Suicide in cancer patients in South East England from 1996 to 2005: a population-based study

Emulating trial to evaluate the effectiveness of routine supportive care on mortality among cancer patients experiencing distress at the time of diagnosis

INTRODUCTION

Few studies have evaluated the effectiveness of interventions for distress during cancer diagnosis on clinical outcomes in a real-world setting. We aimed to evaluate whether routine information and psychosocial support to patients experiencing distress at the time of diagnosis could decrease the risk of mortality within 1 and 3 years after diagnosis.

MATERIAL AND METHODS

We conducted a retrospective cohort study of 4880 newly diagnosed cancer patients who reported distress scores of ≥4 using the tablet or kiosk-based screening between July 2014 and December 2017 at a university-affiliated cancer center in Seoul, South Korea. We performed an emulated target trial with two groups: those that received information and psychosocial support and those that did not. Cox proportional hazards models were used to identify the associations between information and psychosocial support and all-cause mortality.

RESULTS

Of all the patients, 16.6 % had routine information and psychosocial support. The hazard ratio (HR) for one-year mortality comparing participants with information and psychosocial support to those without it were 0.73 (95 % confidence interval (CI) = 0.54, 0.99). Age < 50 and 50 - <60 group had a stronger effect of information and psychosocial support on reducing mortality within one-year than these in age ≥ 60 (p for interaction = 0.03). In terms of three-year mortality, the HR comparing participants with information and psychosocial support to those without it was 0.93 (95 % CI = 0.76, 1.14).

CONCLUSION

This large-scale real-world study suggests that timely psychosocial care benefits newly diagnosed cancer patients who had distress during pre-treatment period.

Suicide risk among patients with cancer by sex in Japan: A population-based study

BACKGROUND

In Japan, few studies have examined suicide risk for five-year relative survival rates for cancer sites. Since five-year relative survival rates differ by sex, we aim to examine suicide risk for patients with cancer separately for men and women.

METHODS

We estimated the risk of suicide among patients with cancer by sex in Japan compared to the general population, using standardized mortality ratios (SMRs). Patients with cancer diagnosed between January 1, 1985-December 31, 2013 and registered in the Osaka Cancer Registry were followed-up with for up to 10 years. The outcome was suicide death. In addition, cancer sites were classified into three prognosis groups based on five-year relative survival rates: good (> 70%), moderate (40-70%), poor (< 40%).

RESULTS

Among 623 995 patients with cancer observed for 2 349 432 person-years, 1210 patients died by suicide (867 men and 343 women). The SMRs were almost equal for men (1.66, 95% CI, 1.55-1.77) and women (1.65, 95% CI, 1.48-1.83). SMRs for cancer prognosis groups were 1.01 (95% CI, 0.84-1.22) for men and 1.47 (95% CI, 1.24-1.73) for women in the good group, 1.53 (95% CI, 1.39-1.68) for men and 1.74 (95% CI, 1.47-2.05) for women in the moderate group, and 2.54 (95% CI, 2.27-2.85) for men and 1.87 (95% CI, 1.43-2.46) for women in the poor group.

CONCLUSIONS

In this population, both sexes had higher suicide risk with poor prognosis, but the difference in SMRs between the good and poor groups was smaller for women than men.

Mental health needs in cancer - a call for change

There is continued under-recognition and underinvestment in the psychological and mental health aspects of care for cancer patients, despite the fact that increased patient survival rates in cancer mean that patients are living longer after diagnosis. In this article, we advocate for better integration and joint working between clinicians across all areas, including education and research, impacting positively on the outcomes and care of cancer patients.

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.

Suicide and women living with and beyond a breast cancer diagnosis

Early diagnosis and intervention, and the use of targeted cancer treatments, have significantly reduced mortality from breast cancer. Emotional distress following a diagnosis of cancer is a normal and anticipated, but it may manifest in some individuals at some point as a level of anxiety or depression that significantly affects quality of life and coping. In extreme cases, these feelings can move from physical symptoms of low energy and an inability to complete basic tasks to despair and hopelessness. Confronting a cancer diagnosis is a life-changing experience, bringing a sense of vulnerability. This may create or precipitate a crisis that threatens to overwhelm a person, resulting in a negative impact on established coping mechanisms. There appears to be a paucity of literature on suicide or suicide attempts by people living with and beyond a cancer diagnosis. A literature search identified 19 papers on suicide and or suicide ideation in patients who had had a cancer diagnosis, which were included in the review. Two clear themes emerged from the literature: that a cancer diagnosis with or without pre-existing mental health comorbidities is a risk factor for suicide; and that there is a significant incidence and prevalence of anxiety and depression in cancer patient populations. The literature identifies multiple variables that impact on prevalence of mental health disorders after a breast cancer diagnosis. Despite this, there appears to be a lack of guidance at national level for screening for mental health comorbidities in patients with a cancer diagnosis.

Cancer and psychiatric diagnoses in the year preceding suicide

BACKGROUND

Patients with cancer are known to be at increased risk for suicide but little is known about the interaction between cancer and psychiatric diagnoses, another well-documented risk factor.

METHODS

Electronic medical records from nine healthcare systems participating in the Mental Health Research Network were aggregated to form a retrospective case-control study, with ICD-9 codes used to identify diagnoses in the 1 year prior to death by suicide for cases (N = 3330) or matching index date for controls (N = 297,034). Conditional logistic regression was used to assess differences in cancer and psychiatric diagnoses between cases and controls, controlling for sex and age.

RESULTS

Among patients without concurrent psychiatric diagnoses, cancer at disease sites with lower average 5-year survival rates were associated with significantly greater relative risk, while cancer disease sites with survival rates of >70% conferred no increased risk. Patients with most psychiatric diagnoses were at higher risk, however, there was no additional risk conferred to these patients by a concurrent cancer diagnosis.

CONCLUSION

We found no evidence of a synergistic effect between cancer and psychiatric diagnoses. However, cancer patients with a concurrent psychiatric illness remain at the highest relative risk for suicide, regardless of cancer disease site, due to strong independent associations between psychiatric diagnoses and suicide. For patients without a concurrent psychiatric illness, cancer disease sites associated with worse prognoses appeared to confer greater suicide risk.

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.

Suicide and Cardiovascular Death Among Patients With Multiple Primary Cancers in the United States

Background

Previous studies have demonstrated that patients with a cancer diagnosis have an elevated risk of suicide and cardiovascular death. However, the effects of the diagnosis of multiple primary cancers (MPCs) on the risk of suicide and cardiovascular death remain unclear. This study aimed to identify the risk of suicide and cardiovascular death among patients with MPCs in the United States.

Methods

Patients with a single or MPC(s) between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results database in a retrospective cohort study. Mortality rates and standardized mortality ratios (SMRs) of suicides and cardiovascular diseases among patients with MPCs were estimated.

Results

Of the 645,818 patients diagnosed with MPCs included in this analysis, 760 and 36,209 deaths from suicides and cardiovascular diseases were observed, respectively. The suicide and cardiovascular-disease mortality rates were 1.89- (95% CI, 1.76–2.02) and 1.65-times (95% CI, 1.63–1.67), respectively, that of the general population. The cumulative mortality rate from both suicides and cardiovascular diseases among patients with MPCs were significantly higher than those of patients with a single primary cancer (Both p &lt; 0.001). In patients with MPCs diagnosed asynchronously, the cumulative incidence rates of suicides and cardiovascular deaths were higher than those diagnosed synchronously. Among all MPCs, cancers of the pancreas and esophagus had the highest SMRs of suicide (5.98 and 5.67, respectively), while acute myeloid leukemia and brain cancer had the highest SMRs of cardiovascular diseases (3.87 and 3.62, respectively). The SMR of suicide was highest within 1 year after diagnosis, while that of cardiovascular diseases was highest 5 years after diagnosis.

Conclusions

This study showed that the mortality rates from suicides and cardiovascular diseases among patients with MPCs were higher than those with a single primary cancer. Therefore, our results underscore the need for psychological assessment and targeted preventive interventions for suicides and cardiovascular diseases among patients with MPCs.

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.

Neuropsychiatric Disorders and Frailty in Older Adults over the Spectrum of Cancer: A Narrative Review

BACKGROUND

The interplay between different neuropsychiatric conditions, beyond dementia, in the presence of a diagnosis of cancer in older adults may mediate patients' fitness and cancer-related outcomes. Here, we aimed to investigate the presence of depression, sleep disturbances, anxiety, attitude, motivation, and support in older adults receiving a diagnosis of cancer and the dimension of frailty in order to understand the magnitude of the problem.

METHODS

This review provides an update of the state of the art based on references from searches of PubMed between 2000 and June 2021.

RESULTS

The evidence obtained underscored the tight association between frailty and unfavorable clinical outcomes in older adults with cancer. Given the intrinsic correlation of neuropsychiatric disorders with frailty in the realm of cancer survivorship, the evidence showed they might have a correlation with unfavorable clinical outcomes, late-life geriatric syndromes and higher degree of frailty.

CONCLUSIONS

The identification of common vulnerabilities among neuropsychiatric disorders, frailty, and cancer may hold promise to unmask similar shared pathways, potentially intercepting targeted new interventions over the spectrum of cancer with the delivery of better pathways of care for older adults with cancer.

Mental Disorders and Suicide Risk among Cancer Patients: A Nationwide Cohort Study

Although cancer patients are known to experience mental disorders and face suicide risk, little is known about the relationship between mental illness and death by suicide in this group. As such, this study aims to examine the association between mental disorders and suicide risk among cancer patients. We used nationally representative cohort data, and included newly diagnosed cancer patients from 2004 to 2012 with whom we followed-up throughout 2013. We used the clinical diagnoses of all mental disorders as an independent variable and suicide death as a dependent variable to estimate the adjusted hazard ratio (AHR) of suicide deaths in patients with cancer using a Cox proportional hazard model. Among total cancer patients (n = 36,220), the 10,567 patients with mental disorders showed higher suicide risk than non-cancer patients (AHR, 1.53; 95% confidence interval [CI], 1.07-2.17), particularly in those who experienced mental disorders prior to cancer diagnosis (AHR, 2.24; 95% CI, 1.35-3.71). Suicide risk among cancer patients who had mood disorders (AHR, 2.23, 95% CI, 1.31-3.81) or anxiety and somatoform disorders (AHR, 1.61, 95% CI, 1.02-2.55) was higher than for those without mental disorders. Suicide risk of stomach (AHR, 3.32; 95% CI, 1.36-8.10) and liver (AHR, 7.57; 95% CI, 1.86-30.72) cancer patients who had mental disorders was higher than for patients without mental disorders. Cancer patients with mental disorders are at increased risk for suicide. During follow-ups after cancer diagnosis, early mental health support needs were provided to patients with mental disorders.

Suicide after cancer diagnosis in South Korea: a population-based cohort study

OBJECTIVE

The present study aimed to determine whether the suicide risk increased after a cancer diagnosis.

DESIGN

Population-based cohort study.

SETTING AND PARTICIPANTS

This study incorporated the National Health Insurance Service-National Sample Cohort in South Korea. Of the 975 348 subjects, 39 027 with cancer and 936 321 who were cancer free participated between 2005 and 2013.

PRIMARY OUTCOME MEASURE

Suicide.

RESULTS

A total of 110 suicides (82 men, 28 women) were identified among these 39 027 subjects with cancer during a total of 127 184 person-years; among the 936 321 cancer-free subjects, 2163 suicides were reported during a total of 8 222 479 person-years. Cox proportional hazards models were used to compare all-cause and suicide mortalities after cancer diagnosis following adjustment for possible confounding covariates. After adjusting for factors related to suicide, we identified an elevated relative risk of suicide among patients with cancer (HR: 1.480, 95% CI: 1.209 to 1.812). Among men, the relative risk was substantially increased among patients with lip, oral cavity/pharyngeal, colon and rectal, pancreatic and lung cancers when compared with cancer-free subjects; whereas among women, the relative risk was substantially increased among patients with colon and rectal cancers.

