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Men VY, Emery CR, Lam TC, Yip PSF. Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis. Psychol Med 2022; 52:2342-2351. [PMID: 33226318 DOI: 10.1017/s0033291720004250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. METHODS Patients aged 10 or above who received their first cancer-related hospital admission (2002-2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. RESULTS In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. CONCLUSIONS Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.
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Affiliation(s)
- Vera Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Clifton Robert Emery
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR
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Alias A, Bertrand L, Bisson-Gervais V, Henry M. Suicide in obstructive lung, cardiovascular and oncological disease. Prev Med 2021; 152:106543. [PMID: 34538370 DOI: 10.1016/j.ypmed.2021.106543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Ali Alias
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Lia Bertrand
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St Joseph's Healthcare Hamilton, West 5(th) Campus, 100 West 5(th) Street, Hamilton, ON L8N 3K7, Canada.
| | - Vanessa Bisson-Gervais
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, 5100 de Maisonneuve Blvd. West, Suite 720, Montreal, QC H4A 3T2, Canada; Segal Cancer Centre, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada; Lady-Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada
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3
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Noel CW, Eskander A, Sutradhar R, Mahar A, Vigod SN, Isenberg-Grzeda E, Bolton J, Deleemans J, Chan WC, Vasdev R, Zuk V, Haas B, Mason S, Coburn NG, Hallet J. Incidence of and Factors Associated With Nonfatal Self-injury After a Cancer Diagnosis in Ontario, Canada. JAMA Netw Open 2021; 4:e2126822. [PMID: 34559226 PMCID: PMC8463938 DOI: 10.1001/jamanetworkopen.2021.26822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown. OBJECTIVE To examine the risk of NFSI after a cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada. EXPOSURES Demographic and clinical factors. MAIN OUTCOMES AND MEASURES Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. RESULTS In total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (<0.1%) died by suicide. The 5-year cumulative incidence of NFSI was 0.27% (95% CI, 0.25%-0.28%). After adjusting for key confounders, prior severe psychiatric illness, whether requiring inpatient care (subdistribution hazard ratio [sHR], 12.6; 95% CI, 10.5-15.2) or outpatient care (sHR, 7.5; 95% CI, 6.5-8.8), and prior self-injury (sHR, 6.6; 95% CI, 5.5-8.0) were associated with increased risk of NFSI. Young adults (age 18-39 years) had the highest NFSI rates relative to individuals aged 70 years or older (sHR, 5.4; 95% CI, 4.5-6.5). The magnitude of association between prior inpatient psychiatric illness and NFSI was greatest for young adults (sHR, 17.6; 95% CI, 12.0-25.8). Certain cancer subsites were also associated with increased risk, including head and neck cancer (sHR, 1.5; 95% CI, 1.2-1.9). CONCLUSIONS AND RELEVANCE In this study, patients with cancer had a higher incidence of NFSI than suicide after diagnosis. Younger age, history of severe psychiatric illness, and prior self-injury were independently associated with risk of NFSI. These exposures appeared to act synergistically, placing young adults with a prior mental health history at the greatest risk of NFSI. These factors should be used to identify at-risk patients.
