Temporal trends and characteristics of suicide among women with gynecologic malignancy in the United States

• Type of Material: Article
• Authors: Caroline J Violette, Emory University; Rachel S Mandelbaum, University of Southern California, Los Angeles; David J Nusbaum, University of Southern California, Los Angeles; Christina J Duval, University of Southern California, Los Angeles; Shinya Matsuzaki, University of Southern California, Los Angeles; Hiroko Machida, Tokai University School of Medicine; Lynda D Roman, University of Southern California, Los Angeles; Koji Matsuo, University of Southern California, Los Angeles
• Language: English
• Date: 2019-11-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s)
• License: Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.gore.2019.100510
• Title of Journal or Parent Work: Gynecologic Oncology Reports
• Volume: 30
• Grant/Funding Information: Ensign Endowment for Gynecologic Cancer Research (K.M.)
• Keywords: Characteristics; Trend; Ovarian cancer; Uterine cancer; Suicide; Cervical cancer
• Research Categories: Health Sciences, Obstetrics and Gynecology

Abstract

Objective To examine the trends, characteristics, and outcomes of women with gynecologic malignancies who died of suicide in the United States. Methods This is a retrospective, observational study using the Surveillance, Epidemiology and End Results program from 1973 to 2013. Women with uterine, ovarian, and cervical cancers who had cause of death recorded as suicide or self-inflicted injury were included, and temporal trends, patient and tumor characteristics, and outcomes were assessed. Results Of 467,368 women with gynecologic cancers, there were 309 (0.07%) suicides during the study period. Across the three malignancies, suicide rates significantly decreased during the study period, with uterine cancer exhibiting the highest interval decrease (relative reduction: uterine cancer 88.2%, cervical cancer 78.1%, and ovarian cancer 73.6%; all, P < 0.05). Women with cervical cancer were younger at age of suicide (median age, 50 versus 60–68 years), and women with ovarian cancer had a shorter time to suicide from diagnosis (median time, 27 versus 66–67 months) (both, P < 0.05). On multivariable analysis, white race (hazard ratio [HR] 3.619), Western U.S. residence (HR 2.012), ovarian cancer (HR 1.991), cervical cancer (HR 1.765), stage IV disease (HR 1.735), and divorced status (HR 1.491) remained independent clinico-pathological characteristics associated with increased risk of suicide (all, P < 0.05). Conclusion This study found that suicide rates in women with gynecologic malignancies have decreased in the United States. Characteristics of suicide vary across cancer types, and certain risk factors of suicide identified in this study may be useful to triage patients at risk for suicidal behavior and inform prevention strategies.