Suicide after cancer diagnosis among older adults: A nationwide study from Austria

Background

Onset of cancer is linked to psychological distress and cancer is prevalent in older adults. Yet, the association to suicide is scarcely examined. The aim of this study was to assess whether cancer diagnosed in older adults is associated with suicide incidence.

Methods

All older adults (65+ years) who lived in Austria in the years 2014-2021 (n=2,175,134) were followed. Of these, 223,932 were diagnosed with a new cancer. We used non-parametric survival models with inverse-probability-treatment weights to compare risk ratios (relative risk) and risk differences (absolute risk) of older adults with and without cancer.

Results

Out of 2,158 suicide deaths, 442 (20.5%; 83.7% males) occurred among older adults with a new cancer diagnosis. The incidence rate was 74 among those with a new cancer diagnosis versus 23 per 100,000 person-years among those with no new cancer. One year after being diagnosed, older adults with a new cancer had a 4 times higher relative risk of dying by suicide compared to those without. The risk was highest within the first three months after diagnosis and for cancers with a poor prognosis (disseminated disease; lung, oesophagus, stomach, liver, pancreas, and brain cancers). The absolute risk of dying by suicide within 5 years after cancer diagnosis was 0.18% versus to 0.11% among those with no new cancer.

Discussion

Older adults who received a new cancer diagnosis had elevated suicide risks. Provision of support to cope with mental distress should be considered at cancer diagnosis, especially for older adults with a poor prognosis.

HIGHLIGHTS

• 1 year after cancer diagnosis, suicide risk was 4-times higher than in the general population

• Suicide risk was highest in the first three months after cancer diagnosis but remained elevated throughout 5 years

• Suicide risk was higher for cancers with a poor prognosis

• Provision of psychosocial support should be considered immediately after diagnosis