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Affiliation(s)
- Christopher W. Noel
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
| | - Alyson Mahar
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Simone N. Vigod
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elie Isenberg-Grzeda
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - James Bolton
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Deleemans
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ravleen Vasdev
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Victoria Zuk
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Barbara Haas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Stephanie Mason
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Natalie G. Coburn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Julie Hallet
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Yu K, Wu B, Chen Y, Kang H, Song K, Dong Y, Peng R, Li F. Suicide and accidental deaths among patients with primary malignant bone tumors. J Bone Oncol 2021; 27:100353. [PMID: 33889483 PMCID: PMC8047448 DOI: 10.1016/j.jbo.2021.100353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background It has been recognized that cancer is associated with a higher risk of suicide or accidental death. Earlier studies have evidenced that patients with malignant bone tumors usually experience psychological dysfunction and physical disability following surgery, which are shared risk factors between suicidal and accidental deaths. To our knowledge, there is no large population-based study on the risk of suicide or accidental death among patients with malignant bone tumors. Questions/purposes This study aimed to determine whether patients with primary malignant bone tumors are at a higher risk of suicide and accidental death than the general population and to identify the demographic and tumour-related characteristics and type of surgery associated with a higher risk of suicide and accidental death among these patients. Methods Overall, 50,817 patients diagnosed with primary malignant bone tumors between 1973 and 1975 were identified from the Surveillance, Epidemiology, and End Results database. The standardised mortality ratio (SMR) was calculated based on the general population's mortality data, gathered by the National Center for Health Statistics. The Cox regression model was developed to determine risk factors associated with a higher risk of suicide and accidental death. Results Patients with primary malignant bone tumors had a higher risk of suicide and accidental death than the general population in the United States (US) (SMR = 2.17; 95% confidence interval (CI) [1.80-2.62] and SMR = 1.73; 95% CI [1.54-1.95]). Compared with limb salvage, amputation significantly increased the risk of suicide (SMR = 3.99; 95% CI [2.52-6.34], hazard ratio (HR) = 2.32; 95% CI [1.31-4.09]; P < 0.01) but did not increase the risk of accidental death (SMR = 1.61; 95% CI [1.07-2.42], HR = 1.11; 95% CI [0.71-1.74]; P = 0.65). Higher suicide risk was observed among older patients whose age at diagnosis was more than 60 years (HR = 4.04; 95% CI [1.98-8.26]; P < 0.001), males (HR = 3.48; 95% CI [2.16-5.62]; P < 0.001), and whites (HR = 3.71; 95% CI [1.17-11.73]; P < 0.001). The risk of suicide and accidental death was highest in the first year after diagnosis (SMR = 2.95; 95% CI [1.86-4.69] and SMR = 2.02; 95% CI [1.48-2.74]). Conclusion We first reported that patients with primary malignant bone tumors had a higher risk of suicide and accidental death than the general US population. Therefore, clinicians should pay more attention to the psychological status, physical function, and cognitive level of these survivors.
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Affiliation(s)
- Kaixu Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Honglei Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Kehan Song
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Renpeng Peng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Xu Z, Zhang Q, Yip PSF. Predicting post-discharge self-harm incidents using disease comorbidity networks: A retrospective machine learning study. J Affect Disord 2020; 277:402-409. [PMID: 32866798 DOI: 10.1016/j.jad.2020.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Self-harm is preventable if the risk can be identified early. The co-occurrence of multiple diseases is related to self-harm risk. This study develops a comorbidity network-based deep learning framework to improve the prediction of individual self-harm. METHODS Between 01/01/2007-12/31/2010, we obtained 2,323 patients with self-harm records and 46,460 randomly sampled controls from 1,764,094 inpatients across 44 public hospitals in Hong Kong. 80% of the samples were randomly selected for model training, and the remaining 20% were set aside for model testing. We propose a novel patient embedding method, namely Dx2Vec (Diagnoses to Vector), based on the comorbidity network constructed by all historical diagnoses. Dx2Vec represents the comorbidity patterns among diseases and temporal patterns of historical admissions for each patient. RESULTS Experiments demonstrate that the Dx2Vec-based model outperforms the baseline deep learning model in identifying patients who would self-harm within 12 months (C-statistic: 0.89). The precision is 0.54 for positive cases and 0.98 for negative cases, whilst the recall is 0.72 for positive cases and 0.96 for negative cases. The model extracted the most predictive diagnoses, and pairwise comorbid diagnoses to help medical professionals identify patients with risk. LIMITATIONS The inpatient data does not contain lab test information. CONCLUSIONS Incorporation of a disease comorbidity network can significantly improve self-harm prediction performance, indicating that it is critical to consider comorbidity patterns in self-harm screening and prevention programs. The findings have the potential to be translated into effective self-harm screening systems.
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Affiliation(s)
- Zhongzhi Xu
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China.
