Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Ann Surg Oncol. 2023 Jul;30(7):3929-3938. doi: 10.1245/s10434-023-13471-x. Epub 2023 Apr 16.
Mental illness (MI) and suicidal ideation (SI) often are associated with a diagnosis of cancer. We sought to define the incidence of MI and SI among patients with gastrointestinal cancers, as well as ascertain the predictive factors associated with SI.
Patients diagnosed between 2004 and 2016 with stomach, liver, pancreatic, and colorectal cancer were identified from the SEER-Medicare database. County-level social vulnerability index (SVI) was extracted from the Centers for Disease Control database. Multivariable logistic regression was used to identify factors associated with SI.
Among 382,266 patients, 83,514 (21.9%) individuals had a diagnosis of MI. Only 1410 (0.4%) individuals experienced SI, and 359 (0.1%) committed suicide. Interestingly, SI was least likely among patients with pancreatic cancer (ref: hepatic cancer; odds ratio [OR] 0.67, 95% confidence interval [CI] 0.52-0.86; p = 0.002), as well as individuals with stage III/IV disease (OR 0.59, 95% CI 0.52-067; p < 0.001). In contrast, male (OR 1.34, 95% CI 1.19-1.50), White (OR 1.34, CI 1.13-1.59), and single (OR 2.03, 95% CI 1.81-2.28) patients were at higher odds of SI risk (all p < 0.001). Furthermore, individuals living in relative privilege (low SVI) had markedly higher risk of SI (OR 1.33, 95% CI 1.14-1.54; p < 0.001). Moreover, living in a county with a shortage of mental health professionals was associated with increased odds of developing SI (OR 1.21, 95% CI 1.04-1.40; p = 0.012).
Oncology care teams should incorporate routine mental health and SI screening in the treatment of patients with gastrointestinal cancers, as well as target suicide prevention towards patients at highest risk.
精神疾病（MI）和自杀意念（SI）通常与癌症诊断有关。我们旨在确定胃肠道癌患者中 MI 和 SI 的发生率，并确定与 SI 相关的预测因素。
从 SEER-Medicare 数据库中确定 2004 年至 2016 年间被诊断为胃癌、肝癌、胰腺癌和结直肠癌的患者。从疾病控制中心数据库中提取县一级社会脆弱性指数（SVI）。多变量逻辑回归用于确定与 SI 相关的因素。
在 382266 名患者中，83514 名（21.9%）患者被诊断为 MI。只有 1410 名（0.4%）患者出现 SI，359 名（0.1%）自杀。有趣的是，胰腺癌患者发生 SI 的可能性最小（参考：肝癌；比值比 [OR] 0.67，95%置信区间 [CI] 0.52-0.86；p = 0.002），以及患有 III/IV 期疾病的患者（OR 0.59，95%CI 0.52-0.67；p < 0.001）。相比之下，男性（OR 1.34，95%CI 1.19-1.50）、白人（OR 1.34，CI 1.13-1.59）和单身（OR 2.03，95%CI 1.81-2.28）患者的 SI 风险更高（均 p < 0.001）。此外，生活在相对特权（低 SVI）环境中的个体的 SI 风险显著增加（OR 1.33，95%CI 1.14-1.54；p < 0.001）。此外，生活在精神卫生专业人员短缺的县与发生 SI 的几率增加相关（OR 1.21，95%CI 1.04-1.40；p = 0.012）。
肿瘤治疗团队应在胃肠道癌患者的治疗中常规进行心理健康和 SI 筛查，并针对高危患者进行自杀预防。
