The receipt of a cancer diagnosis can be devastating, with important implications for a patient’s mental health and well-being. Some evidence has suggested that cancer diagnosis may contribute to an increased risk of suicide in this patient population; however, variation in risk by various patient characteristics has not been well-studied. In this cohort study, investigators utilized data from 4,722,099 adult patients with a cancer diagnosis in order to study the effect of cancer diagnosis on the risk of suicide compared to the general population. Researchers found that out of the 4,722,099 patients identified with a cancer diagnosis, 2491 patients with cancer were identified as having suicide as a cause of death (0.08% of all deaths). The highest standard mortality ratios (SMR) and absolute excess risks (AERs) were observed in patients with mesothelioma, as they had a 4.51-fold risk of suicide compared with the general population (SMR 95% CI 2.91 to 7.00) corresponding to 4.20 extra deaths per 10,000 person-years (AER 95% CI 1.84 to 6.57). Pancreatic cancer (SMR 3.89, 95% CI 2.77 to 5.48), esophageal cancer (SMR 2.65, 95% CI 2.04 to 3.43), lung cancer (SMR 2.57, 95% CI 2.23 to 2.97), and stomach cancer (SMR 2.20, 95% CI 1.71 to 2.84) were also associated with an increased risk of suicide. In contrast, patients with melanoma (SMR 0.80, 95% CI of 0.66 to 0.98) and prostate cancer (SMR 0.90, 95% CI 0.82 to 0.99) had a significantly reduced risk of death by suicide compared to the general population. In terms of timing, SMRs for all cancers were highest in the first 6 months after cancer diagnosis (SMR 2.74, 95% CI 2.52 to 2.98; AER 1.77, 95% CI 1.54 to 2.01) but also remained high over the following 3 years before decreasing in risk over time (p<0.001). In terms of cancer stage, those with stage IV disease had the highest SMR and AER (SMR 2.79, 95% CI 2.24 to 3.47; AER 1.97, 95% CI 1.30 to 2.65), although there was significant heterogeneity found for the association between stage at diagnosis and risk of suicide (p<0.001). Overall, results of this study indicate that cancer diagnosis is associated with an increased risk of suicide, particularly in those with late stage cancer or with certain types of cancer. This has important implications for patients with these risk factors, for whom targeted interventions could potentially prevent deaths due to suicide. This study was limited in that it did not account for ethnicity, preexisting psychiatric disorders, or other confounders such as alcohol or drug use.
Click to read the study in JAMA Psychiatry
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