Suicide Risk in Cancer Patients – Are We Prepared?

IntroductionIndividuals with cancer are at increased risk for suicidal ideation and behaviour when compared to the general population. Suicidal thoughts are sometimes minimized and considered by clinicians as a normal reaction to diagnosis of oncological disease. Less severe forms of suicidal ideation, such a fleeting wish to die may happen in all stages of the disease.ObjectivesWe aim to highlight the cases of cancer patients that present an imminent suicide risk and its related psychopathological aspects, psychosocial and physical risk factors that may increase the probability of suicidal attempt.MethodsNon systematic literature review through the Medline and Clinical Key databases, with time constraints.ResultsIndividuals with cancer have twice the risk of suicide compared to the general population. It was found that suicidal thoughts are more common in patients with advanced disease, in hospital or in palliative care settings or in those who are experiencing severe pain, depression, cognitive impairment or delirium. The first months following the diagnosis are the period of greatest risk and the highest suicide risk occurs in men with respiratory cancers. Death by suicide occurs more often in cancer patients in the advanced stages of disease.ConclusionsAn appropriate therapeutic response should include empathy, active listening, management of realistic expectations and permission to discuss psychological distress. The first intervention should focus on determining imminent risk of suicidal behaviour and act for patient safety.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Depression, suicidal ideation and suicide risk in German veterinarians compared with the general German population

Veterinary Record ◽

10.1136/vr.105430 ◽

2020 ◽

Vol 186 (15) ◽

pp. e2-e2 ◽

Cited By ~ 1

Author(s):

Kathrin Angelika Schwerdtfeger ◽

Mahtab Bahramsoltani ◽

Lena Spangenberg ◽

Nina Hallensleben ◽

Heide Glaesmer

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

General Population ◽

Suicide Risk ◽

Future Research ◽

German Population ◽

Health Questionnaire ◽

Increased Risk ◽

Patient Health ◽

Age Range

BackgroundHigher rates of depression, suicidal ideation and suicide risk have been reported for veterinarians in various studies worldwide. This study investigates whether this is also true for German veterinarians.MethodsA total of 3.118 veterinarians (78.8 per cent female, mean age 41.3 years) between 22 and 69 years were included and compared with two general population samples of the same age range using the Suicide Behaviours Questionnaire-Revised and Patient Health Questionnaire.ResultsCurrent suicidal ideation was found in 19.2 per cent of veterinarians, compared with only 5.7 per cent in the general population. 32.11 per cent of veterinarians were classified with increased suicide risk, compared with 6.62 per cent in the general population. 27.78 per cent of veterinarians screened positive for depression, compared with 3.99 per cent of the general population.ConclusionThe study shows that veterinarians have an increased risk of depression and suicidal ideation and suicide risk compared with the general population in Germany. Similar to previous findings, the level of depression was higher among veterinarians than in the general population. However, this study does not explore causes for higher rates in depression, suicide risk and suicidal ideation. Since other studies strongly suggest specific risk factors lead to higher suicide risk and consequently elevated numbers of completed suicides, future research should focus on identifying and preventing causes.

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Psychiatric comorbidity and suicide risk in patients with psoriasis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1421 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S395-S396 ◽

Cited By ~ 1

Author(s):

M. Pompili ◽

M. Innamorati ◽

D. Erbuto ◽

A. Costanzo

Keyword(s):

