Spouses of cancer patients at increased risk of suicide attempts, deaths
Spouses of cancer patients were 2.56 times more likely to die by suicide within one year of diagnosis compared with controls, according to results of a Danish cohort study.
Having a spouse with cancer is associated with a higher risk of suicide attempt and suicide death, with the risk most pronounced within one year after diagnosis, a cohort study found.
Researchers carried out a nationwide cohort study in Denmark using registry-based data from 1986 to 2016. A total of 409,338 individuals whose spouse was diagnosed with cancer from 1986 to 2015 were compared with 2,046,682 individuals whose spouse did not have a cancer diagnosis during the same period (median age at cohort entry for both groups, 63 years; 55.4% women). Controls were randomly selected from the general population and were matched by birth year and sex. Findings were published by JAMA Oncology on August 15.
During the study period, 2,714 incident cases of suicide attempt were recorded among spouses of patients with cancer (incidence rate [IR], 62.6 per 100,000 person-years) and 9,994 cases were recorded among controls (IR, 50.5 per 100,000 person-years), with 711 and 2,270 suicide deaths, respectively (IR, 16.3 vs. 11.4 per 100,000 person-years). Spouses of individuals diagnosed with cancer had a nearly 1.3-fold increased risk of suicide attempt (hazard ratio [HR], 1.28; 95% CI, 1.23 to 1.34) and a 1.47-fold increased risk of suicide death (95% CI, 1.35 to 1.60).
These risks were higher in the year following a cancer diagnosis (HRs of 1.45 [95% CI, 1.27 to 1.66] for suicide attempt and 2.56 [95% CI, 2.03 to 3.22] for suicide death). Risk was greater for either outcome when the cancer was diagnosed at an advanced stage or when the spouse died after the cancer diagnosis. Risk of suicidal behavior was also greater among individuals with a lower level of household income and among those without a common child with the cancer patient.
One limitation is that researchers only identified registered heterosexual spouses and did not assess data on other caregivers, including unregistered partners and homosexual spouses and partners. The study authors also cautioned that results may not be generalizable to other countries with different health care systems and cultural contexts. The results “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,” the researchers wrote.
An accompanying editorial highlighted that adjusted hazard ratios for suicide death were particularly high among spouses of patients with cancer of the pancreas (3.0), liver (3.0), esophagus (2.7), kidney (2.7), central nervous system (2.5), or rectum (2.3).
“Given the known risks to their mental health, spouses should be fully integrated into cancer follow-up care,” the editorialists wrote. “At health visits in either oncology or primary care clinics, spouses should be screened for psychosocial distress and connected to resources that will support their long-term mental health and well-being. Integration of spouses into survivorship programs is essential for providing comprehensive and effective cancer care.”