Suicidality and its Associated Factors in Cancer Patients: Results of a Multi-Center Study in Korea
Abstract
Objective:
The current study examined the prevalence and associated factors of suicidality among Korean cancer patients. Moreover, the association of multiple psychological morbidities with suicidality was investigated among cancer patients.
Methods:
A cross-sectional, multi-center survey of 400 cancer patients was administered in five cancer-treatment hospitals throughout South Korea. Study variables were assessed using standardized measures including the Mini International Neuropsychiatric Interview suicidality module, the Hospital Anxiety and Depression Scale, and the Impact of Event Scale-Revised.
Results:
20.1% (80/399) of patients were positive cases of suicidality. Having no religion (p = .010), poor performance status (p = .000), and psychological comorbidity (p = .021) were significantly associated with the experience of suicidality in the multivariate analysis. Compared to “fully active” patients, patients who were capable of self-care but unable to perform any work activities had about a six times higher risk of suicidality (p = .000). Compared to patients with no psychological morbidity, the risk of suicidality was significantly higher among patients with comorbid anxiety and depression (p = .024), those experiencing comorbid depression and post-traumatic stress disorder (PTSD) (p = 0.051), and those experiencing comorbid anxiety, depression and PTSD (p = .001).
Conclusions:
This study found that having no religion, impaired levels of overall functioning, and “multiple psychological morbidities” were associated with suicidality in Korean cancer patients. These findings suggest a need for careful monitoring of these factors and enhanced comprehensive care addressing both the physical and psychosocial functioning of patients with cancer in suicide prevention efforts.
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References
1. Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. Journal of Clinical Oncology 2008; 26(29): 4731–4738.
2. Rasic DT, Belik S-L, Bolton JM, Chochinov HM, Sareen J. Cancer, mental disorders, suicidal ideation and attempts in a large community sample. Psycho-Oncology 2008; 17(7): 660–667.
3. Walker J, Waters RA, Murray G, Swanson H, Hibberd CJ, Rush RW, et al. Better off dead: Suicidal thoughts in cancer patients. Journal of Clinical Oncology 2008; 26(29): 4725–4730.
4. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. Journal of American Medical Association 2000; 284(22): 2907–2911.
5. Chochinov HM, Wilson KG. The euthanasia debate: Attitudes, practices and psychiatric considerations. Canadian Journal of Psychiatry 1995; 40(10): 593–602.
6. Jones JM, Huggins MA, Rydall AC, Rodin GM. Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients. Journal of Psychosomatic Research 2003; 55(5): 411–418.
7. Kelly B, Burnett P, Badger S, Pelusi D, Varghese FT, Robertson M. Doctors and their patients: A context for understanding the wish to hasten death. Psycho-Oncology 2003; 12(4): 375–384.
8. Rosenfeld B, Breitbart W, Stein K, Funesti-Esch J, Kaim M, Krivo S, et al. Measuring desire for death among patients with HIV/AIDS: The schedule of attitudes toward hastened death. American Journal of Psychiatry 1999; 156(1): 94–100.
9. Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. The role of physical and psychological symptoms in desire for death: A study of terminally ill cancer patients. Psycho-Oncology 2006; 15(4): 355–360.
10. Hem E, Loge JH, Haldorsen T, Ekeberg O. Suicide risk in cancer patients from 1960 to 1999. Journal of Clinical Oncology 2004; 22(20): 4209–4216.
11. Kendal WS. Suicide and cancer: A gender-comparative study. Annals of Oncology 2007; 18(2): 381–387.
12. Herng-Ching L, Chih-Hsiung W, Hsin-Chien L. Risk factors for suicide following hospital discharge among cancer patients. Psycho-Oncology 2009; 18(10): 1038–1044.
13. Bjorkenstam C, Edberg A, Ayoubi S, Rosen M. Are cancer patients at higher suicide risk than the general population? Scandinavian Journal of Public Health 2005; 33(3): 208–214.
