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Ernst M, Schwinn T, Hirschmiller J, Cleare S, Robb KA, Brähler E, Zwerenz R, Wiltink J, O'Connor RC, Beutel ME. To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research. Clin Psychol Rev 2024; 109:102413. [PMID: 38518584 DOI: 10.1016/j.cpr.2024.102413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/29/2023] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Psychological variables substantially shape the risk of suicidal thoughts and behaviours (STBs). However, it is unclear to what extent they are considered in individuals with cancer. We synthesized the quantitative research landscape concerning psychological risk/protective factors of STBs in the (psycho-) oncological context. This pre-registered review (PROSPERO-ID CRD42022331484) systematically searched the databases PubMed/Medline, CINAHL, PsycInfo, Cochrane Library, and Web of Science (as well as the grey literature and preprints). Risk of bias (RoB) was estimated using the ROBINS-I tool. Of 11,159 retrieved records, 319 studies were eligible for inclusion. Of those, 163 (51.1%) had investigated psychological factors (affective: n = 155; social: n = 65; cognitive: n = 63; personality/individual differences: n = 37; life events: n = 6), in a combined 3,561,741 participants. The most common STBs were suicidal ideation (n = 107) or death wishes (n = 20) rather than behaviour (suicide deaths: n = 26; attempts: n = 14). Most studies had a serious RoB. Thus, a large body of research investigated STBs in cancer patients/survivors, but it rarely aligned with the theoretical or clinical developments in suicide research. We propose a conceptual model of STBs in cancer delineating moderation and mediation effects to advance the integration of the fields, and to inform future research and practice.
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Affiliation(s)
- Mareike Ernst
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria; Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Tamara Schwinn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Judith Hirschmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kathryn A Robb
- Cancer Behaviour Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Kim J, Gang M. Identifying the Risk Factors of Suicidal Ideation in Patients With Hematologic Malignancies Using a Multidimensional Approach. West J Nurs Res 2024; 46:81-89. [PMID: 38078450 DOI: 10.1177/01939459231216870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Patients with hematologic malignancies have a 3.5-fold higher rate of suicide completion than the noncancer population, and the Hodgkin lymphoma has the highest suicide rate among all cancers. Although the risk factors for suicidal ideation among the cancer population are well-known, the specific risk factors contributing to the high suicide rate among patients with hematologic malignancies are elusive. OBJECTIVE This study aimed to identify the risk factors for suicidal ideation among patients with hematologic malignancies using a multidimensional approach. METHODS This was a cross-sectional, observational study. A total of 163 patients were recruited from the oncology department of a university hospital. We collected data on psychological and physical symptoms, social support, and suicidal ideation using the Memorial Symptom Assessment Scale-Short Form, the Multidimensional Scale of Perceived Social Support, and the Suicidal Ideation Scale. Multiple regression analysis was performed using SPSS (version 26.0) to analyze the clinical data. RESULTS Among the 163 participants, 96 (58.9%) were male, 57 (35%) were diagnosed with acute leukemia, and 97 (59.5%) received chemotherapy. The mean age was 55.26 ± 15.75. Physical symptoms, psychological symptoms, and willingness to use mental health services accounted for 39.5% of suicidal ideation cases. CONCLUSIONS Assessment of psychological conditions at the beginning of diagnosis, provision of appropriate interventions throughout treatment, and follow-up care to relieve psychological symptoms should be initiated in patients with hematologic malignancies to prevent suicide.
