The Effect of Marital Status on Suicide Risk Among Patients with Breast Cancer: A Population-Based sIPTW Competing Risk Analysis
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Background
Breast cancer survivors often experience psychological distress that may increase suicide risk. Marital status, a proxy for social support, may influence this risk, but its role within a competing-risk framework is unclear. This study examined the association between marital status and suicide mortality and assessed modification by socioeconomic and geographic factors.
Methods
This is a population-based cohort study using SEER data, including adults diagnosed with primary breast cancer from 2000 to 2022. Marital status was classified as married/partnered or unmarried/non-partnered. Baseline characteristics were balanced using subdistribution inverse probability of treatment weighting (sIPTW). Suicide mortality was analyzed using sIPTW-weighted Fine–Gray competing-risk models, treating non-suicide deaths as competing events. Landmark, subgroup, interaction, and sensitivity analyses were performed.
Results
Among 825,047 patients, 40.7% were unmarried. Covariates were well balanced after weighting (SMD <0.01). During follow-up, 529 suicide deaths occurred. Unmarried status was associated with higher suicide mortality (sHR = 1.34, 95% CI: 1.12–1.60). Male sex and estrogen receptor–negative tumors increased risk, while older age and non-White race were protective. Findings were consistent in Cox models (HR = 1.45) and sensitivity analyses (sHR = 1.42). Landmark analyses showed persistent associations at 1, 3, and 5 years. The association was attenuated in the highest income quartile but not modified by rural–urban status.
Conclusions
Unmarried breast cancer patients had higher suicide mortality. These findings support integrating psychosocial assessment and targeted suicide prevention into survivorship care, especially for socially vulnerable groups.