14. Recklitis CJ, Lockwood RA, Rothwell MA, Diller LR. Suicidal ideation and attempts in adult survivors of childhood cancer. Journal of Clinical Oncology 2006; 24(24): 3852–3857.
15. Akechi T, Okamura H, Nakano T, Akizuki N, Okamura M, Shimizu K. Gender differences in factors associated with suicidal ideation in major depression among cancer patients. Psycho-Oncology 2010; 19(4): 384–389.
16. Miller M, Mogun H, Azrael D, Hempstead K, Solomon DH. Cancer and the risk of suicide in older Americans. Journal of Clinical Oncology 2008; 26(29): 4720–4724.
17. Cougle JR, Resnick H, Kilpatrick DG. PTSD, depression, and their comorbidity in relation to suicidality: Cross-sectional and prospective analyses of a national probability sample of women. Depression and Anxiety 2009; 26(12): 1151–1157.
18. Wilcox HC, Storr CL, Breslau N. Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Archives of General Psychiatry 2009; 66(3): 305–311.
19. Akechi T, Okamura H, Kugaya A, Nakano T, Nakanishi T, Akizuki N, et al. Suicidal ideation in cancer patients with major depression. Japanese Journal of Clinical Oncology 2000; 30(5): 221–224.
20. Chochinov HM, Wilson KG, Enns M, Lander S. Depression, hopelessness, and suicidal ideation in the terminally ill. Psychosomatics 1998; 39(4): 366–370.
21. Mehnert A, Koch U. Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: A prospective study. Psycho-Oncology 2007; 16(3): 181–188.
22. Registry KCC. Cancer incidence in Korea 1999–2001. Gyeonggi-do, Korea: Ministry of Health & Welfare, 2005.
23. Park JY, Moon KT, Chae YM, Jung SH. Effect of sociodemographic factors, cancer, psychiatric disorder on suicide: Gender and age-specific patterns. Journal of Preventive Medicine and Public Health 2008; 41(1): 51–60.
24. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry 2005; 62(6): 617–627.
25. Miyazaki M, Yoshino A, Nomura S. Diagnosis of multiple anxiety disorders predicts the concurrent comorbidity of major depressive disorder. Comprehensive Psychiatry 2001; 51(1): 15–18.
26. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry 1995; 52(12): 1048–1060.
27. Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Sorensen HT, et al. Posttraumatic stress disorder and completed suicide. American Journal of Epidemiology 2010; 171(6): 721–727.
28. You SW, Kim YS, Noh JS, Oh KS, Kim CH, Namkoong K, et al. The validation study of the Korean version of mini-international neuropsychiatric interview. Anxiety and Mood 2006; 2(1): 50–55.
29. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 1998; 59(Suppl 20): 22–33;quiz 34–57.
30. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983; 67(6): 361–370.
31. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. Journal of Psychosomatic Research 2002; 52(2): 69–77.
32. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans—A comparison of normal, depressed and anxious groups. Journal of the Korean Neuropsychiatric Association 1999; 38: 289–296.
33. Lim HK, Woo JM, Kim TS, Kim TH, Choi KS, Chung SK, et al. Reliability and validity of the Korean version of the impact of event scale-revised. Comprehensive Psychiatry 2009; 50(4): 385–390.
34. Weiss DS, Marmar CR. The impact of event scale-revised. In Wilson J, Keane TM., editors. Assessing psychological trauma and PTSD. New York: Guilford, 1996: 399–411.
35. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the eastern cooperative oncology group. American Journal of Clinical Oncology 1982; 5(6): 649–655.
36. Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: A prospective, longitudinal study of 536 patients from a single institution. European Journal of Cancer 1996; 32A(7): 1135–1141.
37. Schneider KL, Shenassa E. Correlates of suicide ideation in a population-based sample of cancer patients. Journal of Psychosocial Oncology 2008; 26(2): 49–62.
38. Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine 1999; 29(1): 9–17.
39. Robins A, Fiske A. Explaining the relation between religiousness and reduced suicidal behavior: Social support rather than specific beliefs. Suicide and Life Threatening Behavior 2009; 39(4): 386–395.