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Affiliation(s)
- Junglyun Kim
- College of Nursing, Chungnam National University, Daejeon, South Korea
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - Moonhee Gang
- College of Nursing, Chungnam National University, Daejeon, South Korea
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Chen J, Ping Z, Hu D, Wang J, Liu Y. Risk factors associated with suicidal ideation among cancer patients: a systematic review and meta-analysis. Front Psychol 2024; 14:1287290. [PMID: 38259550 PMCID: PMC10800839 DOI: 10.3389/fpsyg.2023.1287290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Objective The objective of this review was to provide a comprehensive summary and analysis of the risk factors associated with suicidal ideation among cancer patients. Methods This review adhered to the PICO/S framework and guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework (PROSPERO CRD42023433639). We searched Web of Science, PubMed, Embase, Scopus, PsycINFO, and Cochrane Library from the establishment date of the databases until June 9, 2023 for observational studies that reveal risk factors associated with suicidal ideation among cancer patients. Software Review Manager 5 (vision 5.4) was used for Meta-analyses. Results 4,921 studies were obtained through the search of the databases, 40 of which were eligible. Meta-analysis revealed that suicidal ideation in cancer patients was significantly associated with marital status, living alone, post-traumatic stress disorder (PTSD), panic disorder, education, psychiatric illness history, social functioning, childhood adversity experience, financial problems, pain, depression, demoralization, vomiting, residence and anxiety. Conclusion Being unmarried, living alone, less educated, living in rural, financial problems, pain, vomiting, PTSD, psychiatric illness history, lower social functioning, childhood adversity experience, anxiety, depression, demoralization, panic disorder were risk factors for suicidal ideation among cancer patients. This review provided evidence-based information for identifying and reducing the risk of suicide in cancer survivors.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42023433639.
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Affiliation(s)
- Jie Chen
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiheng Ping
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Deying Hu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqing Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yilan Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Nigussie K, Tesfaye D, Abdisa L, Tolosa L, Bete T, Gemechu K, Negash A, Sertsu A, Dereje J, Debele GR, Dechasa DB. Suicidal ideation, attempt and associated factors among people with cancer attending cancer center, eastern Ethiopia. Front Psychiatry 2023; 14:1184921. [PMID: 37779615 PMCID: PMC10540465 DOI: 10.3389/fpsyt.2023.1184921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Background Suicide is one of the most common public health problems and the second leading cause of death among individuals 15-29 years of age. Suicidal ideation and attempt are one of the common psychiatric emergence in patients with cancer that needs early detection and management before patients end their lives. Therefore, the aim of the study was to assess the magnitude of suicidal ideation, attempts, and associated factors among people with cancer in Eastern Ethiopia. Methods An institutional-based cross-sectional study design was conducted among 362 participants. A composite international diagnostic interview was used to evaluate suicidal ideation and attempt. Epi-Data version 4.6.2 was used for data entry, and SPSS version 20 was used for analysis. Logistic regression analysis was done to identify associated factors for both suicidal ideation and attempt. p-values less than 0.05 are considered statistically significant, and the strength of the association will be represented by an adjusted odds ratio with a 95% confidence interval. Results The magnitude of suicidal ideation and attempt among people with in this study was 22.9% [95% CI, 18.7-27.4] and 9.8% [95%CI, 6.7-12.8] respectively. Being living alone [AOR = 4.90, 95% CI, 2.08-11.90], and having depressive symptoms [AOR = 3.28, 95% CI, 1.37-7.73], female ([AOR = 1.53, 95% CI, 1.30-3.23], anxiety symptoms [AOR = 3.06, 95% CI, 1.35-6.73)] and having poor social support [AOR = 3.08, 95% CI, 1.72-5.05], were significantly associated suicidal ideation whereas, Being living alone [AOR = 2.89, 95% CI, 1.09-7.65], having a depressive symptoms [AOR = 4.88, 95% CI, 1.45-13.28], being divorced/widowed [AOR = 3.46, 95% CI, 1.09-10.09] and stage four cancer [AOR = 5.53, 95% CI 2.97-7.47] were significantly associated with suicidal attempt. Conclusion Nearly one-quarter and one-tenth of people with cancer have suicide ideation and attempt, respectively. Suicidal behavior among cancer patients was found in this study to be a common problem. Living alone, having depressive and anxiety symptoms, being a female, having poor social support, and being in forth stage of cancer were risk factors for suicide. Therefore, early screening, diagnosing, and treating suicide and its factors will be mandatory and expected from health care providers and non-governmental organizations.
