This portion of the blog will cover suicide-related terms, statistics on suicide both within the general population and in cancer patients, and warning signs, risk factors, and protective factors. A second blog will discuss how to respond to a patient’s comments regarding suicide, and importantly, how to facilitate a referral.
First: Cancer-related terms and definitions. There is a continuum of suicide-related thoughts and concepts.
- Thoughts of death: This may be a fleeting wish to die, or to have a hastened death. Patients may say “I want to go to sleep and not wake up.” This statement is not unusual among cancer patients, and unless this thought is persistent, it is not particularly worrisome.
- Suicidal Ideation: Thoughts on how a suicide might be carried out.
- Plans for suicide: Specific thoughts on how to complete suicidal behavior.
- Suicide Attempt: A non-fatal attempt to harm oneself with the intent to die.
- Completed Suicide: Death caused by self-harm with intent to die.
Prevalence of Suicidal Thoughts and Behaviors in US Adults
|Serious thoughts||3.7||8.3 million|
|Made plan||1.0||2.3 million|
|Suicide attempt||0.5||1.1 million|
- Having a chronic disease or chronic pain
- Being older than 65, or younger than 21
- Living alone and being unemployed
- Being male (males are 4 times more likely than females to kill themselves)
- Having a mental illness (90% of those who complete suicide have depression, mental illness, and/or substance abuse)
How does suicide among cancer patients compare with suicide in the general population? Cancer patients have double the rate of suicide compared to the general population.3 In fact, in a study of people who were ill, cancer was the only illness associated with an elevated level of suicide.3 Factors correlated with suicidal behavior among cancer patients include4:
- Site: prostate, lung, head and neck, pancreatic
- Stage: patients with advanced disease have 3 times the rate of major depression.
- Depression/Hopelessness: depression is a major risk factor; also, feeling as if they are a “burden to others.”
- Time since diagnosis:the risk is highest during the first 5 months after diagnosis, and then it decreases.
- Gender: Male
- Age: older (over 65) have an elevated risk, and the risk increases as age increases.
- Race: caucasians have a higher rate
- Personal or family history of suicide attempts or completion
- Psychiatric diagnosis (especially depression) or a history of alcohol or substance abuse
- White male
- Increasing age
- History of sexual abuse
- Easy access to lethal methods
- Physician or prisoner
- Feelings of hopelessness
- Physical illness
- Threats or plans for suicide
- Rage, anger
- Substance use
- Being in withdrawal from substance abuse
- Changes in sleep
- Mood changes
- Agitation or anxiety
- Access to effective treatment for mental and physical disorders
- Support from family and community
- Effective coping skills
- Cultural and religious beliefs which discourage suicide
1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. Available online at http://www.cdc.gov/ViolencePrevention/pdf/Suicide_DataSheet-a.pdf. Accessed June 29, 2015.
2. McDowell AK, Lineberry TW, Bostwick JM. Practical suicide-risk management for the busy primary care physician. Mayo Clin Proc. 2011;86(8):792-800.
3. Miller M, Mogun H, Azrael D, et al. Cancer and the risk of suicide in older americans. J Clin Onc. 2008;26(29):4720-4724.
4. Anguiano L, Mayer DK, Piven ML, et al. A literature review of suicide in cancer patients. Cancer Nursing. 2012;35(4):E14-E26.
5. Rudd MD, Berman AL, Joiner TE Jr, et al. Warning signs for suicide: theory, research, and clinical applications. Suicide Life Threat Behav. 2006;36:255-262.
6. Fawcett J. Treating impulsivity and anxiety in the suicidal patient. Ann N Y Acad Sci. 2001;932:94-102.
7. Busch KA, Fawcett J, Jacobs DG. Clinical correlates of inpatient suicide. J Clin Psychiatry. 2003;64:14-19.
8. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. Available online at http://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html. Accessed June 29, 2015.