title: Suicide ideation and associated mortality in adult survivors of childhood cancer.
abstract: BACKGROUND
  Adult survivors of childhood cancer are at risk for suicide ideation, although longitudinal patterns and rates of recurrent suicide ideation are unknown. This study investigated the prevalence of late report (ie, after initial assessment) and recurrent suicide ideation in adult survivors of childhood cancer, identified predictors of suicide ideation, and examined associations among suicide ideation and mortality.
  
  
  METHODS
  Participants included 9128 adult survivors of childhood cancer and 3082 sibling controls enrolled in the Childhood Cancer Survivor Study who completed a survey question assessing suicide ideation on one or more occasions between 1994 and 2010. Suicide ideation was assessed using the Brief Symptom Inventory-18 instrument. Mortality data was ascertained from the National Death Index.
  
  
  RESULTS
  Survivors were more likely to report late (odds ratio [OR] =1.9, 95% confidence interval [CI] =1.5-2.5) and recurrent suicide ideation (OR=2.6, 95% CI=1.8-3.8) compared to siblings. Poor physical health status was associated with increased risk of suicide ideation in survivors (late report: OR=1.9, 95% CI=1.3-2.7; recurrent: OR=1.9, 95% CI=1.2-2.9). Suicide ideation was associated with increased risk for all-cause mortality (hazard ratio=1.3, 95% CI=1.03-1.6) and death by external causes (hazard ratio=2.4, 95% CI=1.4-4.1).
  
  
  CONCLUSIONS
  Adult survivors of childhood cancer are at risk for late-report and recurrent suicide ideation, which is associated with increased risk of mortality. Routine screening for psychological distress in adult survivors appears warranted, especially for survivors who develop chronic physical health conditions.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Brinkman
authors.forename: Nan
authors.initials: N
authors.lastname: Zhang
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Recklitis
authors.forename: Cara
authors.initials: C
authors.lastname: Kimberg
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: Anna C
authors.initials: AC
authors.lastname: Muriel
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D035781:Siblings; D013315:Stress, Psychological / Q000209:etiology; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D017741:Survivors / Q000523:psychology*
keywords: childhood cancer; late effects; mortality; suicide; survivorship