Japanese Journal of Clinical Oncology 30:568-570 (2000)
© 2000 Foundation for Promotion of Cancer Research
Does Alcohol Drinking Have an Influence on Suicides in Cancer Sufferers? A Population-based Study of 1515 Suicide Victims
1Department of Psychiatry and 2Department of Forensic Medicine, University of Oulu, Oulun Yliopisto, Finland
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Backgroud: We investigated whether alcohol drinking contributes to suicides in cancer sufferers when compared with non-cancer suicides. We also explored the suicide method used in cancer suicides.
Methods: The population-based, prospectively collected data sample consisted of 1515 completed suicides committed in the province of Oulu, Finland, during the period 1988–99. Victims who suffered from cancer were compared with other suicides.
Results: Cancer patients who committed suicide were significantly less commonly under the influence of alcohol than non-cancer suicide victims (84.8% vs 54.7%). Mental disorders were less prevalent among cancer patients than non-cancer patients. The cancer patients were significantly older and more often retired and a trend that a greater proportion of cancer suicide victims were male was noted. Shooting and poisoning were the most common suicide methods among cancer patients.
Conclusion: An early recognition and evaluation of the extent of the suicidal tendencies among cancer patients is of great importance in clinical oncology, since preventive interventions would be effective especially for those without comorbid alcoholism at the time of the suicide.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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According to previous studies, cancer is known to be associated with an increased risk of suicide (1,2). Committers of suicide who suffer from cancer are older and more frequently male than other suicide victims (3). Furthermore, cancer suicide victims often suffer from comorbid mental disorders, particularly depression in addition to uncomfortable pain and physical disability at the time of death (3,4).
Despite the fact that heavy alcohol use increases the suicide risk of a person (5), there have been no studies to date of the role of acute alcohol intoxication at the time of suicide among cancer patients. Akechi et al. (6) recently published a preliminary note that indicated that delirium was a common psychiatric diagnosis of suicidal cancer patients. However, the data sample was small, the cancer patients had been either suicide attempters or had harboured suicidal thoughts and completed suicides were not examined.
In sum, according to the previous literature, severe medical illnesses involving pain and mental disorders, especially depression, are found in up to 70% of suicides. Mental disorders and alcohol or other substance abuse are found to be associated with suicidal behaviour (7). However, the extent of the interaction between alcohol use and suicide mortality among patients with different somatic disorders has been only sparsely studied.
The aim of this study was to investigate whether alcohol drinking contributed to cancer suicides when compared with non-cancer suicides. Second, we explored the method used in cancer suicides. We used a prospectively collected population-based data sample of completed suicides during a 12-year follow-up period in Finland where suicide mortality is one of the highest in the world.
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MATERIALS AND METHODS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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We examined data of 1515 completed suicides (1242 males and 273 females) committed in the province of Oulu, Finland, during the period 1988–99. The study protocol was approved by the Ethical Committee of Oulu University. The relevant data for this study were extracted from the official death certificates, which are based on medico-legal investigations. According to Finnish law, in every case of violent, sudden or unexpected death, the possibility of suicide is assessed by police and medico-legal investigations involving autopsies and forensic examinations.
Alcohol was defined as a contributory factor to the suicide if acute alcohol intoxication was detected in the medical autopsy by a doctor in forensic medicine and entered on the death certificate. Those subjects had to fulfil the ICD-9 (3050A) or ICD-10 (F10.0) diagnostic criteria for acute intoxication due to the use of alcohol.
The cancer diagnoses of suicide victims (ICD-9, codes 140–239 and ICD-10, codes C00–C99, D00–D48) were extracted from the death certificates and the data were divided into two subgroups (33 cancer suicides, 1482 non-cancer suicides). In further analyses, the non-cancer suicides were divided into two groups to see whether at the time of the suicides one or more contributing factors (other than cancer), such as somatic or mental disorders (i.e. the disease has been diagnosed and treated by a medical doctor and entered on the death certificate) or major psychological stress factors (e.g. preceding criminal offence, financial difficulties or problems in personal relationships entered on the death certificate) were present (cancer suicides, 33; no cancer but other contributing factor, 755; no contributing factor, 727).
Differences between cancer and non-cancer suicides were investigated by Pearson’s chi-squared test and one-way analysis of variance. A logistic regression analysis with odds ratio (OR) and its 95% confidence interval (95% CI) was used to assess the probability of alcohol use and mental disorders among cancer suicide victims after adjusting for age, gender and employment status of the suicide victim. The statistical program used was SPSS for Windows (Release 9.0).
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RESULTS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Table 1 shows that cancer patients who committed suicide were more rarely under the influence of alcohol (15.2%) than non-cancer patients (45.3%). Mental disorders were less prevalent in cancer patients than in non-cancer patients. The cancer patients were significantly older and more often retired compared with non-cancer suicides. There was a trend towards statistical significance that a greater proportion of the cancer suicide victims were female (30.3%) compared with non-cancer suicide victims.
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Table 2 shows that shootings and poisonings were the most commonly employed suicide methods among cancer patients. Interestingly, one third of the cancer patients committed suicide by poisoning whereas the corresponding proportions in the other two subgroups (either no cancer but other contributing factor or no contributing factor at all) were 26.9 and 12.0%, respectively.
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After adjusting for age, gender and employment status, mental disorders were found to be more common among cancer suicide victims than non-cancer suicide victims (OR 0.3936, 95% CI 0.1746–0.8874). There was also a trend towards significance that cancer suicide victims were less commonly under the influence of alcohol than non-cancer suicide victims (OR 0.3785, 95% CI 0.1397–1.0253).
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Previous studies have shown that cancer patients are at an increased risk of committing suicide (1). Our novel finding was that cancer patients who committed suicide were significantly less commonly under the influence of alcohol at the time of the suicide compared with the non-cancer suicides. A putative explanation for this is that the suicide itself might be well planned among cancer patients and that a lowered impulse control due to acute alcohol intoxication would not contribute significantly to their suicide acts. It has been found previously that the prevalence of alcohol dependence among cancer suicides is less than half of that of non-cancer suicides (13% vs 32%) (4).
In our study, a history of mental disorders was found to be less common among cancer patients who committed suicide than in non-cancer suicides, although this difference was not statistically significant. In an earlier study by Henriksson et al. (4), it was stressed that cancer patients who commit suicide are commonly depressive, but not often suffering from psychotic mental disorders. Thus, in our opinion, early recognition and evaluation of the extent of the suicidal notion in cancer patients are of great importance, since preventive interventions would be effective especially for those without mental disorders due to psychoactive substance use at the time of the suicide.
Questions concerning early deaths in cancer patients are timely in clinical oncology (8), but these issues have mainly been focused on euthanasia problems. We underline the importance of psychiatric evaluations, namely the occurrence of suicidal thoughts and suicide plans of cancer patients at all levels of medical care where cancer patients are treated. Furthermore, physicians should know whether their patients have lethal doses of drugs available in their homes, since one third of the cancer suicides were committed by poisoning.
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FOOTNOTES |
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+ For reprints and all correspondence: Pirkko Räsänen, Department of Psychiatry, University of Oulu, Box 5000, FIN-90014 Oulun Yliopisto, Finland. E-mail: pirkko.rasanen@oulu.fi
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REFERENCES |
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Received June 30, 2000; accepted September 13, 2000.
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