40. Colucci E, Martin G. Religion and spirituality along the suicidal path. Suicide and Life Threatening Behavior 2008; 38(2): 229–244.
41. Rasic DT, Belik SL, Elias B, Katz LY, Enns M, Sareen J. Spirituality, religion and suicidal behavior in a nationally representative sample. Journal of Affective Disorders 2009; 114(1–3): 32–40. 2008.08.007.
42. McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 2003; 361(9369): 1603–1607. 10.1016/S0140-6736(03)13310-7.
43. McClain-Jacobson C, Rosenfeld B, Kosinski A, Pessin H, Cimino JE, Breitbart W. Belief in an afterlife: Spiritual well-being and end-of-life despair in patients with advanced cancer. General Hospital Psychiatry 2004; 26(6): 484–486.
44. O'Mahony S, Goulet J, Kornblith A, Abbatiello G, Clarke B, Kless-Siegel S, et al. Desire for hastened death, cancer pain and depression: Report of a longitudinal observational study. Journal of Pain and Symptom Management 2005; 29(5): 446–457.
45. Suarez-Almazor ME, Newman C, Hanson J, Bruera E. Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: Predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival. Journal of Clinical Oncology 2002; 20(8): 2134–2141.
46. Balboni TA, Vanderwerker LC, Block SD, Paulk ME, Lathan CS, Peteet JR, et al. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. Journal of Clinical Oncology 2007; 25(5): 555–560.
47. Akechi T, Nakano T, Akizuki N, Nakanishi T, Yoshikawa E, Okamura H, et al. Clinical factors associated with suicidality in cancer patients. Japanese Journal of Clinical Oncology 2002; 32(12): 506–511.
48. Rodin G, Zimmermann C, Rydall A, Jones J, Shepherd FA, Moore M, et al. The desire for hastened death in patients with metastatic cancer. Journal of Pain and Symptom Management 2007; 33(6): 661–675.
49. Morita T, Sakaguchi Y, Hirai K, Tsuneto S, Shima Y. Desire for death and requests to hasten death of Japanese terminally ill cancer patients receiving specialized inpatient palliative care. Journal of Pain and Symptom Management 2004; 27(1): 44–52.
50. Wilson KG, Scott JF, Graham ID, Kozak JF, Chater S, Viola RA, et al. Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide. Archives of Internal Medicine 2000; 160(16): 2454–2460.
51. Suarez-Almazor ME, Belzile M, Bruera E. Euthanasia and physician-assisted suicide: A comparative survey of physicians, terminally ill cancer patients, and the general population. Journal of Clinical Oncology 1997; 15(2): 418–427.
52. Joiner TE Jr, Van Orden KA, Witte TK, Selby EA, Ribeiro JD, Lewis R, et al. Main predictions of the interpersonal-psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology 2009; 118(3): 634–646.
53. Adamsen L, Quist M, Midtgaard J, Andersen C, Moller T, Knutsen L, et al. The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy. Supportive Care in Cancer 2006; 14(2): 116–127.
54. Adamsen L, Quist M, Andersen C, Moller T, Herrstedt J, Kronborg D, et al. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: Randomised controlled trial. British Medical Journal 2009; 339: b3410.
55. Massie MJ. Prevalence of depression in patients with cancer. Journal of National Cancer Institute Monographs 2004; 32: 57–71.
56. Stark D, Kiely M, Smith A, Velikova G, House A, Selby P. Anxiety disorders in cancer patients: Their nature, associations, and relation to quality of life. Journal of Clinical Oncology 2002; 20(14): 3137–3148.
57. Kangas M, Henry JL, Bryant RA. The course of psychological disorders in the 1st year after cancer diagnosis. Journal of Consulting and Clinical Psychology 2005; 73(4): 763–768.
58. Akechi T, Okuyama T, Sugawara Y, Nakano T, Shima Y, Uchitomi Y. Suicidality in terminally ill Japanese patients with cancer. Cancer 2004; 100(1): 183–191.