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Affiliation(s)
- Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemesa Abdisa
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lidiya Tolosa
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Bete
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Gemechu
- School of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Sertsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gebiso Roba Debele
- Department of Public Health, College of Health Science, Mettu University, Metu, Ethiopia
| | - Deribe Bekele Dechasa
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Thapa S, Sharma S, Shrestha S, Ghimire BR, Dahal S, Maharjan R, Thapa S, Koirala R. Distress Thermometer Score Is Useful For Predicting Suicidal Ideation in Patients With Cancer. JCO Glob Oncol 2023; 9:e2300071. [PMID: 37625105 PMCID: PMC10581637 DOI: 10.1200/go.23.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/09/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE Suicidal ideation (SI) and depressive symptoms are common in patients with cancer. A Distress Thermometer (DT) is an effective tool to screen depression and anxiety in such cohorts. We investigated the value of the DT for predicting SI and the prevalence and associated risk factors of SI in the study population. METHODS This cross-sectional study enrolled a total of 162 heterogeneous patients with cancer. Information regarding sociodemographic and clinical characteristics, the Hospital Anxiety and Depression Scale, DT score, and the past month SI were collected. Receiver operating characteristic (ROC) analysis was performed to find accuracy and the optimal cutoff score for predicting risk of SI. The significance of difference between DT scores was obtained using the median independence test. Likelihood of risk was analyzed through odds ratio. RESULTS DT possesses good overall accuracy (area under the ROC curve = 0.797) for predicting SI in patients with cancer. The DT had a sensitivity of 0.929 and a specificity of 0.522 with a cutoff score of ≥4. The patients with SI had significantly higher DT scores than the patients without SI (7 [5,8] v 3 [1,6]; P < .001). The 1-month prevalence of SI was 17.3%. Depression, anxiety, and psychological distress were the predictive factors of SI. CONCLUSION SI is a global issue in patients with cancer. The DT scores may be a rapid predicting tool for identifying SI in patients with cancer. Higher DT scores and patients with psychosocial problems need to be routinely screened for SI, which may help to prevent suicidal risk.
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Affiliation(s)
- Sudip Thapa
- Department Medical Oncology, B&B Hospital Pvt. Ltd, Lalitpur, Nepal
| | - Susmita Sharma
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Sudip Shrestha
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Bijesh Raj Ghimire
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Sanuja Dahal
- Vinayak College of Health Science, Kathmandu, Nepal
| | - Rubina Maharjan
- PGY-1, Pediatrics, New York Health and Hospitals, Woodhull Medical Center, Brooklyn, NY
| | - Sadiksha Thapa
- Department Medical Oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
| | - Rishav Koirala
- Department of Psycho-oncology, Nepal Cancer Hospital and Research Center Pvt. Ltd, Lalitpur, Nepal
- Brain and Neuroscience Center, Kathmandu, Nepal
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Ma Z, Mao Y, Wang Y, Duan Z, Qu D, Li C, Chen R, Liu Z. Suicidal ideation and attempted suicide among cancer patients during the COVID-19 pandemic. J Med Virol 2022; 94:5827-5835. [PMID: 35982024 PMCID: PMC9538100 DOI: 10.1002/jmv.28076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to understand the suicidal ideation and suicidal attempts among cancer patients during the COVID-19 pandemic. The data were collected from patients diagnosed with cancer while attending the largest cancer center in the south of China. A structured questionnaire was used to investigate patients' demographic data, suicidal behavior, and factors related to COVID-19. Mental health conditions were measured by the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Brief Symptom Inventory. Comorbidities and medical conditions of cancer patients were extracted from the electronic healthcare records. Among the 5670 cancer patients, 755 (13.3%) reported suicidal ideation, and 266 (4.7%) reported suicidal attempts during the COVID-19 pandemic. The age group with the highest risk of suicidal ideation was 20-24 years (23.9%). Lifetime history of suffering from mental disorders, longer time since cancer diagnosis, regional and distant tumor stage, depression, anxiety, hostility, having a higher frequency of worrying about cancer management due to COVID-19, higher frequency feeling of overwhelming psychological pressure due to COVID-19, having a higher level of barriers to manage cancer due to COVID-19, and higher barriers to continue treatment of cancer due to inconveniences caused by COVID-19, were all significantly associated with increased risk of suicidal ideation. We also identified the risk factors of suicide attempts. This is the first study investigating the prevalence and risk factors associated with suicidal ideation and suicidal attempts in Chinese cancer patients during the COVID-19 pandemic. Our findings suggest that it is essential to monitor the mental health conditions of this vulnerable population, especially for cancer patients who have comorbidity with a history of mental disorders. Also, government policymakers should take action to protect cancer patients to avoid any interruption of their continued treatment. Further efforts are urgently required to develop specific psychological interventions to reduce the risk factors among cancer patients during the COVID-19 pandemic.
