Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care: A matched‐cohort study of patients with incident solid‐organ malignancies
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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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The statistically nonsignificant tendency toward lower suicide risks observed in women with cancer may be due to greater resilience and stronger social and psychological support in women than in men with cancer.
“The statistically nonsignificant tendency toward lower suicide risks observed in women with cancer may be due to greater resilience and stronger social and psychological support in women than in men with cancer 51 .”
From Suicide risk and mortality among patients with cancer (2022) · cites this paper as [51]
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- Authors
- Klaassen, Z., Wallis, C. J. D., Chandrasekar, T., Goldberg, H., Sayyid, R. K., Williams, S. B., Moses, K. A., Terris, M. K., Nam, R. K., Urbach, D., Austin, P. C., Kurdyak, P., & Kulkarni, G. S.
- Affiliations
- University Health Network (CA)
- Augusta University (US)
- The University of Texas Medical Branch at Galveston (US)
- Vanderbilt University Medical Center (US)
- Sunnybrook Health Science Centre (CA)
- University of Toronto (CA)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Kulkarni, Girish S.
- ORCID
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2019-04-25
- Volume
- 125
- Issue
- 16
- Pages
- 2886-2895
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- PMC
- PMC10182898
- OpenAlex
- W2942339464
- Cited by
- 63
- References
- 56
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 4 · 2023: 10 · 2022: 8 · 2021: 9 · 2020: 11 · 2019: 7
- FWCI
- 10.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Canadian Urological Association
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- suicide, suicide mortality, psychiatric service utilization, solid organ malignancies, cancer diagnosis
- MeSH terms
- Aged, Female, Humans, Male, Middle Aged, Neoplasms, Ontario, Psychotherapy, Risk Factors, Suicide, Cohort Studies, Case-Control Studies
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