Abstract
PurposeThis study aimed to assess the association between the Distress Thermometer (DT) score and risk of suicide in patients with cancer. In addition, we aimed to determine the best cutoff score to predict patients at risk of suicide.MethodsFrom 2015 to 2016, we retrospectively collected data on patients with cancer. DT scores were collected, and the association between DT score and risk of suicide (suicide ideation or death ideation) was analyzed. Furthermore, receiver operating characteristic (ROC) analysis was performed to identify the appropriate cutoff score for predicting risk of suicide.ResultsA total of 260 patients with cancer were included, and suicidal ideation was identified in 33 cases referred for psychological intervention. The DT scores of the patients with suicidal ideation were significantly higher than those of patients without suicidal ideation (6.30±2.11 vs. 4.29±1.72, p<0.05). In addition, the area under the ROC curve for predicting risk for suicide was 0.758. The cutoff DT score of 3 had the highest sensitivity of 1.00 to rule out suicidal ideation, while 9 had the highest specificity of 1.00 to rule in suicidal ideation. Moreover, the appropriate cutoff DT score to predict patients with suicidal ideation was 5, with a sensitivity of 0.52, specificity of .84, positive likelihood ratio of 3.24, and negative likelihood ratio of 0.58.ConclusionThe DT score may be a helpful clinical tool to evaluate emotional distress and risk of suicide in patients with cancer. Clinically, for DT scores greater than 5 in patients with cancer, the risk of suicide greatly increases. In view of the DT’s widespread use internationally by non-mental health clinicians in cancer to guide the need for specialist mental health interventions, its potential utility in also predicting suicide risk is of great interest.
Highlights
Cancer patients often experience significant distress and may be at a higher risk of suicide than the general populations and other patients [1,2,3,4]
We aimed to identify whether the Distress Thermometer (DT) score may be helpful for initially screening the risk of suicide in patients with cancer, and we assessed the association between the DT score and risk of suicide in a sample of patients with cancer
The average DT score was highest in the suicidal ideation group compared to the death ideation and no-risk groups
Summary
Cancer patients often experience significant distress and may be at a higher risk of suicide than the general populations and other patients [1,2,3,4]. The suicide rates among cancer patients are approximately twice compared with general population [5]. The presence of death ideation or suicidal ideation is associated with increased risk for suicide [10]. Detection of suicidal ideation or death ideation may help primary caregivers to prevent suicide in patients with cancer. Systematic screening for suicidal ideation is recommended; screening for suicidal ideation is not be commonly implemented in routine clinical practice in the cancer setting [11]
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