title: Better off dead: suicidal thoughts in cancer patients.
abstract: OBJECTIVE
  Cancer is associated with an increased risk of suicide and attempted suicide. However, we do not know how many cancer patients have thoughts that they would be better off dead or thoughts of hurting themselves. This study aimed to determine the prevalence of such thoughts in cancer outpatients and which patients are most likely to have them.
  
  
  METHODS
  A survey of consecutive patients who attended the outpatient clinics of a regional cancer center in Edinburgh, United Kingdom. Patients completed the Patient Health Questionnaire-9 (PHQ-9), which included Item 9 that asks patients if they have had thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Those who reported having had such thoughts for at least several days in this period were labeled as positive responders. Patients also completed the Hospital Anxiety and Depression Scale (HADS) and a pain scale. The participating patients' cancer diagnoses and treatments were obtained from the cancer center clinical database.
  
  
  RESULTS
  Data were available on 2,924 patients; 7.8% (229 of 2,924; 95% CI, 6.9% to 8.9%) were positive responders. Clinically significant emotional distress, substantial pain, and--to a lesser extent--older age, were associated with a positive response. There was strong evidence of interactions between these effects, and emotional distress played the most important role.
  
  
  CONCLUSIONS
  A substantial number of cancer outpatients report thoughts that they would be better off dead or thoughts of hurting themselves. Management of emotional distress and pain should be a central aspect of cancer care.
authors.affiliation: University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, Edinburgh, United Kingdom EH10 5HF. jane.walker@ed.ac.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Walker
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Waters
authors.forename: Gordon
authors.initials: G
authors.lastname: Murray
authors.forename: Helen
authors.initials: H
authors.lastname: Swanson
authors.forename: Carina J
authors.initials: CJ
authors.lastname: Hibberd
authors.forename: Robert W
authors.initials: RW
authors.lastname: Rush
authors.forename: Dawn J
authors.initials: DJ
authors.lastname: Storey
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Strong
authors.forename: Marie T
authors.initials: MT
authors.lastname: Fallon
authors.forename: Lucy R
authors.initials: LR
authors.lastname: Wall
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010045:Outpatients / Q000523:psychology*; D015995:Prevalence; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D013850:Thinking; D006113:United Kingdom / Q000453:epidemiology