Risk of Suicide After Cancer Diagnosis in England
Risk of Suicide After Cancer Diagnosis in England
复制标题
DOI：
10.1001/jamapsychiatry.2018.3181
复制
发表时间：
2019-01-01
期刊：
影响因子：
25.8
通讯作者：
Pitman, Alexandra
中科院分区：
文献类型：
--
作者：
Henson, Katherine E.;Brock, Rachael;Pitman, Alexandra
重要性 癌症的诊断会带来巨大的心理困扰风险。英国尚未针对癌症诊断后的自杀风险开展一项基于全国人口的研究。 目的 量化英国癌症患者的自杀风险，并确定可能有助于基于需求的心理评估的风险因素。 设计、设置和参与者 这项基于人口的研究使用来自英国国家癌症登记和分析服务中心的数据，与 4 722 099 人的死亡证明数据（2200 万人年面临风险）相关。纳入自 1995 年 1 月 1 日至 2015 年 12 月 31 日诊断的癌症患者（年龄 18-99 岁），随访至 2017 年 8 月 31 日。 暴露 恶性肿瘤的诊断，不包括非黑色素瘤皮肤癌。 主要结果和措施 在研讯中收到自杀判决或公开判决的患者的所有死亡。计算标准化死亡率（SMR）和绝对超额风险（AER）。结果4 722 099例癌症患者中，男性占50.3%，女性占49.7%。该队列中共有 3 509 392 名患者（74.3%）在诊断时年龄为 60 岁或以上。共有2491名癌症患者（1719名男性和772名女性）死于自杀，占随访期间所有死亡人数的0.08%。自杀的总体 SMR 为 1.20（95% CI，1.16-1.25），每 10 000 人年的 AER 为 0.19（95% CI，0.15-0.23）。间皮瘤患者的风险最高，风险为 4.51 倍，相当于每 10000 人年额外死亡 4.20 人。其次是胰腺癌（3.89倍）、食道癌（2.65倍）、肺癌（2.57倍）和胃癌（2.20倍）。癌症诊断后的前 6 个月自杀风险最高（SMR，2.74；95% CI，2.52-2.98）。 结论和相关性 尽管绝对数字较低，但某些癌症患者的自杀风险升高仍然令人担忧，这代表着潜在的可预防的死亡。诊断后前 6 个月内风险增加可能表明对心理支持的需求未得到满足。这项研究的结果表明，需要改善所有癌症患者的心理支持，并关注可改变的危险因素，例如疼痛，特别是在特定癌症群体中。
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.OBJECTIVES To quantify suicide risk in patients with cancers in England and identify risk factors that may assist in needs-based psychological assessment.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.EXPOSURES Diagnosis of malignant tumors, excluding nonmelanoma skin cancer.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.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).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.