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Affiliation(s)
- Zikun Ma
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yize Mao
- Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education SciencesMinistry of EducationChina,School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive ScienceSouth China Normal UniversityChina
| | - Zhizhou Duan
- Preventive health service, Jiangxi provincial people's HospitalThe First Affiliated Hospital of Nanchang Medical CollegeNanchangJiangxiChina
| | - Diyang Qu
- Vanke School of Public HealthTsinghua UniversityBeijingChina,Department of Social and Behavioural SciencesCity University of Hong KongHong KongChina
| | - Chaofeng Li
- Department of Information Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Runsen Chen
- Vanke School of Public HealthTsinghua UniversityBeijingChina,Institute for Healthy ChinaTsinghua UniversityBeijingChina
| | - Zhuowei Liu
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
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Molla A, Aderaw M, Mulat H, Fanta B, Nenko G, Adane A. Suicidal ideation, attempt and associated factors among people living with cancer in Ethiopia: a cross-sectional study. Ann Gen Psychiatry 2022; 21:28. [PMID: 35883094 PMCID: PMC9316727 DOI: 10.1186/s12991-022-00407-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide and cancer are serious public health problems worldwide, and people living with cancer are at high risk of having suicidal behaviors, such as ideation, plan and attempt. Patients with cancer had high possibilities of having suicidal ideation and attempt which lead to poor adherence of medication, worsening of their medical illness, and end the life. Even though people are affected by cancer in Ethiopia, there are limited studies regarding suicidal problem among patients with cancer. Therefore, this study was aimed to assess the magnitude and associated factors of suicidal ideation and attempt among people living with cancer in Ethiopia. METHODS Institutional-based cross-sectional study was conducted among total of 416 participants. Outcome variables were assessed using suicidality module of World health organization (WHO) composite international diagnostic interview (CIDI). Data were analyzed using SPSS-20 and bivariate and multivariate logistic regressions were conducted and variables with P value less than 0.05 were considered as statistically significant with corresponding 95% CI. RESULTS The overall magnitude of suicidal ideation and attempt were 16.6% and 5.5%, respectively. Being divorced [(AOR = 2.97, (95% CI 1.22, 7.22)], having depression [(AOR = 2.67, (95%CI 1.34, 5.32)], the first 18 months, since diagnosed cancer [(AOR = 2.57, (95%CI 1.15, 5.75)], severe pain [(AOR = 3.27, (95%CI 1.18, 9.04)] and stage IV cancer [(AOR = 3.35, (95%CI 1.26, 9.04)] were significantly associated with suicidal Ideation. Whereas, female sex [(AOR = 5.32, (95%CI 1.39, 20.25)], having depression [(AOR = 4.8, (95%CI 1.23, 18)] and advanced stage of cancer [(AOR = 6.76, (95%CL 1.2, 37)] were significantly associated with suicidal attempt. CONCLUSIONS The magnitude of Suicidal ideation and attempt in this study were high. Health care providers working in cancer treatment unit should give more attention to patients with high suicidal risk factors. Consultation services should be strengthened with psychiatric professionals in oncology treatment clinic.
