Elsevier

Cancer Epidemiology

Volume 37, Issue 5, October 2013, Pages 714-718
Cancer Epidemiology

Suicides among cancer patients in Lithuania: A population-based census-linked study

https://doi.org/10.1016/j.canep.2013.05.009Get rights and content

Abstract

Background: This study aims to estimate suicide risk and its socio-demographic determinants among cancer patients in the country showing the highest suicide rates among developed countries. Methods: The study is based on a unique census-linked dataset based on the linkages between the records from death and cancer registers and the 2001 population census records. Standardized mortality ratios for suicide (SMRs) were calculated for patients diagnosed with cancer in Lithuania between April 6, 2001 and December 31, 2009, relative to suicide rates in the general population. Results: We found that the relative suicide risk was elevated for both males and females, with SMRs of 1.43 (95% CI 1.23–1.66) and 1.32 (95% CI 0.95–1.80), respectively. This relationship for females became statistically significant and stronger after excluding skin cancers. The highest suicide risks were observed at older ages and during the period shortly after the diagnosis. The groups showing an increased suicide risk include lower educated, non-married, and rural male patients. Conclusion: The results of our study point to inadequacies of the health care system in dealing with mental health problems of cancer patients. Interventions allowing early detection of depression or suicidal ideation may help to prevent suicide among cancer patients in Lithuania.

Introduction

Registry-based European studies suggest an increased risk of suicide among cancer patients in Nordic countries [1], [2], [3], [4], [5], [6], Switzerland [7], Italy [8], [9], England [10] and Estonia [11]. The results appear to be consistent for males, but not for females. The findings from the USA, Australia, South Korea and other countries outside Europe also confirm this pattern [12], [13], [14], [15], [16].

It has been shown that the highest risk of committing suicide was during the first year [5], [7], [10], [11], [16] or even in the first months [4], [6], [8], [11] after the diagnosis. The results notably differ by anatomic cancer site. The highest suicide risk was found among patients with respiratory and gastrointestinal cancers [1], [2], [3], [4], [5], [7], [11], [14], [16]. A notably increased risk was found for cancers of the brain and nervous system [4], [14], lymphatic and haematopoietic tissue [2], [4], [5], [7], [14], breast (for females only) [2], [4], [5], [14], [16], and prostate and other genital organs for males [2], [4], [5], [7], [11], [14]. The risk of suicide was higher in cancers with poor prognosis and non-localized disease [1], [3], [4], [5], [6], [9], [10], [14], [15], [16].

Levels, patterns, and determinants of suicide risk of cancer patients may notably differ across countries and even continents. This variation can be at least partly explained by differences in socio-cultural characteristics (including attitudes towards both cancer patients and suicide phenomenon) and general levels of suicide across societies. In this respect, Lithuania being a long-standing leader (since the mid-1990s) in suicide rates among the developed countries represents an interesting case for analysis. According to the data for 2009, age-standardized suicide rate was at a striking level of 31.5 per 100,000 (58.5 and 8.9 per 100,000 for males and females, respectively) [17]. In particular, it is important to explore whether generally high suicide rates in the society predetermine higher suicide rates among cancer patients and how the suicide risk differs by anatomic cancer sites and across socio-demographic groups. To our knowledge, no previous study based on the population-level data thoroughly studied suicides among cancer patients in Lithuania.

Section snippets

Study design and data

The study is based on a unique census-linked dataset covering the entire population provided by Statistics Lithuania. The linkages between the 2001 census records, death records, and cancer records from the Cancer Registry were implemented by employees of Statistics Lithuania, who have permission to work with individual-level data. The data for further analyses were provided in an aggregated multidimensional frequency table format that combines first diagnosed cancer cases, deaths, and person

Results

In Lithuania, 215 persons with first cancer diagnosis (174 males and 41 females) committed suicide between April 6, 2001 and December 31, 2009. As for all cancer sites combined, the study found a significantly elevated suicide risk only for male cancer patients (Table 1). However, after exclusion of skin cancers, both males and females showed statistically significant SMRs (1.55 times (95% CI 1.32–1.81) for males and 1.64 times (95% CI 1.16–2.26) for females, respectively (results not shown)).

Discussion

Fox et al. suggested that differences in suicide risk between two populations could be explained by the “Law of initial values”, i.e. the effect of cancer on suicide is lower in populations with higher suicide rates [12]. The results of our study, carried out in a high suicide mortality setting, suggest a significantly increased risk of suicide among cancer patients. This disadvantage was found for both sexes. However, female cancer patients showed a statistically significant increase in

Conflict of interest

None declared.

Acknowledgements

This study was funded by a grant (No. VP1-3.1-SMM-07-K-02-067) from the Research Council of Lithuania. The research was performed by the Institute for Demographic Research (Lithuanian Social Research Centre) in cooperation with the Lithuanian Cancer Registry (Institute of Oncology), Statistics Lithuania, and the Max Planck Institute for Demographic Research (Germany).

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