title: Factors associated with suicide in patients with genitourinary malignancies.
abstract: BACKGROUND
  Approximately 70% of all suicides in patients aged >60 years are attributed to physical illness, with higher rates noted in patients with cancer. The purpose of the current study was to characterize suicide rates among patients with genitourinary cancers and identify factors associated with suicide in this specific cohort.
  
  
  METHODS
  Patients with prostate, bladder, kidney, testis, and penile cancer were identified in the Surveillance, Epidemiology, and End Results database (1988-2010). Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated for each anatomic site. Multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide for each malignancy.
  
  
  RESULTS
  There were 2268 suicides identified among 1,239,522 individuals with genitourinary malignancies observed for 7,307,377 person-years. The SMRs for patients with cancer were 1.37 for prostate cancer (95% CI, 0.99-1.86), 2.71 for bladder cancer (95% CI, 2.02-3.62), 1.86 for kidney cancer (95% CI, 1.32-2.62), 1.23 for testis cancer (95% CI, 0.88-1.73), and 0.95 for penile cancer (95% CI, 0.65-1.35). On multivariable analysis, male sex was found to be associated with odds of suicide among patients with bladder cancer (OR, 6.63) and kidney cancer (OR, 4.98). Increasing age was associated with suicide for patients with prostate, bladder, and testis cancer (OR range, 1.03-1.06). Distant disease was associated with suicide in patients with prostate, bladder, and kidney cancer (OR range, 2.82-5.43). Among patients with prostate, bladder, and kidney cancer, African American patients were less likely to commit suicide compared with white individuals (OR range, 0.26-0.46).
  
  
  CONCLUSIONS
  Suicide in patients with genitourinary malignancies poses a public health dilemma, especially among men, the elderly, and those with aggressive disease. Clinicians should be aware of risk factors for suicide in these patients.
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Klaassen
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Rita P
authors.initials: RP
authors.lastname: Jen
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: John M
authors.initials: JM
authors.lastname: DiBianco
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Lael
authors.initials: L
authors.lastname: Reinstatler
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Rabii
authors.initials: R
authors.lastname: Madi
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Lewis
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Smith
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Durwood E
authors.initials: DE
authors.lastname: Neal
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kelvin A
authors.initials: KA
authors.lastname: Moses
authors.affiliation: Section of Urology, Department of Surgery, Medical College of Georgia-Georgia Regents University, Augusta, Georgia.
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018426:SEER Program; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014565:Urogenital Neoplasms / Q000453:epidemiology* / Q000523:psychology
keywords: Surveillance, Epidemiology, and End Results (SEER); bladder cancer; genitourinary malignancies; kidney cancer; marital status; penile cancer; prostate cancer; race; suicide; testis cancer