CONCLUSION

Our study observed an increased risk of suicide among patients with cancer that varied according to the anatomical cancer site, even after accounting for clinical comorbidities and psychiatric illness. Our findings indicate a need for social support and suicide prevention strategies for patients with cancer.

A systematic review of suicidal behaviour in men: A narrative synthesis of risk factors

RATIONALE

Suicides by men outnumber those by women in every country of the world. To date, there has not been a comprehensive systematic review of risk factors for suicidal behaviour in men to better understand the excess deaths by suicide in men.

OBJECTIVE

The present systematic review seeks to determine the nature and extent of the risk factors to predict suicidal behaviour in men over time.

METHODS

A range of databases (CINAHL, PsycINFO, Web of Science Core Collection, Pubmed, Embase, and Psychology and Behavioural Sciences Collection) were searched from inception to January 2020 for eligible articles. The findings were collated through a narrative synthesis of the evidence.

RESULTS

An initial 601 studies were identified. Following the inclusion and exclusion criteria, there were 105 eligible studies (62 prospective and 43 retrospective) identified. Overall, the risk factors with the strongest evidence predicting suicidal behaviour in men were alcohol and/or drug use/dependence; being unmarried, single, divorced, or widowed; and having a diagnosis of depression. In the prospective studies, the most consistent evidence was for sociodemographic factors (19 risk factors), mental health/psychiatric illness (16 risk factors), physical health/illness (13 risk factors), and negative life events/trauma (11 risk factors). There were a small number of psychological factors (6 factors) and characteristics of suicidal behaviour (3 factors) identified. The findings from the retrospective studies provided further evidence for the risk factors identified in the prospective studies.

CONCLUSIONS

This systematic review has highlighted the wide range of risk factors for suicidal behaviour in men, in this review alone 68 different risk factors were identified. Many factors can interact and change in relevance throughout an individual's life. This review has identified extensive gaps in our knowledge as well as suggestions for future research.

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

BACKGROUND

Growing evidence indicated the higher risk of suicide in cancer survivors compared with general population. Our aim is to systematically quantify the extent of suicide death and identify risk factors associated with the incidence of suicide in cancer patients.

METHODS

We conducted a meta-analysis of relevant studies published in English or Chinese before May 20, 2020. Suicide rate and the number of suicide death were extracted. Our main outcome was suicide rate per 100,000 person-years with 95% CIs using random-effects model.

RESULTS

The pooled incidence of suicide death was 39.72 per 100,000 person-years (95%CI, 33.91-46.52, I ²= 99.6%, P <0 .001). The suicide rate for cancer patients was higher in men (57.78, 95%CI, 47.31-70.56) than in women (14.47, 95%CI, 11.27-18.57). For both sexes combined, esophagus cancer had the highest rate of suicide (87.71, 95%CI, 27.42-280.54). By sex, suicide rates ranked first in males and females were pancreas cancer (195.70, 95%CI, 129.55-295.61) and esophagus cancer (18.34, 95%CI, 5.92-56.84), respectively. The highest suicide rate was 61.02(95%CI, 53.66-69.40) in Asia, and Oceania (24.07, 95%CI, 20.78-27.88) had lowest suicide rate. Suicide rate had a downward trend by years after diagnosis, with the first six months after cancer diagnosis clearly standing out (89.33, 95%CI, 50.64-157.58).

LIMITATIONS

Included studies came from high-income countries and our results might not represent the suicide rate among cancer patients in low- and middle-income countries.

CONCLUSIONS

The incidence of suicide among cancer patients was high despite the declined trend recent years, which emphasized psychological health aspects of interventions and perfecting suicide prevention programs.

Suicide risk among prostate cancer patients before and after the implementation of prostate-specific antigen-based prostate screening in Lithuania in 2006

Despite good prognosis, increased suicide rates are reported for prostate cancer. The aim of this study was to assess the risk of suicide among prostate cancer patients before and after the start of nation-wide prostate-specific antigen (PSA)-based screening programme. Prostate cancer cases diagnosed between 2000 and 2011 were identified from the population-based Lithuanian Cancer Registry and analysis was conducted in 2018. Analysis was stratified by period of diagnosis, age, Gleason score, extent of disease, and time since diagnosis. Standardized mortality ratios (SMRs) were used to assess suicide risk. SMRs were calculated by dividing the observed number of suicides among prostate cancer patients by the expected number of suicides from the general population. Overall, 25 786 prostate cancer cases were diagnosed 2000-2011, and 135 suicides occurred among them compared with expected number of 133 (SMR: 1.10; 95% confidence interval (CI) 0.85-1.20). The suicide risk among prostate cancer patients was 1.08 before and 0.97 after the start of nation-wide PSA-based screening programme. Statistically significant increase in suicide risk was associated with Gleason score 8-10 in the prescreening period (SMR: 2.45; 95% CI 1.23-4.90). Suicide risk among prostate cancer patients before and after introduction of nation-wide PSA-based screening programme is similar to that in the general population.