| | - Paul Siu Fai Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
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6
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Yang K, Zheng Y, Peng J, Chen J, Feng H, Yu K, Chen Y, Luo W, Yang P, Yang Y, Wu B. Incidence of Death From Unintentional Injury Among Patients With Cancer in the United States. JAMA Netw Open 2020; 3:e1921647. [PMID: 32083692 PMCID: PMC7043194 DOI: 10.1001/jamanetworkopen.2019.21647] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Previous studies have suggested that patients with cancer may be at an increased risk of death from unintentional injury, but to our knowledge, no large studies have examined the rates of death from unintentional injury among patients with cancer. OBJECTIVE To characterize the incidence of death from unintentional injury among patients with cancer in the United States. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients diagnosed with a first primary cancer between January 1, 1973, and December 31, 2015, identified from the Surveillance, Epidemiology, and End Results (SEER) program data. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were performed from February 1, 2019, to August 15, 2019. MAIN OUTCOMES AND MEASURES Rates and standardized mortality ratios (SMRs) of death from unintentional injury among patients with cancer. RESULTS A total of 8 271 020 patients with cancer were included in this study (50.2% female; mean [SD] age, 63.0 [15.7] years). Among them, 40 599 deaths from unintentional injury were identified. The rates of death from unintentional injury were 81.90 per 100 000 person-years among patients with cancer and 51.21 per 100 000 person-years in the corresponding US general population. The SMR of death from unintentional injury was 1.60 (95% CI, 1.58-1.61). Higher rates of death from unintentional injury were associated with increasing age at diagnosis (≥80 years; rate ratio [RR], 2.91; 95% CI, 2.84-2.98; P < .001), male sex (RR, 1.69; 95% CI, 1.66-1.73; P < .001), American Indian or Alaskan Native population (RR, 1.48; 95% CI, 1.30-1.68; P < .001), and being unmarried (RR, 1.23; 95% CI, 1.18-1.28; P < .001). Rates of death from unintentional injury were the highest in patients with cancers of the liver (200.37 per 100 000 person-years), brain (175.04 per 100 000 person-years), larynx (148.78 per 100 000 person-years), and esophagus (144.98 per 100 000 person-years). The SMRs were the highest in the first month after cancer diagnosis. CONCLUSIONS AND RELEVANCE This study found that the incidence of death from unintentional injury among patients with cancer was significantly higher than that in the general population in the United States. The rates of death from unintentional injury varied by age, sex, race/ethnicity, marital status, cancer site, disease stage, and time since diagnosis. The findings suggest that death from unintentional injury among patients with cancer requires further attention and that initiatives to identify patients at risk and to develop targeted prevention strategies should be prioritized.
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Affiliation(s)
- Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongqiang Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiangtong Peng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huayi Feng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixu Yu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjing Luo
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengcheng Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ravaioli A, Crocetti E, Mancini S, Baldacchini F, Giuliani O, Vattiato R, Bucchi L, Falcini F. Suicide death among cancer patients: new data from northern Italy, systematic review of the last 22 years and meta-analysis. Eur J Cancer 2020; 125:104-113. [DOI: 10.1016/j.ejca.2019.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 10/25/2022]
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Ismail MF, Lavelle C, Cassidy EM. Steroid-induced mental disorders in cancer patients: a systematic review. Future Oncol 2017; 13:2719-2731. [PMID: 29186986 DOI: 10.2217/fon-2017-0306] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Corticosteroids are a central part of many cancer treatment regimens. Neuropsychiatric toxicity has complicated their use, including an association with a spectrum of symptoms, from insomnia, cognitive impairment and mood symptoms, to severe mental disorders, including mania, psychosis and severe depression. Although steroid-induced mental disorders were first reported in medicine more than 60 years ago, there is a dearth of evidence available to date on optimal treatment and prevention to guide cancer clinicians. We completed a systematic review of the current evidence for therapeutic and prophylactic interventions of steroid-induced mental disorders in cancer. We searched Medline, Embase and PsycINFO and selected studies related to steroid-induced mental disorder. The studies found were limited to case series and case reports only.
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Affiliation(s)
- Muhammad Fahmi Ismail
- Department of Psychiatry & Neurobehavioural Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, Ireland
| | - Clianna Lavelle
- South Lee Mental Health Service, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, Ireland
| | - Eugene M Cassidy
- Department of Psychiatry & Neurobehavioural Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, Ireland
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9
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Abstract
Patients have a heightened risk of injury in the weeks before and after a diagnosis
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Affiliation(s)
- Holly G Prigerson
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Susan C Vaughan
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY 10032, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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10
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Yamauchi T, Inagaki M, Yonemoto N, Iwasaki M, Inoue M, Akechi T, Iso H, Tsugane S. Death by suicide and other externally caused injuries following a cancer diagnosis: the Japan Public Health Center-based Prospective Study. Psychooncology 2014; 23:1034-41. [DOI: 10.1002/pon.3529] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/06/2014] [Accepted: 02/28/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Takashi Yamauchi
- Center for Suicide Prevention, National Institute of Mental Health; National Center of Neurology and Psychiatry; 4-1-1 Ogawahigashi, Kodaira Tokyo 187-8553 Japan
| | - Masatoshi Inagaki
- Department of Neuropsychiatry; Okayama University Hospital; Shikata-cho, Kita-ku Okayama 700-8558 Japan
| | - Naohiro Yonemoto
- Department of Epidemiology and Biostatistics, Translational Medical Center; National Center of Neurology and Psychiatry; 4-1-1 Ogawahigashi, Kodaira Tokyo 187-8553 Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening; National Cancer Center; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - Manami Inoue
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening; National Cancer Center; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine; Nagoya City University Graduate School of Medical Sciences; Mizuho-cho, Mizuho-ku Nagoya 467-8601 Japan
| | - Hiroyasu Iso
- Department of Social and Environmental Medicine, Graduate School of Medicine; Osaka University; 2-2 Yamadaoka, Suita-shi Osaka 565-0871 Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening; National Cancer Center; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
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11
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Kendal WS, Kendal WM. Comparative Risk Factors for Accidental and Suicidal Death in Cancer Patients. CRISIS 2012; 33:325-34. [DOI: 10.1027/0227-5910/a000149] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Cancer patients appear at higher risk of accidental death and suicide. The reasons for this and how suicide and accidental death relate remain unclear. Aims: To clarify and contrast risk factors for such deaths among cancer patients. Methods: A SEER (1973–2007) analysis was conducted on 4,449,957 cancer patients comparing all causes of death (COD) to accidental and suicidal deaths through competing hazards, relative risk and proportional hazards models. SEER did not provide psychological assessments; the analysis was confined to their standard epidemiological and clinicopathological parameters. Results: 2,557,385 overall deaths yielded 16,879 (0.66%) accidents and 6,589 (0.26%) suicides. Mortality reached its highest incidence immediately after diagnosis and obeyed Pareto type II distributions. The major identifiable risk factor for suicide was male gender; for accidental death, First Nations ethnicity; and all COD, metastases. Minor factors for suicide included metastases, advanced age, and respiratory as well as head and neck tumors, whereas for accidental death they were male gender, metastases, advanced age, and brain tumors. Conclusions: Differences were observed in the risk patterns of suicide and accidental death, suggesting distinct etiologies. A high incidence of suicides and accidental deaths following diagnosis (attributed by some to stress from the diagnosis of cancer) correlated here with overall mortality and indicators of physical morbidity. Cancer patients with the above identifiable risk factors warrant supportive attention.
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Affiliation(s)
- Wayne S. Kendal
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa, Canada
- The Ottawa Hospital Research Institute, Canada
| | - Wendy M. Kendal
- Department of Family and Community Medicine, St. Paul’s Hospital, Vancouver, Canada
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12
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Robson A, Scrutton F, Wilkinson L, MacLeod F. The risk of suicide in cancer patients: a review of the literature. Psychooncology 2011; 19:1250-8. [PMID: 20213857 DOI: 10.1002/pon.1717] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This review investigates the risk of suicide in people diagnosed with cancer. METHOD A literature search of PsycINFO, MEDLINE, EMBASE and CINAHL yielded 677 articles of which the abstracts were reviewed for their relevance. Seventy-one articles were identified as relevant and a further 3 were identified in a search of cited and citing articles; following application of inclusion and exclusion criteria, 39 articles were included in the review. RESULTS The reported incidence of completed suicide in cancer patients ranged from standardised mortality ratio of 1 to 11. The reported percentages of suicidal ideation in non-psychiatric populations of cancer patients ranged from 0.8 to 71.4%, compared to a reported prevalence of suicidal ideation in the general population, of between 1.1 and 19.8%. Risk factors identified for completed suicide and suicidal ideation in cancer patients include mental health, socio-demographic and illness factors. Some of these risk factors extend to the general population; however, some are specific to cancer such as cancer site, physical functioning and prognosis. CONCLUSIONS Despite the prevalence of suicidal ideation in a cancer population being comparable to the general population, the prevalence of completed suicide is elevated. Although suicidal ideation does not necessarily result in completed suicide, it is important that adequate training be provided for cancer professionals on the risk factors for suicide in cancer patients.
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Affiliation(s)
- Anna Robson
- Department of Psychological Services and Research, Nithbank, Dumfries, UK.