Suicidal Ideation ◽

Suicide Risk ◽

Psychiatric Comorbidity ◽

Rating Scale ◽

Suicide Attempts ◽

The Other ◽

Depression And Anxiety ◽

Melanoma Patients ◽

Competing Interest ◽

Hamilton Rating Scale

IntroductionPsoriasis has a significant impact on the mental and emotional functioning.ObjectiveIt has been reported that the risk of psychiatric comorbidity increases with the severity of the disorder, and the most frequent associations appear to be those with depression and anxiety.AimsTo analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients affected by psoriasis. To investigate the differences between psoriasis patients and patients with other dermatologic diseases.MethodsParticipants were 242 consecutive patients (142 women and 100 men), 112 patients with psoriasis (46.3%), 77 with melanoma (31.8%) and 53 with allergy (21.0%). All patients were administered a structured sociodemographic interview and the following measures: the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). We also assessed current and previous suicidal ideation and previous suicide attempts.ResultsPatients with psoriasis (compared to other groups of patients) more frequently had a comorbid mood disorder (16.1% vs 3.9% and 0.0%, respectively for patients with melanoma and patients with allergy; χ22 = 14.98; P < 0.001), past suicidal ideation (33.9% vs 15.6% and 18.9%, respectively for patients with melanoma and patients with allergy; χ22 = 2.05; P < 0.01) and attempts (6.3% vs 0.0% and 0.0%, for the other groups of patients; χ22 = 8.37; P < 0.05). Patients with psoriasis reported higher HAM-D scores than melanoma patients.ConclusionsThe clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities and the routinely assessment of suicide risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Mental health in the general population over 1 year of the Covid-19 pandemic: findings from Ireland

European Journal of Public Health ◽

10.1093/eurpub/ckab164.011 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

MI Troya

Keyword(s):

Public Health ◽

Mental Health ◽

General Population ◽

Heavy Drinking ◽

Depression And Anxiety ◽

Suicidal Thoughts ◽

Health Measures ◽

Increased Risk ◽

Self Harm ◽

Nationally Representative

Abstract Background The effects of the Covid-19 pandemic and associated public health measures on mental health is a cause of increasing concern. We have measured indices of mental health among adults in the general population in the Republic of Ireland (ROI) during the period of May 2020-April 2021. Methods Nationally representative cross-sectional telephone survey with data collected in ROI during four study waves involving 3,920 participants: Wave 1: May 26-June 17, 2020 (N = 969), Wave 2: July 1-23, 2020 (N = 1014), Wave 3: September 5-28, 2020 (N = 1008), Wave 4: April 16-28, 2021 (N = 929). Participants were recruited from adults resident in RoI, aged 18 years+ using random-digit-dialling of land lines and mobile phones and interviewed by a professional market research organisation (Ipsos MRBI). Data from Waves 1-4 will be presented including trends over the 12-month period. Finding from Waves 1 and 2 are presented here. Mental health was assessed using the Patient Health Questionnaire Anxiety Depression Scale (PHQ-ADS), including standard questions on self-harm and/or suicidal thoughts. Results Of the 1,983 participants from Waves 1-2, 27.7% (n = 549; 95%CI:0.26%-30%) reported symptoms of depression and anxiety, 74 (3.8%;95%CI:3%-5%) disclosed self-harm and/or suicidal thoughts. Female participants (RR:1.60, 95%CI:1.37-1.87), employed individuals experiencing work change (RR:1.50,95%CI:1.24-1.82), participants cocooning due to a health condition (RR:1.34,95%CI:1.08-1.66), those self-isolating (RR:1.25,95%CI:1.03-1.51) and those reporting moderate-heavy drinking (RR:1.27,95%CI:1.09-1.47) were at increased risk of depression and anxiety symptoms. Participants aged 18-29 and those in the two lowest income categories were most likely to report self-harm and/or suicidal thoughts. Conclusions The prevalence of țanxiety and depression in the general population has increased relative to pre-pandemic estimates in response to the Covid-19 pandemic and associated public health measures. Key messages In nationally representative telephone surveys of Irish adults conducted following the onset of the Covid-19 pandemic, the prevalence of anxiety and depression is estimated at approximately 30%. Higher than average levels of anxiety or depression were reported in females, those who had experienced a change in their work, individuals cocooning and those with moderate to heavy drinking.

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Prediction of suicidal ideation risk in a prospective cohort study of medical interns

PLoS ONE ◽

10.1371/journal.pone.0260620 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260620

Author(s):

Tyler L. Malone ◽

Zhou Zhao ◽

Tzu-Ying Liu ◽

Peter X. K. Song ◽

Srijan Sen ◽

...

Keyword(s):

Cohort Study ◽

Depressive Symptoms ◽

Suicidal Ideation ◽

Medical Errors ◽

Suicide Risk ◽

The United States ◽

Work Hours ◽

Training Dataset ◽

Data Set ◽

Increased Risk

The purpose of this study was to identify individual and residency program factors associated with increased suicide risk, as measured by suicidal ideation. We utilized a prospective, longitudinal cohort study design to assess the prevalence and predictors of suicidal ideation in 6,691 (2012–2014 cohorts, training data set) and 4,904 (2015 cohort, test data set) first-year training physicians (interns) at hospital systems across the United States. We assessed suicidal ideation two months before internship and then quarterly through intern year. The prevalence of reported suicidal ideation in the study population increased from 3.0% at baseline to a mean of 6.9% during internship. 16.4% of interns reported suicidal ideation at least once during their internship. In the training dataset, a series of baseline demographic (male gender) and psychological factors (high neuroticism, depressive symptoms and suicidal ideation) were associated with increased risk of suicidal ideation during internship. Further, prior quarter psychiatric symptoms (depressive symptoms and suicidal ideation) and concurrent work-related factors (increase in self-reported work hours and medical errors) were associated with increased risk of suicidal ideation. A model derived from the training dataset had a predicted area under the Receiver Operating Characteristic curve (AUC) of 0.83 in the test dataset. The suicidal ideation risk predictors analyzed in this study can help programs and interns identify those at risk for suicidal ideation before the onset of training. Further, increases in self-reported work hours and environments associated with increased medical errors are potentially modifiable factors for residency programs to target to reduce suicide risk.

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Depression and suicide ideation in medical students

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2223 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S595-S595

Author(s):

A. Alonso Sanchez ◽

A. Alvarez Astorga ◽

H. De la Red Gallego ◽

R. Hernandez Antón ◽

S. Gómez Sanchez ◽

...

Keyword(s):

Medical Students ◽

Suicidal Ideation ◽

General Population ◽

Suicide Ideation ◽

New Instrument ◽

Proven Efficacy ◽

Patient Health ◽

Academic Information ◽

Competing Interest ◽

Emotional Events

BackgroundMedical students have higher levels of depressive symptoms than the general population. Additionally, depressed students are more likely to commit suicide. Recent studies find up to 10% of medical students experiment depression and suicidal ideation, which is meaningfully higher than general population of similar age (5–8%). However, little is known about depression and suicidal ideation in medical students in Spain.ObjectiveThis study aims to create a self-administered questionnaire to investigate the prevalence and factors involved in depression and suicidal behaviour in medical students from a Spanish University.MethodsWe evaluated the main risk factors leaning to suicide in students. In addition, we selected an appropriate scale to assess depression among the existing ones. The evaluated items included demographic reports, academic information (academic course, unfinished subjects and accomplishment) and sanitary data (psychiatric family history, psychiatric personal history, psychotropic drug consumption, distress emotional events in the last twelve months and drugs consumption). Furthermore, we selected the 9-item Patient Health Questionnaire (PHQ-9) because of its rapidly implementation and proven efficacy.ConclusionsRates of depression and suicidal ideation are high in medical students. Currently, there is no program to detect and prevent depression neither suicide in students. For that reason, we consider that creating a new instrument to evaluate mental health in student is useful in order to offer early detection and treatment at medical school.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796016001049 ◽

2016 ◽

Vol 27 (2) ◽

pp. 186-198 ◽

Cited By ~ 22

Author(s):

A. A. M. Hubers ◽

S. Moaddine ◽

S. H. M. Peersmann ◽

T. Stijnen ◽

E. van Duijn ◽

...

Keyword(s):

Suicidal Ideation ◽

Suicide Risk ◽

Psychiatric Patients ◽

Meta Analysis ◽

First Year ◽

Completed Suicide ◽

Increased Risk ◽

Different Populations ◽

Risk Ratios

Aims.Several authors claimed that expression of suicidal ideation is one of the most important predictors of completed suicide. However, the strength of the association between suicidal ideation and subsequent completed suicide has not been firmly established in different populations. Furthermore, the absolute suicide risk after expression of suicidal ideation is unknown. In this meta-analysis, we examined whether the expression of suicidal ideation predicted subsequent completed suicide in various populations, including both psychiatric and non-psychiatric populations.Methods.A meta-analysis of cohort and case–control studies that assessed suicidal ideation as determinant for completed suicide in adults. Two independent reviewers screened 5726 articles for eligibility and extracted data of the 81 included studies. Pooled risk ratios were estimated in a random effects model stratified for different populations. Meta-regression analysis was used to determine suicide risk during the first year of follow-up.Results.The risk for completed suicide was clearly higher in people who had expressed suicidal ideation compared with people who had not, with substantial variation between the different populations: risk ratio ranging from 2.35 (95% confidence interval (CI) 1.43–3.87) in affective disorder populations to 8.00 (95% CI 5.46–11.7) in non-psychiatric populations. In contrast, the suicide risk after expression of suicidal ideation in the first year of follow-up was higher in psychiatric patients (risk 1.40%, 95% CI 0.74–2.64) than in non-psychiatric participants (risk 0.23%, 95% CI 0.10–0.54). Past suicide attempt-adjusted risk ratios were not pooled due to large underreporting.Conclusions.Assessment of suicidal ideation is of priority in psychiatric patients. Expression of suicidal ideation in psychiatric patients should prompt secondary prevention strategies to reduce their substantial increased risk of suicide.

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A cross-sectional study on associations of physical symptoms, health self-efficacy, and suicidal ideation among Chinese hospitalized cancer patients

BMC Psychiatry ◽

10.1186/s12888-020-02945-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Qingyi Xu ◽

Shuhua Jia ◽

Maiko Fukasawa ◽

Lin Lin ◽

Jun Na ◽

...

Keyword(s):

Logistic Regression ◽

Suicidal Ideation ◽

Cancer Patients ◽

Self Efficacy ◽

Epidemiological Studies ◽

Cross Sectional Study ◽

Physical Symptoms ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk

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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Are Volunteering and Caregiving Associated with Suicide Risk? A Census-based Longitudinal Study

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.273 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S87-S87

Author(s):

D. O’Reilly ◽

M. Rosato ◽

A. Maguire

Keyword(s):

Mental Health ◽

Lower Risk ◽

Suicide Risk ◽

Proportional Hazards ◽

Linkage Study ◽

Poor Mental Health ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Competing Interest

BackgroundThis record linkage study explores the suicide risk of people engaged in caregiving and volunteering. Theory suggests opposing risks as volunteering is associated with better mental health and caregiving with a higher prevalence and incidence of depression.MethodsA 2011 census-based study of 1,018,000 people aged 25–74 years (130,816 caregivers and 110,467 volunteers; 42,099 engaged in both). All attributes were based on census records. Caregiving was categorised as either light (1–19 hours/week) or more intense (20+ hours/week). Suicide risk was based on 45 months of death records and assessed using Cox proportional hazards models with adjustment for and stratification by mental health status at census.ResultsMore intense caregiving was associated with worse mental health (ORadj = 1.15: 95%CI = 1.12, 1.18); volunteering with better mental health (OR 0.87; 95%CIs 0.84, 0.89). The cohort experienced 528 suicides during follow-up. Both volunteering and caregiving were associated with a lower risk of suicide though this was modified by baseline mental ill-health (P = 0.003), HR 0.66; 95%CIs 0.49, 0.88 for those engaged in either activity and with good mental health at baseline and HR 1.02; 95%CIs 0.69, 1.51 for their peers with poor mental health. There was some indication that those engaged in both activities had the lowest suicide risk (HR 0.34; 95%CIs 0.14, 0.84).ConclusionsDespite the poorer mental health amongst caregivers they are not at increased risk of suicide. The significant overlap between caregiving and volunteering and the lower risk of suicide for those engaged in both activities may indicate a synergism of action.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The risk of sleep disorders in Korean cancer patients

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.489 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S204-S205

Author(s):

H. Lee ◽

S.T. Oh ◽

D.W. Kim ◽

W.J. Choi

Keyword(s):

Sleep Disorders ◽

Sleep Disorder ◽

Cancer Patients ◽

National Registry ◽

Initial Diagnosis ◽

Research Database ◽

Cancer Group ◽

Increased Risk ◽

Diagnosis Of Cancer ◽

Competing Interest

PurposeSleep disturbance in cancer patients is common. The aim of this study is to investigate the risk of sleep disorders in cancer patients compared to patients with other diseases using the national registry data.MethodUsing data from the Korean National Health Insurance Research Database between 2002 and 2013, the cancer group was composed of patients with an initial diagnosis of cancer in 2004 (n = 3358). The remaining people were considered as comparison group (n = 493,577) after excluding patients with any cancer or psychiatric disorder from 2002 to 2003 and from 2005 to 2013. Each sampled subject was tracked until 2013. Cox proportional hazard regressions were used to calculate the overall rate for sleep disorder development after adjusting for age, gender, and socio-economical confounders.ResultsCancer patients were associated with an increased risk of sleep disorder in both sexes (male hazard ratio [HR]: 1.319; 95% confidence interval [CI]: 1.232–1.413; female HR: 1.289; 95% CI: 1.198–1.386) after adjusting for potential confounders. Both results were statistically significant (P < 0.001). In terms of age, the effect size of the HR was largest among elder adults, aged ≥ 70 years (male HR: 1.748; female HR: 1.820). The HR tended to increase consistently.ConclusionInitial diagnosis of cancer was significantly associated with sleep disorder development after adjusting for potential confounders. This result suggests that thorough screening and intervention for sleep disorders are required for the newly diagnosed cancer patients to improve their quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Neurotic personality dysfunctions as factors predisposing for reacting with suicidal ideation to intensive psychotherapy

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.341 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S408-S409

Author(s):

P. Rodzinski ◽

A. Ostachowska ◽

K. Cyranka ◽

K. Rutkowski ◽

E. Dembinska ◽

...

Keyword(s):

Suicidal Ideation ◽

Clinical Problem ◽

Integrative Approach ◽

Day Hospital ◽

Loss Of Life ◽

Increased Risk ◽

Important Clinical Problem ◽

Competing Interest ◽

Time Of Admission ◽

Intensive Psychotherapy

IntroductionIdentifying patients’ risk of reacting with suicidal ideation (SI) to psychotherapy is an important clinical problem that calls for empirical verification.ObjectivesAnalysis of associations between patients’ initial neurotic personality dysfunctions not accompanied by SI and emergence of SI at the end of a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital.MethodsNeurotic Personality Questionnaire KON-2006 and Life Inventory were completed by 680 patients at the time of admission to a psychotherapeutic day hospital due to neurotic, behavioral or personality disorders. Symptom Checklist KO “O” as a source of information about emergence of SI was completed both at the admission and at the end of the treatment. Among 466 patients without SI at the admission, in 4% SI occurred at the end of the treatment.ResultsA number of neurotic personality dysfunctions (demeanors declared) that significantly predisposed to SI emergence at the end of the treatment were found: physical aggression against close ones (P < 0.001), grandiose fantasies (P = 0.043), tendencies to resignation (P = 0.022) and resignation-related feeling of loss of life opportunities (P = 0.037), tendency to follow predominantly ones intuition (P = 0.035).ConclusionsIn patients who declared the above-mentioned demeanors increased risk of SI emergence than in others (10–30% vs. 4%) indicate that there are particular vulnerable areas of neurotic personality that require especially careful approach during intensive psychotherapy–dealing with those areas may result in distress or anxiety that may lead to SI.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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