Cancer Diagnosis and Suicide Mortality: A Systematic Review and Meta-Analysis

Cancer is one of the most common diseases and suicide is one of the causes of cancer patients' mortality. However, the suicide mortality rate in cancer patients has not been thoroughly investigated. The aim of this study was to perform a systematic review and a meta-analysis of suicide mortality risk in cancer patients. The authors systematically searched PubMed, Scopus, psycInfo, and Google Scholar databases using MESH keywords until July 2018; searching was limited to English. Random effects model was used for meta-analyzing the studies. Forest plot was calculated for the whole of the 22 studies and the subgroups. Publication bias was examined, and qualitative evaluation of the articles entered into the meta-analysis was also carried out. 22 studies were included in the meta-analysis. Pooled Standardized Mortality Ratio (SMR) for suicide mortality (SMR = 1.55; 95% and confidence interval (CI) CI = 1.37-1.74) in cancer patients were achieved. It has been shown (SMR = 1.67; 95% CI = 1.48-1.89 and p < 0.001) that cancer has increased suicidal rates in men and also in women (SMR = 1.34; 95% CI = 1.20-1.50 and p < 0.001). The following results were reported based on the subtypes of cancer; pooled SMR = 2.06; 95% CI = 1.32-3.23, and p < 0.001 in esophagus, stomach, pancreas and liver cancers; SMR = 1.57; 95% CI = 1.26-1.97, and p < 0.001 in colon and rectum cancers; SMR = 3.07; 95% CI = 2.20-4.28, and p < 0.001 in bronchus, trachea and lung cancers; SMR = 1.24; 95% CI = 1.03-1.48, and p = 0.020 in breast cancer; SMR = 1.71; 95% CI = 1.38-2.12, and p < 0.001 in prostate cancer. Overall, there is an evaluated suicide mortality rate in cancer patients. There was some evidence of publication bias. Our findings indicate that cancer increases the risk of suicide. Given the results and co-morbidities between suicide-induced cancer and other psychological disorders, the development of psychological interventions can be useful in reducing the risk of suicide in these patients.

Interventions to prevent suicidal behavior and ideation for patients with cancer: A systematic review

OBJECTIVE

This study aimed to summarize interventions for suicide prevention in patients with cancer and highlight any methodological issues.

METHODS

We searched PubMed, PsycINFO, CINAHL, and the Cochrane database from their inception until July 2018. Additionally, we manually searched the references of included studies and recent systematic reviews of psychotherapy, antidepressants, and collaborative care for cancer patients with depression.

RESULTS

Of the 1365 retrieved articles, 11 randomized controlled trials and 11 intervention studies met the inclusion criteria. These were categorized by type of intervention: psychotherapy, pharmacotherapy, integrated collaborative care, muscle relaxation and therapeutic walking, and cancer treatment. The trials showed little evidence to confirm the effects of suicide prevention strategies. Seven trials were designed to assess the efficacy of interventions treating depression. In all studies, suicidal behavior or ideation was reported as one of the secondary outcomes. Three trials did not report information about suicidal ideation, despite assessing depressive symptoms using scales that contained suicidal ideation items. Most trials demonstrated inadequate study quality.

CONCLUSIONS

Our review summarized interventions for suicide prevention in patients with cancer and revealed methodological issues. The findings highlighted a need to explore new treatment strategies that focus on unique suicide risk factors among patients with cancer.

Suicidal death within a year of a cancer diagnosis: A population-based study

BACKGROUND

The suicide risk after a new cancer diagnosis remains a controversial issue. This study examines the suicide risk within the year after a cancer diagnosis. This is the largest study to assess recent trends in suicide risk after a cancer diagnosis.

METHODS

Data were obtained from the Surveillance, Epidemiology, and End Results Program. All patients diagnosed with cancer between 2000 and 2014 were selected. The event was defined as death due to suicide within the first year after a cancer diagnosis, and patients who experienced the event after their diagnosis were observed. The observed/expected (O/E) ratio was assessed as well as the excess risk per 10,000 person-years to determine the suicide risk change after the diagnosis in comparison with the general population.

RESULTS

A total of 4,671,989 patients with cancer were included; 1585 committed suicide within 1 year of their diagnosis. The risk of suicide increased significantly with an O/E ratio of 2.52 and with an excess risk of 2.51 per 10,000 person-years. When the risk of suicide was studied according to the cancer site, the highest increases in the O/E ratio came after diagnoses of pancreatic cancer (8.01) and lung cancer (6.05). The risk of suicide also increased significantly after a diagnosis of colorectal cancer with an O/E ratio of 2.08. However, the risk of suicidal death did not increase significantly after breast and prostate cancer diagnoses.

CONCLUSIONS

The risk of suicide increases significantly in the first year after a diagnosis of cancer in comparison with the general population, and this increase varies with the type and prognosis of cancer. Close observation and referral to mental health services, when indicated, are important for mitigating such risk.

Risk of Suicide After Cancer Diagnosis in England

IMPORTANCE

A diagnosis of cancer carries a substantial risk of psychological distress. There has not yet been a national population-based study in England of the risk of suicide after cancer diagnosis.

OBJECTIVES

To quantify suicide risk in patients with cancers in England and identify risk factors that may assist in needs-based psychological assessment.

DESIGN, SETTING, AND PARTICIPANTS

Population-based study using data from the National Cancer Registration and Analysis Service in England linked to death certification data of 4 722 099 individuals (22 million person-years at risk). Patients (aged 18-99 years) with cancer diagnosed from January 1, 1995, to December 31, 2015, with follow-up until August 31, 2017, were included.

EXPOSURES

Diagnosis of malignant tumors, excluding nonmelanoma skin cancer.

MAIN OUTCOMES AND MEASURES

All deaths in patients that received a verdict of suicide or an open verdict at the inquest. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were calculated.

RESULTS

Of the 4 722 099 patients with cancer, 50.3% were men and 49.7% were women. A total of 3 509 392 patients in the cohort (74.3%) were aged 60 years or older when the diagnosis was made. A total of 2491 patients (1719 men and 772 women) with cancer died by suicide, representing 0.08% of all deaths during the follow-up period. The overall SMR for suicide was 1.20 (95% CI, 1.16-1.25) and the AER per 10 000 person-years was 0.19 (95% CI, 0.15-0.23). The risk was highest among patients with mesothelioma, with a 4.51-fold risk corresponding to 4.20 extra deaths per 10 000 person-years. This risk was followed by pancreatic (3.89-fold), esophageal (2.65-fold), lung (2.57-fold), and stomach (2.20-fold) cancer. Suicide risk was highest in the first 6 months following cancer diagnosis (SMR, 2.74; 95% CI, 2.52-2.98).

CONCLUSIONS AND RELEVANCE

Despite low absolute numbers, the elevated risk of suicide in patients with certain cancers is a concern, representing potentially preventable deaths. The increased risk in the first 6 months after diagnosis may indicate an unmet need for psychological support. The findings of this study suggest a need for improved psychological support for all patients with cancer, and attention to modifiable risk factors, such as pain, particularly in specific cancer groups.