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Maddineni SB, Lau MM, Sangar VK. Identifying the needs of penile cancer sufferers: a systematic review of the quality of life, psychosexual and psychosocial literature in penile cancer. BMC Urol 2009; 9:8. [PMID: 19664235 PMCID: PMC2731105 DOI: 10.1186/1471-2490-9-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 08/08/2009] [Indexed: 11/10/2022] Open
Abstract
Background Penile cancer is an uncommon malignancy with an incidence of 1 per 100,000. Conservative and radical treatments can be disfiguring and may have an impact on sexual function, quality of life (QOL), social interactions, self-image and self-esteem. Knowledge of how this disease affects patients is paramount to developing a global, multi-disciplinary approach to treatment. Methods A Medline/PubMed literature search was conducted using the terms "sexual function penis cancer"; "quality of life penis cancer" and "psychological effects penis cancer" from 1985 to 2008. Articles containing quantitative data on QOL, sexual function or psychological well-being were included. Results 128 patients from 6 studies were included. 5 studies contained retrospective data whilst 1 study collected prospective data on erectile function. In the 6 studies 13 different quantitative tools were used to assess psychological well-being, QOL and sexual function. The General Health Questionnaire (GHQ) showed impaired well-being in up to 40% in 2 studies. Patients undergoing more mutilating treatments were more likely to have impaired well-being. The Hospital Anxiety and Depression Score (HADS) demonstrated pathological anxiety up to 31% in 2 studies. 1 study used the Diagnostic and Statistical Manual of Mental Disorders of psychiatric illness (DSM III-R) with 53% exhibiting mental illness, 25% avoidance behaviour and 40% impaired well-being. 12/30 suffered from post-traumatic stress disorder. The IIEF-15 was the commonest tool used to assess sexual function. The results varied from 36% in 1 study with no sexual function to 67% in another reporting reduced sexual satisfaction to 78% in another reporting high confidence with erections. Conclusion The treatment of penile cancer results in negative effects on well-being in up to 40% with psychiatric symptoms in approximately 50%. Up to two-thirds of patients report a reduction in sexual function. This study demonstrates that penile cancer sufferers can exhibit significant psychological dysfunction, yet no standardised tools or interventional pathways are available. Therefore, there is a need to identify and assess adequate tools to measure psychological and sexual dysfunction in this group of patients.
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Robinson D, Renshaw C, Okello C, Møller H, Davies EA. Suicide in cancer patients in South East England from 1996 to 2005: a population-based study. Br J Cancer 2009; 101:198-201. [PMID: 19471277 PMCID: PMC2713698 DOI: 10.1038/sj.bjc.6605110] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Studies from around the world have shown that suicide risk is increased in cancer patients, but no previous detailed analysis has been carried out in England. METHODS We calculated standardised mortality ratios (SMRs) for suicide in 206,129 men and 211,443 women diagnosed with cancer in South East England between 1996 and 2005, relative to suicide rates in the general population. RESULTS We found a significantly increased risk of suicide in men (SMR 1.45, 95% confidence interval (CI) 1.20-1.73) and a moderately increased risk in women (SMR 1.19, 95% CI 0.88-1.57). In both sexes, relative risk of suicide was greatest in the first year after cancer diagnosis (SMR for men 2.42, 95% CI 1.84-3.13; SMR for women 1.44, 95% CI 0.82-2.33), and was also greater in individuals diagnosed with types of cancer with high fatality (SMR for men 2.67, 95% CI 1.71-3.97; SMR for women 2.17, 95% CI 0.80-4.73). CONCLUSION There is a critical period immediately after the diagnosis of cancer during which the excess risk of suicide is particularly high. Carers need to be aware of the importance of attending to both the physical and emotional needs of cancer patients and cancer survivors.
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Affiliation(s)
- D Robinson
- Division of Cancer Studies, King's College London, Thames Cancer Registry, London, UK.
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Suicidal Risk Evaluation Using a Similarity-Based Classifier. ADVANCED DATA MINING AND APPLICATIONS 2008. [DOI: 10.1007/978-3-540-88192-6_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Suicide is a major health issue worldwide and is among the top ten causes of death in many countries. Much research, media attention and public health initiatives are focused on reducing the suicide rate among adolescents and young adults. In many countries, however, it is the elderly population with the greatest number of suicides, the majority of which die by drug overdose. This is commonly explained by an increased suicidal intent among older people due to co-morbidity and social isolation. The physical vulnerability of elderly people to potential toxins however is also likely to play an important role. This review examines the epidemiology of elderly suicide, considers commonly implicated drugs, and discusses associated risk factors in this complex and multifactorial problem.
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