59. Owen C, Tennant C, Levi J, Jones M. Cancer patients' attitudes to final events in life: Wish for death, attitudes to cessation of treatment, suicide and euthanasia. Psycho-Oncology 1994; 3: 1–9.
60. Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, et al. (2009). Cross-national analysis of the associations among mental disorders and suicidal behavior: Findings from the WHO world mental health surveys. PLoS Medicine 2009; 6(8): e1000123.
61. Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, ten Have M, et al. Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Archives of General Psychiatry 2005; 62(11): 1249–1257.
62. Smith MY, Redd WH, Peyser C, Vogl D. Post-traumatic stress disorder in cancer: A review. Psycho-Oncology 1999; 8(6): 521–537.
63. Palmer SC, Kagee A, Coyne JC, DeMichele A. Experience of trauma, distress, and posttraumatic stress disorder among breast cancer patients. Psychosomatic Medicine 2004; 66(2): 258–264.
64. Härter M, Reuter K, Aschenbrenner A, Schretzmann B, Marschner N, Hasenburg A, et al. Psychiatric disorders and associated factors in cancer: Results of an interview study with patients in inpatient, rehabilitation and outpatient treatment. European Journal of Cancer 2001; 37(11): 1385–1393.
65. Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJ. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine 2007; 69(3): 242–248.
66. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 2008; 192(2): 98–105. 107.040113.
67. Nock MK, Hwang I, Sampson NA, Kessler RC. Mental disorders, comorbidity and suicidal behavior: Results from the national comorbidity survey replication. Molecular Psychiatry 2010; 15(8): 868–876.
68. Suominen K, Henriksson M, Suokas J, Isometsa E, Ostamo A, Lonnqvist J. Mental disorders and comorbidity in attempted suicide. Acta Psychiatrica Scandinavica 1996; 94(4): 234–240.
69. Rudd MD, Dahm PF, Rajab MH. Diagnostic comorbidity in persons with suicidal ideation and behavior. American Journal of Psychiatry 1993; 150(6): 928–934.
70. Lin HC, Wu CH, Lee HC. Risk factors for suicide following hospital discharge among cancer patients. Psycho-Oncology 2009; 18(10): 1038–1044.
71. Vijakumar L, Pirkis J, Huong TT, Yip P, Seneviratne RA, Hendin H. Socio-economic, cultural and religious factors affecting suicide prevention in Asia In Hendin H, Phillips MR, Vijakumar L, Pirkis J, Wang H, Yip P, et al., editors. Suicide and suicide prevention in Asia. Geneva: World Health Organization, 2008: 19–28.
72. Cheng JK, Fancher TL, Ratanasen M, Conner KR, Duberstein PR, Sue S, et al. Lifetime suicidal ideation and suicide attempts in Asian Americans. Asian American Journal of Psychology 1(1): 18–30.
73. Zhang J, Conwell Y, Zhou L, Jiang C. Culture, risk factors and suicide in rural china: A psychological autopsy case control study. Acta Psychiatrica Scandinavica 2004; 110(6): 430–437.
74. Kugaya A, Akechi T, Nakano T, Okamura H, Shima Y, Uchitomi Y. Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for death. Supportive Care in Cancer 1999; 7(6).
75. Hudson PL, Kristjanson LJ, Ashby M, Kelly B, Schofield P, Hudson R, et al. Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: A systematic review. Palliative Medicine 2006; 20(7): 693–701.
76. Hudson PL, Schofield P, Kelly B, Hudson R, O'Connor M, Kristjanson LJ, et al. Responding to desire to die statements from patients with advanced disease: Recommendations for health professionals. Palliative Medicine 2006; 20(7): 703–710.
77. LeMay K, Wilson KG. Treatment of existential distress in life threatening illness: A review of manualized interventions. Clinical Psychology Review 2008; 28(3): 472–493.
78. Joe S, Canetto SS, Romer D. Advancing prevention research on the role of culture in suicide prevention. Suicide and Life Threatening Behavior 2008; 38(3): 354–362.
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Article first published online: September 17, 2012
Issue published: May 2012
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PubMed: 23094469
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