英国癌症诊断后的自杀风险。

Risk of Suicide After Cancer Diagnosis in England.

机构信息

National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, United Kingdom.

Bury St Edmunds GP Specialty Training Programme, West Suffolk Hospital, Bury St Edmunds, United Kingdom.

出版信息

JAMA Psychiatry. 2019 Jan 1;76(1):51-60. doi: 10.1001/jamapsychiatry.2018.3181.

DOI:10.1001/jamapsychiatry.2018.3181

PMID:30476945

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6583458/

Abstract

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.

摘要

重要性

癌症的诊断会带来很大的心理困扰风险。在英国，还没有一项全国性的基于人群的研究来调查癌症诊断后自杀的风险。

目的

量化英格兰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、地点和参与者：这是一项基于人群的研究，使用了来自英格兰国家癌症登记和分析服务的数据，并与 4722099 人的死亡证明数据相关联（2200 万人年的风险）。纳入了 1995 年 1 月 1 日至 2015 年 12 月 31 日期间诊断患有癌症（年龄 18-99 岁）的患者，并随访至 2017 年 8 月 31 日。

暴露情况

恶性肿瘤的诊断，不包括非黑色素瘤皮肤癌。

主要结果和测量指标

所有接受自杀或调查中的开放裁决的患者的死亡。计算标准化死亡率比（SMR）和绝对超额风险（AER）。

结果

在 4722099 名癌症患者中，50.3%为男性，49.7%为女性。队列中有 3509392 名患者（74.3%）在诊断时年龄为 60 岁或以上。共有 2491 名（男性 1719 名，女性 772 名）癌症患者自杀死亡，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 10000 人年的 AER 为 0.19（95%CI，0.15-0.23）。风险最高的是间皮瘤患者，对应的风险为 4.51 倍，即每 10000 人年额外死亡 4.20 人。其次是胰腺癌（3.89 倍）、食管癌（2.65 倍）、肺癌（2.57 倍）和胃癌（2.20 倍）。癌症诊断后 6 个月内自杀风险最高（SMR，2.74；95%CI，2.52-2.98）。