White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Psychooncology. 2021 Apr;30(4):581-590. doi: 10.1002/pon.5605. Epub 2020 Dec 13.
To evaluate the effect of a preexisting posttraumatic stress disorder (PTSD) diagnosis on suicide and non-suicide mortalities among men with newly diagnosed prostate cancer, and examine potential mediating factors for the relationship between PTSD and suicide.
We used patient-level data from Veterans Health Administration electronic medical records to identify men (age ≥40 years) diagnosed with prostate cancer between 2004 and 2014. We used Fine and Gray regression model to estimate the risk for competing mortality outcomes (suicide, non-suicide, and alive). We used structural equation models to evaluate the mediating factors.
Our cohort comprised 214,649 men with prostate cancer, of whom 12,208 (5.7%) had a preexisting PTSD diagnosis. Patients with PTSD compared to those without utilized more healthcare services and had lower risk cancer at diagnosis. Additionally, they experienced more suicide deaths (N = 26, 0.21% vs. N = 269, 0.13%) and fewer non-suicide deaths (N = 1399, 11.5% vs. N = 45,625, 22.5%). On multivariable analysis, PTSD was an independent suicide risk factor (HR = 2.35; 95% CI: 1.16, 4.78). Depression, substance use disorder, and any definitive prostate cancer treatment were partial mediators. However, PTSD was associated with lower non-suicide mortality risk (HR = 0.86; 95% CI: 0.77, 0.96).
Patients with PTSD experienced greater suicide risk even after adjusting for important mediators. They may have experienced lower non-suicide mortality risk due to favorable physical health resulting from greater healthcare service use and early diagnosis of lower risk cancer. Our findings highlight the importance of considering psychiatric illnesses when treating patients with prostate cancer and the need for interventions to ameliorate suicide risk.
评估患有创伤后应激障碍（PTSD）的男性在被诊断患有前列腺癌后的自杀和非自杀死亡率，并探讨 PTSD 与自杀之间关系的潜在中介因素。
我们使用退伍军人健康管理局电子病历中的患者水平数据，确定了 2004 年至 2014 年间被诊断患有前列腺癌的男性（年龄≥40 岁）。我们使用 Fine 和 Gray 回归模型来估计竞争死亡率结局（自杀、非自杀和存活）的风险。我们使用结构方程模型来评估中介因素。
我们的队列包括 214649 名患有前列腺癌的男性，其中 12208 名（5.7%）患有 PTSD。与无 PTSD 的患者相比，患有 PTSD 的患者使用了更多的医疗服务，且在诊断时癌症的风险较低。此外，他们经历了更多的自杀死亡（N=26，0.21%）和更少的非自杀死亡（N=1399，11.5%）。多变量分析显示，PTSD 是自杀的独立风险因素（HR=2.35；95%CI：1.16，4.78）。抑郁、物质使用障碍和任何明确的前列腺癌治疗是部分中介因素。然而，PTSD 与较低的非自杀死亡率风险相关（HR=0.86；95%CI：0.77，0.96）。
即使在调整了重要的中介因素后，患有 PTSD 的患者仍面临更高的自杀风险。他们可能由于更多的医疗服务使用和早期诊断出低风险癌症导致身体健康状况改善，从而经历较低的非自杀死亡率。我们的研究结果强调了在治疗前列腺癌患者时考虑精神疾病的重要性，以及需要采取干预措施来降低自杀风险。
