TY  - JOUR
PY  - 2019//
TI  - Risk of suicide after cancer diagnosis in England
JO  - JAMA Psychiatry
A1  - Henson, Katherine E.
A1  - Brock, Rachael
A1  - Charnock, James
A1  - Wickramasinghe, Bethany
A1  - Will, Olivia
A1  - Pitman, Alexandra
SP  - 51
EP  - 60
VL  - 76
IS  - 1
N2  - 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. <br><br>OBJECTIVES: To quantify suicide risk in patients with cancers in England and identify risk factors that may assist in needs-based psychological assessment. <br><br>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. <br><br>EXPOSURES: Diagnosis of malignant tumors, excluding nonmelanoma skin cancer. <br><br>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. <br><br>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). <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 2168-622X
UR  - http://dx.doi.org/10.1001/jamapsychiatry.2018.3181
ID  - ref1
ER  -