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Affiliation(s)
- Alemayehu Molla
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia.
| | - Mekidem Aderaw
- College of Medicine and Health Science, Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Haregewoin Mulat
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Biruk Fanta
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Goshu Nenko
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Aynishet Adane
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Kazlauskiene J, Navickas A, Lesinskiene S, Bulotiene G. Factors Affecting Suicidal Thoughts in Breast Cancer Patients. Medicina (B Aires) 2022; 58:medicina58070863. [PMID: 35888582 PMCID: PMC9322153 DOI: 10.3390/medicina58070863] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Women diagnosed with breast cancer experience severe trauma. Psychological help for breast cancer patients is not sufficient because of limited professional resources. The goal of this study was to identify groups of breast cancer patients with the greatest suicidal risk, who could be the first target for psychosocial interventions. Materials and Methods: The study included 421 women with stage T1–T3/N0–N3/M0 breast cancer. We provided women with a set of questionnaires 1–2 days prior to breast surgery and one year after surgery. One hundred eighty-eight patients completed the questionnaires after one year. We used the Beck Depression Inventory Second Edition (BDI-II) item Suicidal Thoughts or Intentions for the assessment of suicidal risk. The Impact of Event Scale-Revised (IES-R) was used to measure the risk of PTSD and the Vrana–Lauterbach Traumatic Events Questionnaire-Civilian, TEQ-C (TEQ-CV) was used to measure whether patients had experienced other traumatic events in their lifetime. Results: The incidence of suicidal ideation one year after surgery increased from 4.3% to 12.8% of patients. Patients who lived in rural areas had a two times greater risk of suicidal thoughts than patients who lived in urban areas. Working patients were 2.5 times more likely to have suicidal thoughts prior to surgery. Severely traumatic events increased the chances of suicidal ideation (OR 7.72; 95% CI 1.63–36.6; p = 0.01). The symptoms of PTSD showed a threefold increase in the likelihood of suicidal ideation (OR 2.89; 95% CI 0.98–8.55; p = 0.05). Conclusions: Living in the countryside, having a history of traumatic experience, having a paid job and having symptoms of post-traumatic stress disorder influence suicidal ideation in breast cancer patients. Particular attention should be drawn to individuals with multiple risk factors.
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Affiliation(s)
- Jurgita Kazlauskiene
- Faculty of Health Care, Vilnius University of Applied Sciences, Saltoniskiu Str. 58, LT-08105 Vilnius, Lithuania;
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21/27, LT-03101 Vilnius, Lithuania; (A.N.); (S.L.)
| | - Alvydas Navickas
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21/27, LT-03101 Vilnius, Lithuania; (A.N.); (S.L.)
| | - Sigita Lesinskiene
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21/27, LT-03101 Vilnius, Lithuania; (A.N.); (S.L.)
| | - Giedre Bulotiene
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21/27, LT-03101 Vilnius, Lithuania; (A.N.); (S.L.)
- Department of Physical Medicine and Rehabilitation, National Cancer Institute, Santariskiu Str. 1, LT-08660 Vilnius, Lithuania
- Correspondence:
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Gentile G, Tambuzzi S, Calati R, Zoja R. A Descriptive Cohort of Suicidal Cancer Patients: Analysis of the Autopsy Case Series from 1993 to 2019 in Milan (Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020829. [PMID: 35055655 PMCID: PMC8776118 DOI: 10.3390/ijerph19020829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/10/2022]
Abstract
Suicide in cancer patients has always been a subject of clinical studies, but the contribution of forensic pathology to this phenomenon is poorly reported. With the aim of at least partially filling this gap in information, at the Institute of Forensic Medicine of Milan, Italy, we assessed all suicides that occurred in cancer patients. A descriptive and retrospective analysis was carried out by examining the database of the Institute and autopsy reports. We included 288 suicide cases with proven cancer diseases. For each suicide, sex, age, country of origin, body area affected by cancer, further pathological history, medications, previous suicide attempts and suicidal communications, as well as the place where the suicide occurred, were assessed. Furthermore, from a forensic point of view, we considered the chosen suicide method and any involved means. The majority of cases were male older adults affected by lung, colon and prostate cancer. Violent suicide methods were prevalent, and the most represented suicide method was falling from height regardless of the body area affected by cancer. Such data may be of clinical use for clinicians engaged in the front lines in order to address suicide risk prevention strategies among cancer patients.
