Certain groups of individuals seem to have an increased risk of committing suicide, and a number of studies have reported an increased risk of suicide among cancer patients. In this study, we aim to estimate the risk of suicide among cancer patients in Lithuania over the period 1993-2012. The records of patients diagnosed with primary cancer were extracted from the population-based Lithuanian Cancer Registry and 273 511 cases of first cancer were included in the analysis. Sex, age and calendar period-standardized mortality ratios (SMRs) were calculated by dividing the observed numbers of suicides among cancer patients by the expected number using national rates. An increased suicide risk was found for both sexes combined [SMR=1.31, 95% confidence interval (CI): 1.21-1.41] compared with the general population. For all cancer sites except melanoma and skin, and breast and thyroid cancers, the relative suicide risk was elevated. The suicide risk was almost three-fold higher for advanced-stage patients compared with the general population (SMR=2.89, 95% CI: 2.24-3.73). The highest suicide risk observed in our study was during the first 3 months following cancer diagnosis (SMR=2.43, 95% CI: 1.96-3.01), indicating a critical period shortly after diagnosis. Despite ongoing increases in survival among cancer patients and decreases in suicide mortality in the general Lithuanian population during our study period, the increasing risk for suicide indicates that cancer patients' clinical and psychosocial needs remain unsatisfied. The major clinical implication of these data suggests the importance of multidisciplinary preventive interventions.
Background and Objectives: Women diagnosed with breast cancer experience severe trauma. Psychological help for breast cancer patients is not sufficient because of limited professional resources. The goal of this study was to identify groups of breast cancer patients with the greatest suicidal risk, who could be the first target for psychosocial interventions. Materials and Methods: The study included 421 women with stage T1–T3/N0–N3/M0 breast cancer. We provided women with a set of questionnaires 1–2 days prior to breast surgery and one year after surgery. One hundred eighty-eight patients completed the questionnaires after one year. We used the Beck Depression Inventory Second Edition (BDI-II) item Suicidal Thoughts or Intentions for the assessment of suicidal risk. The Impact of Event Scale-Revised (IES-R) was used to measure the risk of PTSD and the Vrana–Lauterbach Traumatic Events Questionnaire-Civilian, TEQ-C (TEQ-CV) was used to measure whether patients had experienced other traumatic events in their lifetime. Results: The incidence of suicidal ideation one year after surgery increased from 4.3% to 12.8% of patients. Patients who lived in rural areas had a two times greater risk of suicidal thoughts than patients who lived in urban areas. Working patients were 2.5 times more likely to have suicidal thoughts prior to surgery. Severely traumatic events increased the chances of suicidal ideation (OR 7.72; 95% CI 1.63–36.6; p = 0.01). The symptoms of PTSD showed a threefold increase in the likelihood of suicidal ideation (OR 2.89; 95% CI 0.98–8.55; p = 0.05). Conclusions: Living in the countryside, having a history of traumatic experience, having a paid job and having symptoms of post-traumatic stress disorder influence suicidal ideation in breast cancer patients. Particular attention should be drawn to individuals with multiple risk factors.
KEYWORDSbreast cancer, depression, delivery of diagnosis, psychocial, risk factors, support 1 | BACKGROUND Breast cancer is the second most common cancer in the world and the most frequent cancer among women. 1 This disease is one of the most stressful events in someone's life, what can trigger a depression. 2 In investigations made worldwide tendency was observed, that older, not employed, low educated and single patients are more prone to depression. [3][4][5][6] Lithuania remains a country where depression in cancer patients is under studied. Taking into account that the suicidal rate of the general population of Lithuania is one of the biggest in Europe since 1993, 7 it is very important to investigate the risk factors for depression. Lithuania is a country in which many economic, political, and social changes have occurred during the last two decades. We had a hypothesis that risk factors of depression in Lithuanian breast cancer patients will differ from other European non post-soviet countries because of economic level and social-cultural features. 8 The main aims of this study were to evaluate prevalence and risk for depression in Lithuanian women diagnosed with breast cancer, and to identify the influence of social, demographic, psychological, and clinical factors on the depression. 2 | METHODS 2.1 | Design and data collection The questionnaire survey was performed in the National Cancer Institute between 2012 and 2014. Participants were newly diagnosed breast cancer patients, age 18 to 80 years with T1-3N0-3M0 stage breast cancer. Patients completed questionnaires before beginning cancer treatment and at one-year follow-up. Completed questionnaires included: The Beck Depression Inventory Second Edition (BDI-II) 9 ; Vrana &Lauterbach Traumatic Events Scale-Civilian version (TEQ) 10 ; a questionnaire on patients' satisfaction about the communication of the diagnosis, and necessity of psychological support. | Statistical analysisDescriptive statistics were used to characterize the sample. Categorical variables were expressed as absolute and relative frequencies.Mann-Whitney U was used for between-group comparisons of BDI-II scores and Pearson's chi-square test for categorical variables. Categorical variables were compared using Pearson's chi-square test. The odds ratios (OR) and 95% confidence intervals (95% CI) for depression and risk variables were estimated using multiple logistic regression.The BDI-II cut-off of ≥13 score was used to dichotomize patients into cases and non-cases. Unvariate logistic regression was conducted to explore the unadjusted association between variables and outcome.Likelihood ratio test was used for models fit. Summary measures of goodness of fit (likelihood ratio chi-square and Hosmer and Lemeshow's goodness-of-fit test) were conducted for assessing fit of the models. Receiver operating characteristics curve was used to assess discrimination power of the model. For assessing changes of prevalence of depression symptoms over time, McNemar's chi-square
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