizations on suicide among cancer sufferers: a case-control study in Hong Kong

Background

Few studies have investigated whether hospital utilization patterns of cancer sufferers are associated with their suicide. This study aims to explore whether clinical profiles and healthcare utilization patterns are related to suicide among cancer sufferers.

Methods

Verified suicide cases with cancer (2012-2016) were identified. Each case was matched with two non-suicide controls suffering cancer, by birthyear, sex, and admission year. Cancer-related information, physical and psychiatric comorbidities, opioid-based painkiller usage, the number and length of inpatient admissions, and the number of outpatient and Accident & Emergency (A&E) attendances, in the six months leading up to the suicide, were identified. Conditional logistic regression models were constructed to explore the influence of clinical profiles and hospital utilization on suicide. These models were stratified by age and cancer stage.

Outcomes

383 cases and 766 controls were included in the analyses. Overall, younger age, metastasis/recurrent status, suffering head and neck cancer, having psychiatric comorbidities, using opioid-based painkillers, and high frequency of A&E attendances and inpatient admissions increased the odds of suicide. Being diagnosed with liver cancer, consuming high numbers of outpatient attendances, and high numbers of inpatient days decreased the odds of suicide. Stratified analyses confirmed the influence of young age and metastatic/recurrent cancer status on risk of suicide.

Interpretations

Suicidal cancer sufferers had distinctive clinical profiles and hospital utilization patterns. Detecting and mitigating suicidal risk should be incorporated as an important component in treatment of cancer sufferers in the clinical setting.

Funding

Li Ka Shing Foundation and Hong Kong Research Grants Council

Suicide in obstructive lung, cardiovascular and oncological disease

Healthcare institutions face increasing demands stemming from the burden of noncommunicable diseases. The personal, social, financial and societal impact of these diseases are well-documented. However, the mental health concerns and trajectories of patients afflicted by chronic medical diseases have been under-recognized and are under-resourced. Despite that chronic diseases are associated with substantially increased risk of suicide, the medical world has largely failed to properly address suicide in the medically ill. Considering their high prevalence and mortality rate, this review article will highlight the mental health burden and suicide risk in obstructive lung, cardiovascular (including stroke) and oncological disease, in light of relevant data and conceptual models of suicide. Finally, general evidence-based suicide intervention strategies and potential selective adaptation of these strategies to the chronic medically ill patient populations and medical settings will be reviewed.

Using suicide notes to understand suicide among cancer patients: A mixed-method study

BACKGROUND

Cancer patients are at risk of suicide. However, no studies have used suicide notes to investigate their expressed reasons for suicide. The objectives of this study were to compare the characteristics between note leavers and non-leavers among cancer suicide cases and to understand the patterns in expressed reasons for suicide using suicide notes.

METHOD

Suicide cases (2012-2017) were identified from the Hong Kong Coroner's Court reports, which provide detailed information as well as the content of suicide notes. Bivariate tests and multiple logistic regression were performed to compare the characteristics of note leavers and non-leavers among suicide cases with cancer. Thematic analysis was performed on suicide notes to extract themes of expressed reasons for suicides by cancer status and age group.

RESULTS

Among cancer suicide cases and compared to non-leavers, note leavers were younger, more likely to be male, use non-violent suicide methods, have better housing conditions, and live alone. Suffering from physical disease was a major theme identified among cancer note leavers across all age groups. Young and middle-aged non-cancer note leavers had various themes identified. Physical illness was the major theme for elderly non-cancer note leavers.

CONCLUSIONS

Cancer note leavers had unique characteristics and suffering from physical illness was the major expressed reason identified in the suicide notes. Healthcare professionals should pay attention to the mental as well as the physical needs of patients. Improving quality of life and regaining control of life are vital for suicide prevention among cancer patients.

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context

Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.

Sociodemographic Characteristics Associated with an eHealth System Designed to Reduce Depressive Symptoms among Patients with Breast or Prostate Cancer: Prospective Study (Preprint)

Background

eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions.

Objective

This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer.

Methods

The study included a total of 129 patients diagnosed with breast (n=80, 62%) or prostate (n=49, 38%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period.

Results

The analysis was based on 108 patients (n=68, 63%, patients with breast cancer and n=40, 37%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men (β=.16; P=.03, 95% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use (β=–0.13; P=.04, 95% CI −0.25 to −0.01), after adjusting for other covariates.

Conclusions

The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability.

