Zachary Klaassen1,2, Christopher J D Wallis1, Thenappan Chandrasekar1, Hanan Goldberg1, Rashid K Sayyid3, Stephen B Williams4, Kelvin A Moses5, Martha K Terris3, Robert K Nam2,6,7, David Urbach2,7,8, Peter C Austin2,7, Paul Kurdyak2,7,9, Girish S Kulkarni1,2,7. 1. Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Center, Toronto, Ontario, Canada. 2. Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. 3. Division of Urology, Medical College of Georgia-Augusta University, Augusta, Georgia. 4. Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, Texas. 5. Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 6. Division of Urology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. 7. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 8. Department of Surgery, University of Toronto, Women's College Hospital, Toronto, Ontario, Canada. 9. Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Previous studies have demonstrated an association between a diagnosis of cancer and the risk of suicide; however, they failed to account for psychiatric care before a cancer diagnosis, which may confound this relationship. The objective of this study was to assess the effect of a cancer diagnosis on the risk of suicide, accounting for prediagnosis psychiatric care utilization. METHODS: All adult residents of Ontario, Canada who were diagnosed with cancer (1 of prostate, breast, colorectal, melanoma, lung, bladder, endometrial, thyroid, kidney, or oral cancer) between 1997 and 2014 were identified. Noncancer controls were matched 4:1 based on sociodemographics, including a psychiatric utilization gradient (PUG) score (with 0 indicating none; 1, outpatient; 2, emergency department; and 3, hospital admission). A marginal, cause-specific hazard model was used to assess the effect of cancer on the risk of suicidal death. RESULTS: Among 676,470 patients with cancer and 2,152,682 matched noncancer controls, there were 8.2 and 11.4 suicides per 1000 person-years of follow-up, respectively. Patients with cancer had an overall higher risk of suicidal death compared with matched patients without cancer (hazard ratio, 1.34; 95% CI, 1.22-1.48). This effect was pronounced in the first 50 months after cancer diagnosis (hazard ratio, 1.60; 95% CI, 1.42-1.81); patients with cancer did not demonstrate an increased risk thereafter. Among individuals with a PUG score 0 or 1, those with cancer were significantly more likely to die of suicide compared with controls. There was no difference in suicide risk between patients with cancer and controls for those who had a PUG score of 2 or 3. CONCLUSIONS: A cancer diagnosis is associated with increased risk of death from suicide compared with the general population even after accounting for precancer diagnosis psychiatric care utilization. The specific factors underlying the observed associations remain to be elucidated.
BACKGROUND: Previous studies have demonstrated an association between a diagnosis of cancer and the risk of suicide; however, they failed to account for psychiatric care before a cancer diagnosis, which may confound this relationship. The objective of this study was to assess the effect of a cancer diagnosis on the risk of suicide, accounting for prediagnosis psychiatric care utilization. METHODS: All adult residents of Ontario, Canada who were diagnosed with cancer (1 of prostate, breast, colorectal, melanoma, lung, bladder, endometrial, thyroid, kidney, or oral cancer) between 1997 and 2014 were identified. Noncancer controls were matched 4:1 based on sociodemographics, including a psychiatric utilization gradient (PUG) score (with 0 indicating none; 1, outpatient; 2, emergency department; and 3, hospital admission). A marginal, cause-specific hazard model was used to assess the effect of cancer on the risk of suicidal death. RESULTS: Among 676,470 patients with cancer and 2,152,682 matched noncancer controls, there were 8.2 and 11.4 suicides per 1000 person-years of follow-up, respectively. Patients with cancer had an overall higher risk of suicidal death compared with matched patients without cancer (hazard ratio, 1.34; 95% CI, 1.22-1.48). This effect was pronounced in the first 50 months after cancer diagnosis (hazard ratio, 1.60; 95% CI, 1.42-1.81); patients with cancer did not demonstrate an increased risk thereafter. Among individuals with a PUG score 0 or 1, those with cancer were significantly more likely to die of suicide compared with controls. There was no difference in suicide risk between patients with cancer and controls for those who had a PUG score of 2 or 3. CONCLUSIONS: A cancer diagnosis is associated with increased risk of death from suicide compared with the general population even after accounting for precancer diagnosis psychiatric care utilization. The specific factors underlying the observed associations remain to be elucidated.
Authors: Danyon Anderson; Abrahim N Razzak; Matthew McDonald; David Cao; Jamal Hasoon; Omar Viswanath; Alan D Kaye; Ivan Urits Journal: Health Psychol Res Date: 2022-08-20
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Authors: Rashid K Sayyid; Christopher J D Wallis; Kyle Dymanus; Usama Jazzar; Hanan Goldberg; Stephen B Williams; Zachary Klaassen Journal: Ann Transl Med Date: 2020-03
Authors: Christopher W Noel; Antoine Eskander; Rinku Sutradhar; Alyson Mahar; Simone N Vigod; Elie Isenberg-Grzeda; James Bolton; Julie Deleemans; Wing C Chan; Ravleen Vasdev; Victoria Zuk; Barbara Haas; Stephanie Mason; Natalie G Coburn; Julie Hallet Journal: JAMA Netw Open Date: 2021-09-01