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Affiliation(s)
- Guendalina Gentile
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
| | - Stefano Tambuzzi
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 30029 Nimes, France
- Correspondence:
| | - Riccardo Zoja
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
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Lai Q, Huang H, Zhu Y, Shu S, Chen Y, Luo Y, Zhang L, Yang Z. Incidence and risk factors for suicidal ideation in a sample of Chinese patients with mixed cancer types. Support Care Cancer 2022; 30:9811-9821. [PMID: 36269433 PMCID: PMC9715447 DOI: 10.1007/s00520-022-07386-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Suicidal ideation (SI) is often overlooked as a risk factor for people with cancer. Because it is often a precursor for suicidal behavior, it is critical to identify and address SI in a timely manner. This study investigated SI incidence and risk factors in a cohort of Chinese patients with mixed cancer types. METHODS Data from this cross-sectional study were collected from 588 patients receiving medical therapy for tumors at Nanfang Hospital and the Integrated Hospital of Traditional Chinese Medicine at Southern Medical University. SI was measured using the Self-rating Idea of Suicide Scale (SIOSS). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). The Chinese version of the Demoralization Scale II (DS-II-C) was used to assess demoralization. Univariate and correlation analyses were used to identify correlative factors of SI and multiple stepwise linear regression analysis was used to characterize potential risk factors. RESULTS SI was reported in 24.7% of participants and the SIOSS score was 14.00 (13.00, 15.00) in the SI group. Multiple linear regression results showed that demoralization, medical financial burden, cancer type, living condition, caretaker, working state, residence, gender, and marital status explained 32.1% of the SI in this cohort (F = 28.705, P < 0.001). CONCLUSION Approximately one-quarter of cancer patients in this study reported SI influenced by both external and internal factors. Characterizing these factors can be informative for prevention and treatment efforts.
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Affiliation(s)
- Qianlin Lai
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Hong Huang
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Yinting Zhu
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Siwei Shu
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Yaner Chen
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Yuanyuan Luo
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Lili Zhang
- School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
| | - Zhihui Yang
- School of Nursing, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
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11
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Xu Q, Jia S, Fukasawa M, Lin L, Na J, Mu Z, Li B, Li N, Zhao T, Ju Z, He M, Yu L, Kawakami N, Li Y, Jiang C. A cross-sectional study on associations of physical symptoms, health self-efficacy, and suicidal ideation among Chinese hospitalized cancer patients. BMC Psychiatry 2020; 20:544. [PMID: 33213416 PMCID: PMC7678141 DOI: 10.1186/s12888-020-02945-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 11/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epidemiological studies have shown increased risk of suicide in cancer patients compared with the general population. The present study aimed to examine the association between physical symptoms and suicidal ideation in Chinese hospitalized cancer patients and test the modifying effect of health self-efficacy on the association. METHODS A cross-sectional study was conducted with 544 hospitalized cancer patients in two general hospitals in northeast China via face-to-face interviews. Suicidal ideation was measured by using the first four items on the Yale Evaluation of Suicidality scale and then dichotomized into a positive and negative score. Multivariate logistic regression analyses were conducted to examine the impacts of physical symptoms, health self-efficacy, and their interactions on suicidal ideation. RESULTS The suicidal ideation rate was 26.3% in the enrolled cancer patients. Logistic regression showed that insomnia (aOR = 1.84, 95% CI 1.13 to 3.00, p = 0.015) and lack of appetite (aOR = 2.14, 95% CI 1.26 to 3.64, p = 0.005) were significantly associated with suicidal ideation. Low health self-efficacy had a marginally significant exaggerating effect on the association between pain and suicidal ideation (aOR = 2.77, 95% CI 0.99 to 7.74, p = 0.053), after adjusting for significant socio-demographics, clinical characteristics, and depression. CONCLUSIONS These findings demonstrate significant associations between physical symptoms (insomnia and/or lack of appetite) and suicidal ideation and highlight the potential modifying role of health self-efficacy in the identification and prevention of suicide among cancer patients.
