Spouses of people with cancer more likely to attempt, die of suicide
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Key takeaways:
- Spouses of people with cancer exhibited significantly higher risk for suicide attempt and suicide death.
- The risks appeared particularly high in the first year after cancer diagnosis.
Spouses of people with cancer exhibited significantly higher risk for attempted suicide and suicide death than those whose spouses had not been diagnosed with cancer, according to a nationwide cohort study in Denmark.
The risks appeared highest in the first year following cancer diagnosis but it persisted throughout 30-year follow-up, results showed.
“To our knowledge, [this study] is the first to show that spouses of patients with cancer have an elevated risk [for] both suicide attempt and suicide death,” Qianwei Liu, MD, PhD, professor in the department of hematology at Southern Medical University in China, and colleagues wrote.
Liu and colleagues used registry-based data to compare risk for suicide attempt and suicide death between spouses of people with or without cancer.
One cohort included 409,338 people in Denmark whose spouses had been diagnosed with cancer between 1986 and 2015. The other cohort included 2.04 million individuals from the general population — matched by sex and birth year — whose spouse did not receive a cancer diagnosis. More than half (55.4%) of the study population were women.
Researchers used the Danish National Patient Register and the Danish Psychiatric Central Research Register to identify suicide attempt. They used the Danish Causes of Death Register to assess suicide death.
Spouses of people with cancer exhibited increased risk for suicide attempt (HR = 1.28; 95% CI, 1.23-1.34) and suicide death (HR = 1.47; 95% CI, 1.35-1.6) compared with the matched cohort.
The elevated risks for suicide attempt (HR = 1.45; 95% CI, 1.27-1.66) and suicide death (HR = 2.56; 95% CI, 2.03-3.22) appeared greatest in the first year after cancer diagnosis.
Researchers also observed greater increases in risks for suicide attempt and suicide death among spouses of people with cancer who were diagnosed at an advanced stage or when the spouse died after diagnosis.
Researchers acknowledged study limitations, including the fact the analysis only accounted for registered heterosexual spouses and not unregistered partners or homosexual spouses/partners. It also is unclear if the findings can be generalized to other countries, where cultural contexts, health care systems, and burdens of cancer and suicidal behavior may vary, researchers wrote.
The work by Liu and colleagues contributes to an area that has “long been neglected in both research and clinical care,” Casey Crump, MD, PhD, of the department of family and community medicine at The University of Texas Health Science Center, and Weiva Sieh, MD, PhD, of the department of epidemiology at The University of Texas MD Anderson Cancer Center, wrote in an accompanying editorial,
The findings can help further oncologists’ understanding of the importance of mental health efforts for both patients with cancer and their spouses or caregivers.
“Clinicians should be aware that cancer diagnosis and treatment may cause severe psychosocial distress in spouses as well as the patients themselves,” Crump and Sieh wrote. “There is a pressing need to integrate spousal health more fully into cancer survivorship care.
American Cancer Society guidelines recommend screening all people with cancer for psychosocial distress and depression. The U.S. Preventive Services Task Force also notes people with cancer are at higher risk for depression than the general adult population.
Spouses of people with cancer also should be recognized as an at-risk group, Crump and Sieh wrote.
“Psychosocial distress should no longer be a hidden and unaddressed cause of suffering [among] spouses of patients with cancer,” they wrote. “Given the known risks to their mental health, spouses should be fully integrated into cancer follow-up care. At health visits in either oncology or primary care clinics, spouses should be screened for psychosocial distress and connected to resources that will support their long-term mental health and well-being. Integration of spouses into survivorship programs is essential for providing comprehensive and effective cancer care.”
References:
- Crump C, et al. JAMA Oncol. 2024;doi: 10.1001/jamaoncol.2024.2903.
- Liu Q, et al. JAMA Oncol. 2024;doi:10.1001/jamaoncol.2024.3036.
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Liu Q, et al. JAMA Oncol. 2024;doi:10.1001/jamaoncol.2024.3036.
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