Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
JAMA Oncol. 2024 Oct 1;10(10):1323-1330. doi: 10.1001/jamaoncol.2024.3036.
Little is known about the risk of suicidal behavior in relation to having a spouse with a cancer diagnosis.
To estimate the risk of suicide attempt and suicide death among spouses of patients with cancer.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study in Denmark collected registry-based data from 1986 through 2016. Analyses were performed from August 8, 2022, to October 30, 2023. Individuals who had a spouse with a cancer diagnosed during 1986 to 2015 were compared with individuals whose spouse did not have a cancer diagnosis during the same period, randomly selected from the general population and matched by birth year and sex.
Having a spouse with a cancer diagnosis.
Suicide attempt was identified through the Danish National Patient Register and the Danish Psychiatric Central Research Register, whereas suicide death was identified through the Danish Causes of Death Register, through 2016. Flexible parametric and Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for suicide attempt and suicide death among spouses of patients with a cancer diagnosis.
The study included 409 338 exposed individuals and 2 046 682 unexposed individuals (median [IQR] age at cohort entry for both groups, 63 [54-70] years; 55.4% women). During the follow-up, 2714 incident cases of suicide attempt among exposed individuals (incidence rate [IR], 62.6 per 100 000 person-years) and 9994 among unexposed individuals (IR, 50.5 per 100 000 person-years) were identified, as well as 711 cases of suicide death among the exposed individuals (IR, 16.3 per 100 000 person-years) and 2270 among the unexposed individuals (IR, 11.4 per 100 000 person-years). An increased risk of suicide attempt (HR, 1.28; 95% CI, 1.23-1.34) and suicide death (HR, 1.47; 95% CI, 1.35-1.60) was observed among spouses of patients with cancer throughout the follow-up. The increased risk was particularly notable during the first year after the cancer diagnosis, with an HR of 1.45 (95% CI, 1.27-1.66) for suicide attempt and 2.56 (95% CI, 2.03-3.22) for suicide death. There was a greater risk increase for both suicide attempt and suicide death when the cancer was diagnosed at an advanced stage or when the spouse died after the cancer diagnosis.
These findings suggest a need for clinical and societal awareness to prevent suicidal behaviors among spouses of patients with cancer, particularly during the first year following the cancer diagnosis.
关于配偶患有癌症与自杀行为风险的关系，人们知之甚少。
评估癌症患者配偶自杀未遂和自杀死亡的风险。
设计、地点和参与者：这项在丹麦进行的全国性队列研究收集了 1986 年至 2016 年基于登记的资料。分析于 2022 年 8 月 8 日至 2023 年 10 月 30 日进行。将在 1986 年至 2015 年期间有配偶被诊断患有癌症的个体与同期没有癌症诊断的配偶进行比较，后者是从普通人群中随机选择的，并按出生年份和性别进行匹配。
有配偶被诊断患有癌症。
通过丹麦国家患者登记处和丹麦精神病中央研究登记处确定自杀未遂，而通过丹麦死因登记处确定自杀死亡，截至 2016 年。使用灵活参数和 Cox 比例风险模型估计癌症患者配偶自杀未遂和自杀死亡的风险比（HR）和 95%置信区间（CI）。
该研究纳入了 409338 名暴露个体和 2046682 名未暴露个体（两组队列入组时的中位[IQR]年龄，63[54-70]岁；55.4%为女性）。在随访期间，暴露个体中有 2714 例自杀未遂事件（发生率[IR]，62.6/10 万患者年）和 9994 例未暴露个体（IR，50.5/10 万患者年），以及 711 例暴露个体的自杀死亡事件（IR，16.3/10 万患者年）和 2270 例未暴露个体（IR，11.4/10 万患者年）。研究期间，癌症患者配偶的自杀未遂风险（HR，1.28；95%CI，1.23-1.34）和自杀死亡风险（HR，1.47；95%CI，1.35-1.60）均有所增加。在癌症诊断后的第一年，风险增加尤为明显，自杀未遂的 HR 为 1.45（95%CI，1.27-1.66），自杀死亡的 HR 为 2.56（95%CI，2.03-3.22）。当癌症被诊断为晚期或配偶在癌症诊断后死亡时，自杀未遂和自杀死亡的风险增加更大。
这些发现表明，需要临床和社会意识到癌症患者配偶的自杀行为风险，特别是在癌症诊断后的第一年。