Suicide risk among cancer survivors: Head and neck versus other cancers

BACKGROUND

Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC).

METHODS

The Surveillance, Epidemiology, and End Results 18-registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non-HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis.

RESULTS

There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person-years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI, 1.77-2.19). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16-1.38) compared with the period from 2000 to 2004.

CONCLUSIONS

Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC.

Increasing suicide risk among cancer patients in Lithuania from 1993 to 2012: a cancer registry-based study

Certain groups of individuals seem to have an increased risk of committing suicide, and a number of studies have reported an increased risk of suicide among cancer patients. In this study, we aim to estimate the risk of suicide among cancer patients in Lithuania over the period 1993-2012. The records of patients diagnosed with primary cancer were extracted from the population-based Lithuanian Cancer Registry and 273 511 cases of first cancer were included in the analysis. Sex, age and calendar period-standardized mortality ratios (SMRs) were calculated by dividing the observed numbers of suicides among cancer patients by the expected number using national rates. An increased suicide risk was found for both sexes combined [SMR=1.31, 95% confidence interval (CI): 1.21-1.41] compared with the general population. For all cancer sites except melanoma and skin, and breast and thyroid cancers, the relative suicide risk was elevated. The suicide risk was almost three-fold higher for advanced-stage patients compared with the general population (SMR=2.89, 95% CI: 2.24-3.73). The highest suicide risk observed in our study was during the first 3 months following cancer diagnosis (SMR=2.43, 95% CI: 1.96-3.01), indicating a critical period shortly after diagnosis. Despite ongoing increases in survival among cancer patients and decreases in suicide mortality in the general Lithuanian population during our study period, the increasing risk for suicide indicates that cancer patients' clinical and psychosocial needs remain unsatisfied. The major clinical implication of these data suggests the importance of multidisciplinary preventive interventions.

Suicide following acute admissions for physical illnesses across England and Wales

BACKGROUND

The study aim was to establish and quantify suicide risk following acute admissions for all major physical illnesses, for confirmatory purposes, from two independent information sources from different countries.

METHODS

Record linkage of inpatient and death certificate data for 11 004 389 acute admissions for physical illnesses in England and 713 496 in Wales. The main outcome measure was standardised mortality ratios (SMRs) for suicide at 1 year following discharge from hospital.

RESULTS

There were 1781 suicides within 1 year of discharge in England (SMR = 1.7; 95% = 1.6-1.8) and 131 in Wales (SMR = 2.0; 1.7-2.3). Of 48 major physical illnesses that were associated with at least eight suicides in either country, there was high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5). There was high suicide mortality in one country for alcoholic liver disease, other liver disease and chronic pancreatitis; for epilepsy and Parkinson's disease; for diabetes, hypoglycaemia and hypo-osmolality & hyponatraemia; and for pneumonia, back pain and urinary tract infections.

CONCLUSIONS

There is little or no increased suicide mortality following acute admissions for most physical illnesses. Much of the increased suicide mortality relates to gastrointestinal disorders that are often alcohol related or specific chronic conditions, which may be linked to side effects from certain therapeutic medications. Acute hospital admissions for physical illnesses may therefore provide an opportunity for targeted suicide prevention among people with certain conditions, particularly alcohol related disorders.

Risk of suicide within 1 year of cancer diagnosis

The association of the risk of suicide with cancer at different time points after a new cancer diagnosis is unclear. This study explored the suicide hazard at different time points after a first cancer diagnosis during the 1-year period before suicide. This case-crossover study included 2,907 suicide cases from 2002 to 2012 in Taiwan and compared the odds of suicide risk at different time points during one year after any cancer diagnosis with self-matched periods. The 13th month preceding the suicide date was used as the control period, and the hazard period was the duration from the 1st to 12th month in the conditional logistic regression for case-crossover comparisons. Among major groups of cancers, group of lip, oral cavity and pharynx cancers tended to have higher risk of suicide than other groups of cancers. The first month of cancer diagnosis was associated with the highest risk of suicide compared with the 13th month before suicide. The odds ratio (OR) of suicide were significantly in the first six months after cancer diagnosis but declined afterwards. For example, the adjusted OR was 3.47 [95% confidence interval (CI) = 2.60-4.62] in the first month and 1.53 (95% CI = 1.11-2.12) in the sixth month following cancer diagnosis. These findings provide clinicians with a vital reference period during which sufficient support and necessary referral to mental health support should be provided to reduce the risk of suicide among patients with newly diagnosed cancer morbidity.

Risk and predictors of suicide in colorectal cancer patients: a Surveillance, Epidemiology, and End Results analysis

Background

The risk of suicide is higher for patients with colorectal cancer (crc) than for the general population. Given known differences in morbidity and sites of recurrence, we sought to compare the predictors of suicide for patients with colon cancer and with rectal cancer.

Methods

Using the U.S. Surveillance, Epidemiology, and End Results database, adult patients with confirmed adenocarcinoma of the colon or rectum during 1973-2009 were identified. Parametric and nonparametric tests were used to assess selected variables, and Cox proportional hazards regression models were used to determine predictors of suicide.

Results

The database identified 187,996 patients with rectal cancer and 443,368 with colon cancer. Compared with the rectal cancer group, the colon cancer group was older (median age: 70 years vs. 67 years; p < 0.001) and included more women (51% vs. 43%, p < 0.001). Suicide rates were similar in the colon and rectal cancer groups [611 (0.14%) vs. 337 (0.18%), p < 0.001]. On univariate analysis, rectal cancer was a predictor of suicide [hazard ratio (hr): 1.26; 95% confidence interval (ci): 1.10 to 1.43]. However, after adjusting for clinical and pathology factors, rectal cancer was not a predictor of suicide (hr: 1.05; 95% ci: 0.83 to 1.33). In the colon cancer cohort, independent predictors of suicide included older age, male sex, white race, and lack of primary resection. The aforementioned predictors, plus metastatic disease, similarly predicted suicide in the rectal cancer cohort.

