title: Suicide and cardiovascular death after a cancer diagnosis.
abstract: BACKGROUND
  Receiving a diagnosis of cancer is a traumatic experience that may trigger immediate adverse health consequences beyond the effects of the disease or treatment.
  
  
  METHODS
  Using Poisson and negative binomial regression models, we conducted a historical cohort study involving 6,073,240 Swedes to examine the associations between a cancer diagnosis and the immediate risk of suicide or death from cardiovascular causes from 1991 through 2006. To adjust for unmeasured confounders, we also performed a nested, self-matched case-crossover analysis among all patients with cancer who died from suicide or cardiovascular diseases in the cohort.
  
  
  RESULTS
  As compared with cancer-free persons, the relative risk of suicide among patients receiving a cancer diagnosis was 12.6 (95% confidence interval [CI], 8.6 to 17.8) during the first week (29 patients; incidence rate, 2.50 per 1000 person-years) and 3.1 (95% CI, 2.7 to 3.5) during the first year (260 patients; incidence rate, 0.60 per 1000 person-years). The relative risk of cardiovascular death after diagnosis was 5.6 (95% CI, 5.2 to 5.9) during the first week (1318 patients; incidence rate, 116.80 per 1000 person-years) and 3.3 (95% CI, 3.1 to 3.4) during the first 4 weeks (2641 patients; incidence rate, 65.81 per 1000 person-years). The risk elevations decreased rapidly during the first year after diagnosis. Increased risk was particularly prominent for cancers with a poor prognosis. The case-crossover analysis largely confirmed results from the main analysis.
  
  
  CONCLUSIONS
  In this large cohort study, patients who had recently received a cancer diagnosis had increased risks of both suicide and death from cardiovascular causes, as compared with cancer-free persons. (Funded by the Swedish Council for Working Life and Social Research and others.).
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. fang.fang@ki.se
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.forename: Katja
authors.initials: K
authors.lastname: Fall
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: Pär
authors.initials: P
authors.lastname: Sparén
authors.forename: Weimin
authors.initials: W
authors.lastname: Ye
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
authors.forename: Unnur
authors.initials: U
authors.lastname: Valdimarsdóttir
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000523:psychology; D016012:Poisson Distribution; D012044:Regression Analysis; D012306:Risk; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology