Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care

A matched-cohort study of patients with incident solid-organ malignancies

Zachary Klaassen, Christopher J.D. Wallis, Thenappan Chandrasekar, Hanan Goldberg, Rashid K. Sayyid, Stephen Williams, Kelvin A. Moses, Martha K. Terris, Robert K. Nam, David Urbach, Peter C. Austin, Paul Kurdyak, Girish S. Kulkarni

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalCancer
DOIs
StatePublished - Jan 1 2019

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Suicide
Psychiatry
Cohort Studies
Neoplasms
Kidney Neoplasms
Mouth Neoplasms
Ontario
Thyroid Neoplasms
Proportional Hazards Models
Mental Disorders
Canada
Hospital Emergency Service
Melanoma
Prostatic Neoplasms
Urinary Bladder
Breast
Outpatients
Lung

Keywords

  • cancer
  • mental health
  • psychiatric utilization
  • psycho-oncology
  • suicidal death
  • suicide

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care : A matched-cohort study of patients with incident solid-organ malignancies. / Klaassen, Zachary; Wallis, Christopher J.D.; Chandrasekar, Thenappan; Goldberg, Hanan; Sayyid, Rashid K.; Williams, Stephen; Moses, Kelvin A.; Terris, Martha K.; Nam, Robert K.; Urbach, David; Austin, Peter C.; Kurdyak, Paul; Kulkarni, Girish S.

In: Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Klaassen, Z, Wallis, CJD, Chandrasekar, T, Goldberg, H, Sayyid, RK, Williams, S, Moses, KA, Terris, MK, Nam, RK, Urbach, D, Austin, PC, Kurdyak, P & Kulkarni, GS 2019, 'Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care: A matched-cohort study of patients with incident solid-organ malignancies', Cancer. https://doi.org/10.1002/cncr.32146
Klaassen, Zachary ; Wallis, Christopher J.D. ; Chandrasekar, Thenappan ; Goldberg, Hanan ; Sayyid, Rashid K. ; Williams, Stephen ; Moses, Kelvin A. ; Terris, Martha K. ; Nam, Robert K. ; Urbach, David ; Austin, Peter C. ; Kurdyak, Paul ; Kulkarni, Girish S. / Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care : A matched-cohort study of patients with incident solid-organ malignancies. In: Cancer. 2019.
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title = "Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care: A matched-cohort study of patients with incident solid-organ malignancies",
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.",
keywords = "cancer, mental health, psychiatric utilization, psycho-oncology, suicidal death, suicide",
author = "Zachary Klaassen and Wallis, {Christopher J.D.} and Thenappan Chandrasekar and Hanan Goldberg and Sayyid, {Rashid K.} and Stephen Williams and Moses, {Kelvin A.} and Terris, {Martha K.} and Nam, {Robert K.} and David Urbach and Austin, {Peter C.} and Paul Kurdyak and Kulkarni, {Girish S.}",
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T2 - A matched-cohort study of patients with incident solid-organ malignancies

AU - Klaassen, Zachary

AU - Wallis, Christopher J.D.

AU - Chandrasekar, Thenappan

AU - Goldberg, Hanan

AU - Sayyid, Rashid K.

AU - Williams, Stephen

AU - Moses, Kelvin A.

AU - Terris, Martha K.

AU - Nam, Robert K.

AU - Urbach, David

AU - Austin, Peter C.

AU - Kurdyak, Paul

AU - Kulkarni, Girish S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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KW - mental health

KW - psychiatric utilization

KW - psycho-oncology

KW - suicidal death

KW - suicide

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