High suicide mortality soon after diagnosis among cancer patients in central Italy

Abstract

Summary A high suicide mortality risk has been documented among a population-based cohort of 27 123 cancer patients resident in central Italy where the general suicide rate is low. Forty-one suicides were observed (SMR = 2.36) which were only 0.2% of all deaths. However, the highest risk (SMR = 27.7) during the first 6 months after diagnosis, represents a greater contrast with the general population than has been observed in other studies.Keywords: suicide; mortality An increased suicide risk has been shown for cancer patients in some population-based studies (Campbell, 1966;Louhivuori and Hakama, 1979;Olafsen, 1981;Fox et al, 1982;Allebeck et al, 1989;Chatton-Reith et al, 1990;Allebeck and Bolund, 1991;Levi et al, 1991; Storm et al, 1992;Louhivuori, 1993;Tanaka et al, 1996). All these studies have been carried out in countries with suicide rates in the general population that are from two to five times greater than in Italy (La Vecchia et al, 1994).Some of these studies evidenced a high risk near the time of cancer diagnosis (Fox et al, 1982;Allebeck and Bolund, 1991;Chatton-Reith et al, 1990;Levi et al, 1991; Storm et al, 1992;Tanaka et al, 1996). During the first year after diagnosis the risk varied from two to five times the expected (Allebeck et al, 1989;Allebeck and Bolund, 1991;Levi et al, 1991; Storm et al, 1992;Tanaka et al, 1996), but among Swedish cancer patients it was considerably higher (SMR = 16.0 for men and SMR = 15.4 for women) (Allebeck et al, 1989).The purpose of the present study was to estimate the risk of suicide among cancer patients resident in a low-risk area for suicide mortality, and its relationship with time since diagnosis. MATERIALS AND METHODSIn the provinces of Florence and Prato, central Italy (about 1 200 000 inhabitants), a population-based cancer registry, the Tuscany Cancer Registry (RTT), has been active since 1984 (Buiatti et al, 1992).After the exclusion of non-melanomatous skin cancers (2361 cases, 7.6%), cancers known from the death certificate only (DCO = 1355 cases, 4.4%) or from autopsy only (69 cases, 0.2%), 27 123 incident cancer cases (14 683 men and 12 440 women) The suicide risk was significantly elevated in all age groups relative to the general population, except for persons younger than 54 years of age.According to time since cancer diagnosis, the highest risk was observed during the first 6 months (SMR = 27.7, 95% CI 13.8-49.6). This finding was confirmed in both genders (men: SMR = 22.9, 95% CI 9.9-45.2; women: SMR = 62.6, 95% CI 9.4-133.6). During the second period, the risk was still significantly increased in men (SMR = 11.36, 95% CI 3.7-26.5) but not in women (SMR = 15.23,). Overall, the SMR for the first year was 18.8 (95%

Hospital admissions and deaths relating to deliberate self-harm and accidents within 5 years of a cancer diagnosis: a national study in Scotland, UK

“…For males, the RR was 1.38 (95% CI: 1.12 -1.68), and for females it was 1.74 (95% CI: 1.36 -2.19) ( Table 6). Previous studies conducted in non-UK countries, or regions of countries, have demonstrated similarly altered RRs of suicide (either when codified as DSH, or when DSH events are assessed in combination with events of undetermined intent) for male cancer patients in the 1.3 -2.8 range, and for female cancer patients in the 0.5 -2.7 range (Louhivuori and Hakama, 1979;Fox et al, 1982;Allebeck et al, 1989;Allebeck and Bolund, 1991;Levi et al, 1991;Crocetti et al, 1998;Tanaka et al, 1999;Innos et al, 2003;Yousaf et al, 2005).…”

“…Similar patterns have been reported in many of the non-UK cancer-suicide studies consistent with the greatest psychological morbidity occurring on diagnosis (Louhivuori and Hakama, 1979;Fox et al, 1982;Allebeck et al, 1989;Allebeck and Bolund, 1991;Levi et al, 1991; Storm et al, Note: Owing to the inclusion of both primary and secondary field information in the hospital admission data, a single event resulting in admission may appear within 41 subcategory of harm. 1991; Crocetti et al, 1998;Tanaka et al, 1999;Innos et al, 2003;Yousaf et al, 2005). Suicide in the setting of cancer may, for example, be more associated with hopelessness than depression per se.…”

“…In conjunction with other causes of confusion or debility relating to their underlying disease, their risk of accidental harm may be increased. Similarly, depression and suicidal or deliberate self-harm (DSH) ideation are known to be common within this patient group (Chochinov, 2001), which may increase their risk of non-fatal DSH and of fatal DSH (suicide) (Louhivuori and Hakama, 1979;Fox et al, 1982;Allebeck et al, 1989;Allebeck and Bolund, 1991;Levi et al, 1991;Crocetti et al, 1998;Tanaka et al, 1999;Innos et al, 2003;Yousaf et al, 2005).…”

Risk and Predictors of Suicide in Colorectal Cancer Patients: A Surveillance, Epidemiology, and End Results Analysis

“…A potential explanation for that finding could be related to the timing of suicide. The risk of suicide is felt to be strongest very early after diagnosis [14][15][16]33 . Fang et al 15 found that the highest risk fell within the first 12 weeks after diagnosis (relative risk: 4.7) and that the risk lessened after that time (relative risk at 12-52 weeks: 2.1; relative risk at 52 weeks and beyond: 1.6).…”

Suicide after hematopoietic SCT: the story of AG

“…1 The first year after diagnosis and especially the first 3 months are associated with an increased risk. 2 A second smaller peak is between 12 and 14 months following diagnosis and is possibly the result of either disease progression or failure of treatment. 3 Suicide in the general population seems as an extreme manifestation of failure to cope with chronic distress, whereas in cancer patients, acute stressors that severely affect quality of life such as pain, physical impairment, depression, and loss of independence and autonomy are often the triggers for suicidal action.…”