Conclusions

The suicide risk in crc patients is low (<0.2%), and no difference was found based on location of the primary tumour. Sex, age, race, distant spread of disease, and intact primary tumour were the main predictors of suicide among crc patients. Further studies and interventions are needed to target these high-risk groups.

Risk factors for feelings of sadness and suicide attempts among cancer survivors in South Korea: findings from nationwide cross-sectional study (KNHANES IV-VI)

INTRODUCTION

As the number of cancer survivors is rapidly increasing with the increased incidence of the disease and improved survival of patients, the prevalence of, and risk factors for, mental health problems and suicidality among cancer survivors should be examined.

METHODS AND ANALYSIS

Using data obtained from the Korean National Health and Nutrition Examination Survey (2007-2013), we examined 1285 and 33 772 participants who had been and never been diagnosed with cancer, respectively. We investigated the risks of feelings of sadness and suicide attempts among cancer survivors and general population and examined differences in the risks of cancer survivors among subgroups according to cancer-related characteristics.

RESULTS

The median age of survivors at the time of the survey and at diagnosis was 63 and 54 years, respectively. After adjusting for sex, level of education, household income, occupation, marital status, cancer type, current status of treatment, age at diagnosis and years since diagnosis, the risk of suicide attempts was significantly higher in participants diagnosed with cancer before 45 years of age compared with those diagnosed at 45-64 years (adjusted OR=3.81, 95% CI 1.07 to 13.60, P=0.039), and the higher risk of suicide attempts with borderline significance was found in those for whom more than 10 years had passed since diagnosis compared with those for whom the diagnosis was made only 2-10 years ago (adjusted OR=3.38, 95% CI 0.98 to 11.70, P=0.055). However, feelings of sadness were not significantly associated with any cancer-related characteristic.

CONCLUSION

Our results reveal an increased risk of suicide attempts among cancer survivors diagnosed early in life and in those for whom more than 10 years has passed since the diagnosis, suggesting the need for intensive monitoring and support for mental health problems and suicidal risks in this population.

Demographic and clinical factors associated with suicide in gastric cancer in the United States

While increased suicidal tendencies among cancer patients have been well documented, there has been no specific examination of suicide and gastric cancer. The purpose of this study is to characterize suicide incidence among patients diagnosed with gastric cancer from 1973 to 2013 and identify variables associated with higher suicide rates. Patients with gastric cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The study included clinical and demographic data from 1973 to 2013. Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated. Comparisons with the general US population were based on mortality data collected by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control using the Web-based Injury Statistics Query and Reporting System. Multivariable logistic regression models generated odds ratios (ORs) to assess factors associated with increased suicide in gastric malignancy. There were 210 suicides for patients with gastric cancer (SMR, 3.21; 95% CI: 2.80-3.67). Female gender (SMR 8.54), White race (SMR 4.08), age ≤39 years (SMR 3.06), and age 70-79 years (SMR 2.90), were found to be significant for an increased incidence of suicide compared with the general population. There was not a statistically significant relationship between suicide and marital status, income, mode of radiation therapy, and the role of surgical intervention. Approximately 77% of deaths by suicide occurred within the first year following diagnosis. Female gender, White race, age ≤39 years, and age 70-79 years are factors associated with increased risk of suicide in patients with gastric cancer. These results, coupled with further studies and analyses, will be used to formulate a comprehensive suicide risk factor scoring system for screening all cancer patients.

Assessing suicide risk in older adults

Suicide in older adults is continuing to rise and, as the older population increases, so will the rate of suicide. By learning more about the risk factors, assessment areas to explore, and ways to improve treatment, primary care providers can help decrease the incidence of suicidal behaviors in this population.

Associations between the neuron-specific glucocorticoid receptor (NR3C1) Bcl-1 polymorphisms and suicide in cancer patients within the first year of diagnosis

Background

Cancer diagnosis is associated with an increased suicide risk, particularly within the first 1 year after diagnosis of cancer. Abnormal function of the hypothalamic–pituitary–adrenal axis has been implicated in the pathophysiology of depression and suicide. We examined genetic associations of the functional Bcl-1 polymorphism of (rs41423247) neuron-specific glucocorticoid receptor (NR3C1) gene, with death by suicide in cancer patients. Suicides occurring within a year of cancer diagnosis (‘early suicide’) were considered separately from those suicides during the second or subsequent year (‘late suicide’) after cancer diagnosis.

Methods

The subjects consisted of 343 cancer patients admitted to a general hospital in Seoul, South Korea from 1996 to 2009, of which 182 had died by suicide and 161 were alive on December 31, 2009. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue sample of patients with cancer. We conducted a case-control association analysis of Bcl-1 polymorphism of NR3C1 gene.

Results

Subjects carrying the GG genotype of Bcl-1 polymorphism were at increased risk of early suicide when compared to those carrying the CC genotype (OR 3.80, 95 % CI 1.02–14.16, p = .047). Similarly, those individuals carrying the GG genotype (recessive mode) had an increased risk of early suicide relative to the CC or CG genotype (OR 3.71, 95 % CI 1.03–13.43, p = .045). However, there were no differences in the genotype distributions of the NR3C1 Bcl-1 polymorphism between late suicide cases and controls.

Conclusions

Our findings suggest that the NR3C1 Bcl-1 polymorphisms may be involved in the susceptibility to suicide within the first year after cancer diagnosis among cancer patients in Korean population.

Suicide in patients with gastric cancer: a population-based study

OBJECTIVE

We conducted this study to examine the rate of suicide in patients with gastric cancer and to identify factors associated with increased risk of suicide using the Surveillance, Epidemiology, and End Results database.

METHODS

The database was queried for patients who were diagnosed with gastric cancer from 1998 to 2011. The rate of suicide and standardized mortality ratio were calculated. Multivariable analyses were conducted to identify factors associated with increased risk of suicide.

RESULTS

A total of 65 535 patients with 109 597 person-years of follow-up were included. A total of 68 patients died of suicide. The age-adjusted rate of suicide was 34.6 per 100 000 person-years (standardized mortality ratios, 4.07; 95% confidence interval, 3.18-5.13). The rate of suicide was highest within the first 3 months after cancer diagnosis (standardized mortality ratios, 67.67; 95% confidence interval, 40.74-106.15). Results of multivariable analyses showed that male sex (incidence rate ratio, 7.15; 95% confidence interval, 3.05-16.78; P < 0.0001), White race (incidence rate ratio, 3.23; 95% confidence interval, 1.00-10.35; P = 0.0491), unmarried status (incidence rate ratio, 2.01; 95% confidence interval, 1.22-3.30; P = 0.0060) and distant stage disease (incidence rate ratio, 2.90; 95% confidence interval, 1.72-4.92; P < 0.0001) were significantly associated with increased risk of suicide.

CONCLUSIONS

Patients with gastric cancer have an ~4-fold higher risk of suicide compared with the general US population. The suicide risk is highest within the first 3 months after diagnosis. Male sex, White race, unmarried status and distant stage disease are significantly associated with increased risk of suicide.

Anxiety and depression in patients with head and neck cancer: 6-month follow-up study

OBJECTIVE

We aimed to assess psychiatric morbidities of patients with head and neck cancer (HNC) in a prospective study at pretreatment, and 3 and 6 months after treatment, and to compare their health-related quality of life (HRQL) between those with and without depressive disorders (depression).

MATERIALS AND METHODS

Patients with newly diagnosed HNC from a tertiary hospital were recruited into the study. They were assessed for psychiatric morbidities using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Their HRQL was simultaneously evaluated using the quality of life questionnaire of the European Organisation for Research and Treatment of Cancer with a specific module for head and neck cancer; and depressed and nondepressed HNC patients were compared by using the generalized mixed-effect model for repeated measurements.

RESULTS

A total of 106 patients were recruited into this study. High rates of anxiety were found at pretreatment, but steadily declined over time (from 27.3% to 6.4%, and later 3.3%). A skew pattern of depression was observed, with prevalence rates from 8.5% at pretreatment to 24.5% and 14% at 3 and 6 months, respectively, after treatment. We found that loss of sense (P=0.001), loss of speech (P<0.001), low libido (P=0.001), dry mouth (P<0.001), and weight loss (P=0.001) were related to depression over time. The depressed patients had a higher consumption of painkillers (P=0.001) and nutrition supplements (P<0.001). The results showed that depression was predicted by sticky saliva (P<0.001) and trouble with social contact (P<0.001) at 3 months, and trouble with social eating (P<0.001) at 6 months.

CONCLUSION

Patients with HNC experienced different changes in anxiety and depression in the first 6 months of treatment. Dysfunction in salivation, problems with eating, and problems with social contacts were major risk factors for depression.

Risk of suicide and suicide attempts associated with physical disorders: a population-based, balancing score-matched analysis

BACKGROUND

The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders.

METHOD

Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3:1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1-90, 91-364, ⩾ 365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923).

RESULTS

Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03-1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71-9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73).

CONCLUSIONS

People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.

Pain and depression: a neurobiological perspective of their relationship

Remarkable progresses have been achieved regarding the understanding of the neurobiological bases of pain and depression. The principal role of neurotransmitters, neuromodulators, and neurohormones has been proposed in the development of pain and depression. With the progression of molecular biology, an intricate interaction among biological factors accountable to the development and management of pain and depression has been also shown in a numerous preclinical and clinical researches. This mini-review will briefly describe the current issues and future research direction for better understanding of the relationship between pain and depression.

Increased suicide risk in cancer patients in Tyrol/Austria

OBJECTIVES

To investigate whether suicide risk in Tyrol/Austria was increased for cancer patients as compared to the general population and whether subgroups at excess risk could be defined.

STUDY DESIGN AND SETTING

Cohort design based on all malignant cancer cases diagnosed in Tyrol between 1991 and 2010 and excluding nonmelanoma skin cancer. Entry date was date of diagnosis of the index cancer; exit date was either date of suicide or date of death for reasons other than suicide or end of follow-up (Dec 31, 2011). Standardized mortality ratios (SMRs) were computed in the classical way after adjustment for sex, age and year of follow-up.

RESULTS

For all cancer sites except nonmelanoma skin cancer, we observed a SMR of 1.86 [95% confidence interval (CI), 1.57-2.19]. Suicide risk was greatest during the first 6 months after diagnosis with an SMR of 4.74 (95% CI, 3.27-6.66) and was more than fivefold in cases with advanced Stage IV. We observed the greatest excess risk for suicide in patients with head and neck cancers (13 suicides; SMR, 4.73; 95% CI, 2.52-8.09) and lung cancer (14 suicides; SMR, 4.16; 95% CI, 2.27-6.98).

CONCLUSION

In our study population in Tyrol/Austria, we observed a twofold suicide risk in cancer patients as compared with the general population, with the excess risk concentrated in the period shortly after diagnosis and in patients with poor prognosis. Therefore, psychooncological care should be intensified in this group of patients.

Suicide risk in primary care: identification and management in older adults

The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior.

Identifying suicidal symptoms in prostate cancer survivors using brief self-report

PURPOSE

Prostate cancer (PC) survivors are at elevated risk for completed suicide even many years post-treatment. Despite this risk, practical and efficient methods for assessing these symptoms have not been established. We sought to determine if suicidal symptoms could be effectively and efficiently identified in a cohort of PC survivors, and whether these men were receptive to emotional health interventions.

METHODS

Six hundred fifty-six PC survivors, an average of 5 years post-diagnosis, completed eight self-report items about suicidal symptoms and behavior in the past 7 days, and 12 months, as well as medical utilization and interest in emotional health support.

RESULTS

Between 3.6 and 17.9% of PC survivors endorsed a single suicidal ideation item, and denied all other ideation. All survivors who endorsed serious suicidal ideation/behavior also endorsed either passive or active ideation. 58.3% of survivors denied any suicidal symptoms within the past week, but endorsed it within the past year. Most survivors had medical provider contact within the past year and were open to receiving information about emotional health interventions.

CONCLUSIONS

Suicidal ideation in PC survivors cannot be accurately evaluated using only a one-item screen, or by inquiring within a single time frame.

IMPLICATIONS FOR CANCER SURVIVORS

In both research and clinical settings, the evaluation for suicidal ideation in PC survivors should utilize multiple questions, across several time periods. It is possible to skip queries about serious ideation/behavior if passive or active ideation is denied. Once identified, medical providers should refer these men to psychosocial providers who can offer emotional support.

A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer

PURPOSE

This study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention.

METHODS

Purposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3.

RESULTS

Tobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t = 2.84, p < 0.01). When PHQ-9 ≥ 10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77-0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively.

CONCLUSIONS

Demoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.

The interference in the suicide ideation of patients with malignant tumors by mental clinical nursing pathway

BACKGROUND

The purpose of this study was to examine the effect of mental clinical nursing pathways on suicidal ideation and life quality of patients with malignant tumors.

METHODS

Two hundred patients with malignant tumors were randomly divided into a study group and a control group, with 100 patients in each group. During the treatment, patients in the study group received mental clinical nursing pathway care, while those in the control group were given the usual nursing care, such as timely inspection, nurse's reactions to patient's behavior, and execution of medical orders. Thereafter, the "self-rating idea of suicide scale" and Karnofsky Performance Status (KPS) were used to compare the differences in the suicidal ideation of patients with malignant tumors between the two groups before and after the treatment.

RESULTS

There were no statistical differences in the scores of despair factor, optimistic factor, sleep factor, and cover factor between the two groups before the treatment (P>0.05). After different styles of nursing, the former four factors of patients in the study group were significantly lower than those in the control group (P<0.01), while there were no significant differences in the score of cover factor between the two groups (P>0.05). The KPS of patients receiving mental clinical nursing pathway care was higher than those receiving usual nursing care, and there was a statistical significant difference between the two groups (P<0.01). Interestingly, the patients' suicidal ideation scale was negatively correlated with KPS (r =-0.29, P<0.05).

CONCLUSION

For individuals diagnosed with a malignant tumor, using a mental health clinical nursing pathway can effectively decrease the degree of suicidal ideation and positively impact the quality of life.

Research to reduce the suicide rate among older adults: methodology roadblocks and promising paradigms

The National Institute of Mental Health and the National Action Alliance for Suicide Prevention have requested input into the development of a national suicide research agenda. In response, a working group of the American Association for Geriatric Psychiatry has prepared recommendations to ensure that the suicide prevention dialogue includes older adults, a large and fast-growing population at high risk of suicide. In this Open Forum, the working group describes three methodology roadblocks to research into suicide prevention among elderly persons and three paradigms that might provide directions for future research into suicide prevention strategies for older adults.

Increase of suicide and accidental death after hematopoietic stem cell transplantation: a cohort study on behalf of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

BACKGROUND

Relapse and transplant-related complications are leading causes of mortality after hematopoietic stem cell transplantation (HSCT). Suicides and accidents have not been studied in these patients. This study sought to determine whether there is an excess of suicide and accidental deaths after HSCT, and to determine risk factors.

METHODS

The incidence of suicidal and accidental death in patients after undergoing HSCT, standardized mortality ratio (SMR), and absolute excess risk (AER) of suicide and accidental deaths was determined, compared with the general European population. A case-control analysis was done to define factors associated with suicide and accidental deaths. Data were derived from the European Group for Blood and Marrow Transplantation Registry, including 294,922 patients who underwent autologous or allogeneic HSCT from 1980 to 2009.

RESULTS

The 10-year cumulative incidence of suicide and accidental deaths was 101.8 and 55.6 per 100,000 patients, respectively. SMR and AER of suicide after HSCT were 2.12 (P < .001) and 10.91, higher than in the European general population for 100,000 deaths, respectively. SMR and AER of accidental death were 1.23 (P < .05) and 2.54, respectively. In the case-control study, relapses were more frequent among patients who committed suicide after autologous HSCT (37% versus 18%; P < .0001). Chronic graft-versus-host disease was higher among patients who committed suicide after allogeneic HSCT (64% versus 37%; P = .001).

CONCLUSIONS

There is an excess of deaths due to suicide and accidents in patients after undergoing HSCT as compared with the European general population. Relapse was associated with more suicide and accidental deaths after autologous HSCT, and chronic graft-versus-host disease was associated with more deaths by suicide after allogeneic HSCT. Cancer 2013;119:2012–2021. © 2013 American Cancer Society.

A literature review of suicide in cancer patients

BACKGROUND

Cancer survivors have a higher suicide rate than the general population. Oncology nurses need to have knowledge and skills in assessing risk for suicide in this population.

OBJECTIVE

This study aimed to conduct a literature review on risk factors for and incidence of suicide in patients with cancer and to identify potential screening tools.

METHODS

PubMed, CINAHL, and PsycINFO databases were searched to identify research articles in peer-reviewed journals from 1999 to 2009. The variables under study included suicide rate, cancer type, demographic characteristics, and signs and symptoms associated with suicide. In addition, articles focused on suicide risk assessment tools were also included.

RESULTS

Twenty-four articles met the inclusion criteria. As in the general population, suicide risk was higher among men with cancer as compared with women with cancer. Patients aged 65 years or older with cancer have a higher rate of suicide compared with those younger than 65 years, with rates highest among men 80 years or older. Specific diagnoses associated with higher suicide rates include prostate, lung, pancreatic, and head and neck cancers. The first year after diagnosis carries a higher risk for completed suicide. Multiple risk assessment tools have been developed and are effective in identifying patients with depression or hopelessness, factors associated with higher risk for suicide. However, no tools exist that sensitively and specifically predict suicide.

CONCLUSION

The incidence of suicide in someone with a cancer diagnosis is approximately double the incidence of suicide in the general population. Early detection of depression in special cancer populations, such as older male patients, may help identify those at greatest suicide risk.

IMPLICATIONS FOR PRACTICE

Oncology nurses should be aware of cancer patients considered at higher risk for suicide. Systematic screening for suicidal ideation and behavior may identify cancer patients at high risk and facilitate appropriate mental health evaluation and treatment.