Originally published as JCO Early Release 10.1200/JCO.2007.14.3990 on August 11 2008

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Cancer and the Risk of Suicide in Older Americans

Matthew Miller, Helen Mogun, Deborah Azrael, Katherine Hempstead, Daniel H. Solomon

From the Harvard School of Public Health; and Brigham and Women's Hospital, Boston, MA; Center for State Health Policy, Rutgers University, New Brunswick, NJ

Corresponding author: Matthew Miller, MD, ScD, Harvard School of Public Health, 677 Huntington Ave, Kresge Bldg, Rm 305, Boston, MA 02115; e-mail: mmiller{at}hsph.harvard.edu

Purpose To determine whether the risk of suicide is greater among patients with cancer than among patients with other medical illnesses.

Patients and Methods A case-control study of the suicide risk associated with medical illness among older Americans that used healthcare utilization data linked to prescription and mortality files. The patient population was comprised of 1,408 New Jersey residents age 65 years or older who were enrolled in Medicare and in a pharmaceutical insurance program. Patient cases (n = 128) died as a result of suicide during the study period of 1994 to 2002. Control patients (n = 1,280) were frequency-matched to patient cases on age and sex. Data were analyzed by using the odds ratio (OR) of suicide adjusted for age, sex, ethnicity, medical and psychiatric comorbidity, and use of prescription medications.

Results In adjusted analyses, the only medical condition that remained associated with suicide was cancer (OR, 2.3; 95% CI, 1.1 to 4.8). Suicide also remained associated with a diagnosis of affective disorder (OR, 2.3; 95% CI, 1.3 to 4.2), anxiety/personality disorder (OR, 2.2; 95% CI, 1.3 to 3.6), treatment with antidepressants (OR, 2.0; 95% CI, 1.2 to 3.2), and treatment with opioid analgesics (OR, 1.6; 95% CI, 1.0 to 2.5).

Conclusion The risk of suicide in older adults is higher among patients with cancer than among patients with other medical illnesses, even after psychiatric illness and the risk of dying within a year were accounted for.

published online ahead of print at www.jco.org on August 11, 2008

Supported by the American Foundation for Suicide Prevention and by the Centers for Disease Control Grants No. R49/CCR115279-09 for Injury Control Research Centers.

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

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