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Suicidal Ideation and Attempts in Adult Survivors of Childhood Cancer

Christopher J. Recklitis, Rebecca A. Lockwood, Monica A. Rothwell, Lisa R. Diller

From the Dana-Farber Cancer Institute/Harvard Medical School; and Suffolk University, Boston, MA

Address reprint requests to Christopher J. Recklitis, PhD, MPH, Perini Family Survivors' Center, Dana-Farber Cancer Institute, 44 Binney St, SW320B, Boston, MA 02115-6084; e-mail: christopher_recklitis{at}dfci.harvard.edu

PURPOSE: This study examined the prevalence of suicidal ideation and past suicide attempt in adult survivors of childhood cancer and investigated the relationship of suicidal symptoms to cancer treatment and current health. The hypothesis that poor physical health would be significantly associated with suicidality after adjusting for mental health variables was specifically tested.

METHODS: Two hundred twenty-six adult survivors of childhood cancer (mean age, 28 years) seen in a survivor clinic completed the Short Form-36 and the Beck Depression Inventory (BDI), as well as suicide items from the Symptom Checklist-90 Revised, and Beck Scale for Suicide Ideation. Participants reporting current suicide ideation or any past suicide attempt were classified as suicidal.

RESULTS: Twenty-nine participants (12.83%) reported suicidality, although only 11 of these were significantly depressed by BDI criteria. Univariate analyses found suicidality unrelated to age or sex but positively associated with younger age at diagnosis, longer time since diagnosis, cranial radiation treatment, leukemia diagnosis, depression, hopelessness, pain, and physical appearance concern. A hierarchical logistic regression showed that current physical functioning, including pain, was significantly associated with suicidality even after adjusting for treatment and depression variables.

CONCLUSION: Suicidal symptoms, which are reported by a significant minority of adult survivors of childhood cancer, are related to cancer treatments and post-treatment mental and physical health. Association of suicidal symptoms with physical health problems is important because these represent treatable conditions for which survivors may seek follow-up care. The relationship of physical well-being to suicidality underscores the need for a multidisciplinary approach to survivor care.

Supported by a Survivorship Research Grant from the Lance Armstrong Foundation.

Presented at the 2nd Annual Conference of the American Psychosocial Oncology Society, Phoenix, AZ, January 27-29, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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