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Affiliation(s)
- Qingyi Xu
- grid.411971.b0000 0000 9558 1426Department of Psychology, College of Humanities and Social Sciences, Dalian Medical University, Dalian, China
| | - Shuhua Jia
- grid.411971.b0000 0000 9558 1426Department of Psychology, College of Humanities and Social Sciences, Dalian Medical University, Dalian, China
| | - Maiko Fukasawa
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health, the Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Lin Lin
- grid.412735.60000 0001 0193 3951School of Psychology, Tianjin Normal University, Tianjin, China
| | - Jun Na
- Liaoning Provincial Center for Disease Control and Prevention, Institute of Chronic Disease, Shenyang, China
| | - Zhen Mu
- grid.411971.b0000 0000 9558 1426Department of Psychology, College of Humanities and Social Sciences, Dalian Medical University, Dalian, China
| | - Bo Li
- grid.452505.30000 0004 1757 6882Department of Geriatrics, Guangzhou Brain Hospital, Guangzhou, China
| | - Ningning Li
- Department of Psychology, Benxi Kangning Hospital, Benxi, China
| | - Tong Zhao
- grid.440706.10000 0001 0175 8217Department of Oncology, Zhongshan Affiliated Hospital of Dalian University, Dalian, China
| | - Zaishuang Ju
- grid.440706.10000 0001 0175 8217Department of Oncology, Zhongshan Affiliated Hospital of Dalian University, Dalian, China
| | - Meng He
- grid.452828.1Department of Oncology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianzheng Yu
- Liaoning Provincial Center for Disease Control and Prevention, Institute of Chronic Disease, Shenyang, China
| | - Norito Kawakami
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health, the Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yuejin Li
- grid.260238.d0000 0001 2224 4258Department of Biology, Morgan State University, Baltimore, Maryland USA
| | - Chao Jiang
- Department of Psychology, College of Humanities and Social Sciences, Dalian Medical University, Dalian, China.
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12
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Kolva E, Hoffecker L, Cox-Martin E. Suicidal ideation in patients with cancer: A systematic review of prevalence, risk factors, intervention and assessment. Palliat Support Care 2020; 18:206-219. [PMID: 31554521 DOI: 10.1017/s1478951519000610] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Suicidal ideation (SI) underlies risk of death by suicide. It is well established that patients with cancer are at increased risk of death by suicide. Therefore, understanding SI in patients with cancer is critically important. The goal of this systematic review was to investigate the prevalence, risk factors, intervention, and assessment of SI in patients with cancer. METHODS This systematic review was registered with the PROSPERO database (CRD42018115405) and was guided by the PRISMA statement. We searched Medline, PsycInfo, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and Cochrane Central. Two reviewers independently screened abstracts and assessed for quality assurance using a revised Newcastle-Ottawa Scale. RESULTS We identified 439 studies to screen for eligibility. Eligible studies included adults with cancer diagnoses and listed SI as an outcome. Ultimately, 44 studies were included in the analyses. Prevalence of SI ranged greatly from 0.7% to 46.3%. Single items drawn from validated measures were the most frequent method of assessing SI (n = 20, 45.5%); additional methods included validated measures and psychological interviews. Commonly identified risk factors for SI included age, sex, and disease/treatment-related characteristics, as well as psychological constructs including depression, anxiety, hopelessness, existential distress, and social support. SIGNIFICANCE OF RESULTS Assessment of SI in patients with cancer is the concern of researchers worldwide. Prevalence of SI varied with study population and was likely influenced by the method of assessment. Psychological distress consistently predicted SI. Increasing awareness of demographic, clinical, and psychological associations is critical for risk assessment and intervention development.
