ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.
CMAJ Open. 2023 Apr 4;11(2):E291-E297. doi: 10.9778/cmajo.20220157. Print 2023 Mar-Apr.
Psychological distress following a cancer diagnosis potentially increases the risk of intentional, nonfatal self-injury. The purpose of this work is to evaluate and compare rates of nonfatal self-injury among individuals in Ontario diagnosed with cancer against matched controls with no history of cancer.
Adults in Ontario diagnosed with cancer from 2007 to 2019 were matched to 2 controls with no history of cancer, based on age and sex. We calculated the absolute and relative difference in rates of nonfatal self-injury in the 5 years before and after the index date (date of cancer diagnosis and dummy date for controls). We used crude difference-in-differences methods and adjusted Poisson regression-based analyses to examine whether the change in rates of nonfatal self-injury before and after index differed between cancer patients and controls.
The cohort included 803 740 people with cancer and 1 607 480 matched controls. In the first year after diagnosis, individuals with cancer had a 1.17-fold increase in rates of nonfatal self-injury (95% confidence interval [CI] 1.03-1.33) compared with matched controls, after accounting for pre-existing differences in rates of nonfatal self-injury and other clinical characteristics between the groups. Rates of nonfatal self-injury remained elevated in the cancer group by 1.07-fold for up to 5 years after diagnosis (95% CI 0.95-1.21).
In this study, incidence of nonfatal self-injury was higher among individuals diagnosed with cancer, with the greatest impact observed in the first year after diagnosis. This work highlights the need for robust and accessible psychosocial oncology programs to support mental health along the cancer journey.
癌症诊断后出现心理困扰可能会增加故意、非致命性自我伤害的风险。本研究旨在评估和比较安大略省癌症患者与无癌症病史的匹配对照者在非致命性自我伤害率方面的差异。
根据年龄和性别，将 2007 年至 2019 年期间在安大略省被诊断患有癌症的成年人与无癌症病史的 2 名对照者进行匹配。我们计算了在指数日期（癌症诊断日期和对照者虚拟日期）前后 5 年内非致命性自我伤害率的绝对差异和相对差异。我们使用未调整的差异-差异法和调整后的泊松回归分析来检验癌症患者和对照者在指数日期前后非致命性自我伤害率变化是否存在差异。
该队列包括 803740 名癌症患者和 1607480 名匹配对照者。在诊断后第一年，癌症患者的非致命性自我伤害率增加了 1.17 倍（95%置信区间 1.03-1.33），这是在考虑到两组之间非致命性自我伤害率和其他临床特征的预先存在差异后得出的。在诊断后 5 年内，癌症患者的非致命性自我伤害率仍保持 1.07 倍的升高（95%置信区间 0.95-1.21）。
在这项研究中，被诊断患有癌症的个体中非致命性自我伤害的发生率更高，在诊断后的第一年观察到的影响最大。这项工作强调了需要有强大且易于获取的肿瘤心理学计划来支持癌症患者的心理健康。