Trial Registration

German Clinical Trials Register RKS00013391; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013391

Incidence of suicide mortality among childhood cancer survivors: A population-based retrospective study

The aim of our study was to investigate the suicide rates among childhood cancer survivors and assess factors associated with higher suicide risk. A review of data from Surveillance, Epidemiology, and End Results (SEER) program from 1975 to 2016 was performed for this study. This program is based on the US population and is supported by the US National Cancer Institute (NCI). Survivors diagnosed with childhood cancer were recorded. There were 40 suicides among 567,233 person-years, giving a suicide rate of 7.1 per 100,000 person-years. Compared with cancer diagnosed between 10 and 14 years old, survivors with cancer diagnosed between 0 and 4 years old had lower suicide risk. Females had a lower risk of suicide than males. Compared with survivors of thyroid cancer, the aHRs were 0.16 for acute lymphocytic leukemia, 0.15 for nodal Hodgkin's lymphoma, 0.14 for brain cancers and 0.09 for kidney cancers. Most suicides occurred after 15 years old. Suicide was a problem for survivors, especially those with thyroid cancer. Beside treating patients holistically, early psychological interventions such as communicating effectively, providing social support and follow-up care related to psychological health are needed.

Risk factors for suicide mortality and cancer-specific mortality among patients with gastric adenocarcinoma: A SEER based study

OBJECTIVE

This study aims to investigate the risk factors for suicide in patients with gastric adenocarcinoma (GAC) to recognize patients at higher risk who require special mental health care.

METHODS

Patients' data were collected from the Surveillance, Epidemiology, and End Results database from 1975 to 2016. The relationships among categorical variables were assessed using Person's chi-square test. Standardized mortality ratio was used to compare ratios of suicide and other causes of death between the US population and adenocarcinoma patients. Cox regression and Kaplan-Meier were used for multivariate and univariate analyses. The probability of suicide was assessed using the binary regression analysis. All analyses were conducted using SPSS software.

RESULTS

Among 59,580 patients included in this study, 86 died due to suicide. The mean survival months was higher in patients <50 years (81.759) than in patients ≥50 years (42.961), and in females (49.116) than in males (44.591). The multivariate analysis showed a higher suicide mortality risk in divorced patients (HR = 2.461; 95% CI [1.015, 5.966], p = 0.046), patients not recommended for surgery (HR = 1.997; 95% CI [1.08, 3.694], p = 0.027) and patients with distant stage of the disease (HR = 2.68; 95% CI [1.395, 5.147], p = 0.003). Females had a lower suicide mortality risk (HR = 0.124; 95% CI [0.045, 0.314], p < 0.001).

CONCLUSION

GAS predisposes to suicide. The risk is higher in patients who are males, divorced, not recommended for surgery, or have a distant spread of the disease.

Depression, Anxiety, and Other Mental Disorders in Patients With Cancer in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis

Cancer is a growing public health issue in low- and lower-middle–income countries (LLMICs), but the mental health consequences in this setting have not been well-characterized. We aimed to systematically evaluate the available literature on the prevalence, associates, and treatment of mental disorders in patients with cancer in LLMICs.

Death by suicide, other externally caused injuries and cardiovascular diseases within 6 months of cancer diagnosis (J-SUPPORT 1902)

OBJECTIVE

To conduct the first national population-based study in Japan to characterize risks of death by suicide, other externally caused injuries and cardiovascular diseases within 6 months of cancer diagnosis.

METHODS

Cancer patients diagnosed between 1 January and 30 June 2016 and registered in the National Cancer Registry in Japan were followed up until death or 6 months after diagnosis. We calculated standardized mortality ratios and excess absolute risks per 10 000 person-years for death by suicide, other externally caused injuries and cardiovascular diseases compared with the Japanese general population.

RESULTS

Of 546 148 patients with cancer (249 116 person-years at risk), we observed 145 suicides, 298 deaths due to other externally caused injuries and 2366 cardiovascular deaths during the follow-up period. Standardized mortality ratios within 6 months were 2.68 for suicide (95% confidence interval, 2.26-3.16; excess absolute risk, 3.65), 1.49 for other externally caused injuries (95% confidence interval, 1.32-1.67; excess absolute risk, 3.92) and 1.38 for cardiovascular diseases (95% confidence interval, 1.33-1.44; excess absolute risk, 26.85). Risks were highest during the first month after cancer diagnosis (standardized mortality ratios: suicide, 4.06 [95% confidence interval, 2.90-5.53]; other externally caused injuries, 2.66 [95% confidence interval, 2.17-3.12] and cardiovascular diseases, 2.34 [95% confidence interval, 2.18-2.51]).

CONCLUSIONS

The first 6 months, and especially the first month, after cancer diagnosis were found to be a critical period for risks of death by suicide, other externally caused injuries and cardiovascular diseases. Our findings suggest that oncologists need to evaluate suicidal and cardiovascular risks of patients immediately after cancer diagnosis and provide preventive interventions.