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Affiliation(s)
- Elissa Kolva
- Division of Medical Oncology, University of Colorado - Anschutz Medical Campus
| | - Lilian Hoffecker
- Health Sciences Library, University of Colorado - Anschutz Medical Campus
| | - Emily Cox-Martin
- Division of Medical Oncology, University of Colorado - Anschutz Medical Campus
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13
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Bulotiene G, Pociute K. Interventions for Reducing Suicide Risk in Cancer Patients: A Literature Review. EUROPES JOURNAL OF PSYCHOLOGY 2019; 15:637-649. [PMID: 33680150 PMCID: PMC7909181 DOI: 10.5964/ejop.v15i3.1741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/20/2018] [Indexed: 01/26/2023]
Abstract
The suicide risk of people diagnosed with cancer is two times higher than the general population. The number of cases of diagnosed cancer is estimated to rise by 70% over the next two decades. Evidence-based prevention strategies are necessary to protect this vulnerable group of individuals. The purpose of this review was to find out the risk factors of suicide and which types of interventions can serve as prevention strategies. Psychosocial interventions, pharmacotherapy and physical activity can play a preventive role in reducing psychosocial and physical risk factors, such as mental disorders, poor social support, poor performance status and pain. Further research is needed to develop effective suicide prevention strategies for cancer patients.
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Affiliation(s)
- Giedre Bulotiene
- Department of Physical Medicine and Rehabilitation, National Cancer Institute, Vilnius, Lithuania
| | - Kamile Pociute
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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14
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Yan X, Chen X, Li M, Zhang P. Prevalence and risk factors of anxiety and depression in Chinese patients with lung cancer:a cross-sectional study. Cancer Manag Res 2019; 11:4347-4356. [PMID: 31190999 PMCID: PMC6514253 DOI: 10.2147/cmar.s202119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/08/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Lung cancer is very common in China. The low cure rate, limited overall survival, and continuous therapies lead the patients to experience considerable psychological distress. Traditional Chinese medicine therapy is one unique treatment method in China. Nevertheless, most patients in the existing studies on anxiety and depression were treated in western medical hospitals. Therefore, it is necessary to identify the prevalence and risk factors of these emotional disorders in lung cancer patients treated in traditional Chinese medical hospitals. These findings may assist in clinical intervention. Patients and methods: A total of 315 patients with lung cancer were enrolled. Individuals completed the Hospital Anxiety and Depression Scale to assess their levels of anxiety and depression. Demographic and clinical data were also collected. Binary logistic regression analysis was used to identify factors that significantly predicted anxiety and depression. Results: The anxiety and depression prevalence rates of lung cancer patients were 43.5% and 57.1%, respectively. In the univariate analysis, patients without surgery, who were young, or who received radiotherapy were more likely to experience anxiety. Patients without surgery, who were young, or who had late-stage cancer, were more likely to experience depression. Binary logistic regression analysis showed that the risk factors of both anxiety and depression were lack of surgery and young and middle age (<65, especially 45–65 years). Conclusion: Anxiety and depression were very common in lung cancer patients. Lack of surgery, young, and middle age, were independent risk factors for anxiety and depression. Therefore, medical workers should pay close attention to the emotional changes of young or middle-aged patients, or patients without the chance to undergo surgery.
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Affiliation(s)
- Xiaoru Yan
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China.,Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Xun Chen
- Graduate School, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Gastroenterology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Meng Li
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China.,Graduate School, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Peitong Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
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15
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Increasing suicide risk among cancer patients in Lithuania from 1993 to 2012: a cancer registry-based study. Eur J Cancer Prev 2018; 26 Joining forces for better cancer registration in Europe:S197-S203. [PMID: 28914692 DOI: 10.1097/cej.0000000000000375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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16
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Diaz-Frutos D, Baca-Garcia E, García-Foncillas J, López-Castroman J. Predictors of psychological distress in advanced cancer patients under palliative treatments. Eur J Cancer Care (Engl) 2016; 25:608-15. [DOI: 10.1111/ecc.12521] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- D. Diaz-Frutos
- Department of Psychiatry and Clinical Psychology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
- Department of Oncology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
- Spanish Association Against Cancer (AECC); Barcelona Spain
| | - E. Baca-Garcia
- Department of Psychiatry and Clinical Psychology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
| | - J. García-Foncillas
- Department of Oncology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
| | - J. López-Castroman
- Department of Psychiatry and Clinical Psychology; Fundación Jiménez Díaz Hospital; Autonoma University of Madrid (UAM); Madrid Spain
- Department of Emergency Psychiatry; CHRU Montpellier; Montpellier France
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