Suicide attempts and non-suicidal self-injury among depressed COPD and lung cancer patients: A nationwide longitudinal study in Pakistan and Afghanistan

Abstract

Background: Suicide in depressed patients is a major health concern and has gained substantial attention in public health fields. However, the role of COPD, with or without lung cancer, in suicide attempts in patients with depression remains unknown. This study aimed to assess whether COPD and lung cancer precipitates suicide attempts. Methods: We identified 1397 depressed adolescents and adults with comorbid COPD alone or alongside lung cancer. Depression types were postpartum depression (n¼145), pre-menstrual dysphoric disorder (n¼196), bipolar disorder (n¼535), or major depression (n¼521). Patients were included from 2001 to 2016 from records in 116 major hospitals in Pakistan and Afghanistan. Patients were matched according to gender (587 males, 810 females) and age (11e72 years) with 6335 (control) patients with COPD without depression. The longitudinal cohort was observed until the end of 2015. Patients with other psychiatric comorbidities were excluded from the study. Findings: Patients with both COPD and lung cancer had a greater incidence of completed suicide than those with COPD alone (2.9% versus 0.9%, p¼0.006). After adjustment for psychiatric comorbidities, a Cox-regression analysis identified lung cancer as an independent risk factor for attempted suicide later in life among depressed COPD patients (hazard ratio 3.12, 95% CI 1.44e4.27). Interpretation: Adolescents and adults who had depression and went to develop COPD and lung cancer had an elevated risk of attempted suicide later in life compared to controls with only COPD. This is the first study to demonstrate an independent influence of COPD with or without lung cancer on attempted suicide. We have not assessed risk of suicide for other psychiatric comorbidities. Funding: None. Conflicts of interest: We declare that we have no conflicts of interest.

Depression, Suicidal Tendencies, Hopelessness, and Stress among Patients with Learning Disabilities

“…In our previous studies [5,15], we had analyzed suicidal tendencies and NSSIs among adolescents as well as adults with or without comorbidities. But, in this research, we have focused entirely on adolescents with no other comorbidity.…”