Insurance status and risk of suicide mortality among patients with cancer: a retrospective study based on the SEER database

OBJECTIVE

Given that the presence of insurance may affect the risk of suicide mortality in cancer patients, we aimed to examine the association in a population-based study using the Surveillance, Epidemiologic, and End Results (SEER) database.

STUDY DESIGN

A retrospective analysis of data from the SEER database.

METHODS

We conducted a retrospective study using the SEER database. Hazard ratios (HRs), adjusted HRs (aHRs), and 95% confidence intervals (95% CIs) of suicide death were calculated using Cox proportional hazard models to evaluate the risk of suicide mortality among the cohorts.

RESULTS

Multivariable analysis revealed that cancer patients without insurance had an increased risk of suicide death compared with patients with private insurance (aHR, 1.37; 95% CI, 1.01-1.72), whereas no significant result was observed in patients with any Medicaid (aHR, 1.10; 95% CI, 0.93-1.30; P = 0.27). In addition, the stratified analysis indicated that the risk of suicide death in patients in the uninsured and Medicaid groups presented with localized stage of disease (aHR, 1.32; 95% CI, 1.02, 1.69), White (aHR, 1.34; 95% CI, 1.05, 1.71), and American Indian/Alaska Native and Asian/Pacific Islander (aHR, 1.89; 95% CI, 1.08, 3.30) were greater than insured patients.

CONCLUSION

Overall, our results indicated that insurance status was a statistically significant predictor of suicide death in patients with cancer. Healthcare providers should identify those patients at high risk of suicide and provide appropriate mental health and psychosocial oncology services in time.

Investigation of anxiety and depressive disorders and psychiatric medication use before and after cancer diagnosis

OBJECTIVE

Data regarding the prevalence of depression and anxiety among cancer patients, especially before cancer diagnosis, remains scarce. This study investigated the prevalence of these conditions and associated drug use among cancer patients pre- and post-diagnosis.

METHODS

This population-based cohort study using data from Taiwan's National Health Insurance Research Database recruited patients with a registered cancer diagnosis and matched control between January 1, 2000, and December 31, 2011. We compared the prevalence of anxiety and depressive disorders between cancer patients and non-cancer participants during a 2-year period both pre- and post-diagnosis by Pearson's chi-square test. Psychiatric medication use was also examined for the associated mental condition.

RESULTS

We examined participants diagnosed with liver (N = 17,154), colorectal (N = 30,391), breast (N = 40,036), gynecological (N = 23,218), and lung (N = 15,671) cancer. Before the cancer diagnosis, the prevalence of depression was higher in non-cancer participants than in gynecological cancer patients (p = 0.018) but anxiety is higher in liver, colorectal, and lung cancer patients when compared to non-cancer participants (p < 0.05). After the cancer diagnosis, the prevalence of anxiety and depression became significantly higher in all enrolled cancer patients than non-cancer participants (p < 0.05). Similar results were observed in psychiatric medication use trends.

CONCLUSIONS

This study proposed that patients with liver, colorectal, and lung cancer had an increased risk of developing anxiety, which might be a sentinel diagnosis. The participants had a significantly higher level of anxiety and depressive disorder post-diagnosis, which highlights the importance of the care for both mental and physical conditions in cancer management.

Death of a Child and Mortality after Cancer: A Nationwide Cohort Study in Sweden

BACKGROUND

The death of a child is a traumatic life event that may influence mortality in patients with cancer. Only a few studies investigated this association and their findings have been mixed. We analyzed whether the death of a child is associated with mortality in patients with cancer.

METHODS

We conducted a cohort study of 371,673 parents who were diagnosed with cancer in Sweden during 1973 to 2014 by linking several population-based registers. We analyzed the association between the death of a child after the diagnosis of cancer and mortality using Cox proportional hazards models with time-varying exposure.

RESULTS

The death of a child was associated with an increased risk of mortality [HR, 1.27; 95% confidence intervals (CI), 1.17-1.39]. The association was present not only in case of children's death due to cancer or other natural deaths, but also in case of unnatural deaths. Mortality was increased only in the long-term follow-up period (HR, 1.42; 95% CI, 1.29-1.56), but not in the short-term (HR, 0.95; 95% CI, 0.78-1.15). The association was most pronounced following loss of an adult child and for patients with reproductive cancers.

CONCLUSIONS

Death of a child is associated with increased risks of overall and long-term mortality in patients with cancer. The findings that the association was present not only in case of natural but also in case of unnatural deaths suggests that stress-related mechanisms may also operate.

IMPACT

Our findings highlight the importance of psychosocial support for patients with cancer experiencing severe stress.