Risk and predictors of attempted and completed suicide in patients with hematological malignancies.

Abstract

Hematological malignancies can cause high levels of distress, but few studies have assessed risk of suicidal behavior among these patients. We evaluated risk of attempted and completed suicide in a cohort of 46,309 patients diagnosed with malignant lymphoma, myeloma and leukemia in Sweden 1992 to 2009 and 107,736 cancer-free subjects, using Poisson regression. In all, 146 suicide attempts and 63 completed suicides occurred during a median follow up of 3.1 years (maximum 19 years). The risk of completed suicide was 3.5-fold increased among patients with myeloma [incidence rate ratio (IRR) = 3.52, 95% confidence interval (CI) = 2.05-6.03] and 1.9-fold increased among patients with lymphoma (IRR = 1.87, 95% CI = 1.31-2.67) but not significantly increased among patients with leukemia. Risk of attempted suicide was increased among patients with myeloma (IRR = 2.13, CI = 1.39-3.26) and lymphoma (IRR = 1.34, 95% CI = 1.07-1.69). Both male and female patients were at increased risk of attempted as well as completed suicide. A pre-malignant history of mental disorders conferred 15-fold to 30-fold increased risks, but elevated risks were also observed among patients without such history. Suicidal actions in patients with hematological malignancies have high suicidal intent, and that subgroups of patients should be monitored for suicidal ideation.