title: Are cancer patients at higher suicide risk than the general population?
abstract: OBJECTIVE
  The aims were to test whether suicide is more prevalent among cancer patients than among the general population, whether the association changes over time, and whether the risk depends on the severity of the cancer disease.
  
  
  METHODS
  A register study was carried out, where standardized suicide rates for different cancer sites were analysed by sex, time periods (1965-74, 1975-84, and 1985-94), and five-year survival rates.
  
  
  METHODS
  The setting was the Swedish population from 1965 to 1999.
  
  
  METHODS
  The cohort studied was 1,031,919 cancer cases and 2,587,152 person-years.
  
  
  METHODS
  The main outcome measure was the standardized mortality ratio (SMR) with the world population as standard population.
  
  
  RESULTS
  Cancer patients run a higher risk of suicide than the general population. The suicide rate ratio between male cancer patients and the general population was about 2.5 in 1965-74, which thereafter reduced to about 1.5 in 1985-94. The suicide rate among female cancer patients was in excess of 2.9 in 1965-74 and 2.3 in 1985-94. In fact, a slightly higher rate for women was observed for 1985-94 than for 1975-84. There is also a strong negative association between survival rates and suicide rates, i.e. suicide rates are higher for severe cancer sites with low survival rates.
  
  
  CONCLUSIONS
  Our findings support the hypothesis that cancer patients run greater risks of committing suicide than the general population does. The severity of the cancer increases the suicide risk. More attention to cancer patients' psychological and care situation is called for.
authors.affiliation: Centre for Epidemiology, The National Board of Health and Welfare, Sweden. charlotte.bjorkenstam@sos.se
authors.forename: Charlotte
authors.initials: C
authors.lastname: Björkenstam
authors.forename: Annika
authors.initials: A
authors.lastname: Edberg
authors.forename: Shiva
authors.initials: S
authors.lastname: Ayoubi
authors.forename: Måns
authors.initials: M
authors.lastname: Rosén
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000523:psychology*; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology