背景:已知对接受癌症诊断的孩子的父母造成的心理伤害很高,但是这些父母对自杀行为的认识存在差距。这项研究的目的是调查与患有癌症的孩子有关的自杀未遂和自杀死亡的风险。
结果:我们进行了一项基于人群和同胞对照的双边队列研究,包括在丹麦(1978年至2016年)或瑞典(1973年至2014年)患有癌症的所有父母,每个暴露父母10个匹配的未暴露父母(人口比较),和未受影响的父母的完整兄弟姐妹(兄弟姐妹比较)。通过丹麦的患者登记册和精神病学中心登记册以及瑞典的患者登记册确定了自杀企图。而自杀死亡是通过丹麦死亡原因登记册和瑞典死亡原因登记册确定的。在人口比较中,我们使用Cox回归来估计与儿童癌症诊断相关的自杀未遂和自杀死亡的风险比(HRs)和95%置信区间(CIs)。适应性,年龄,居住国,日历年,婚姻状况,达到的最高教育水平,家庭收入,癌症史,精神病史,和精神病家族史。进行同胞比较以评估家族混杂在所研究的关联中的作用。人口比较包括106,005名暴露父母和1,060,050名匹配的未暴露父母,进入队列时的平均年龄为56岁,男性占46.9%。在7.3年和7.2年的中位随访期间,我们观察到613(发病率[IR],每100,000人年58.8)和5,888(IR,57.1/100,000人年)在暴露和未暴露的父母中首次自杀未遂的案例,分别。在儿童癌症诊断后的头几年,父母自杀未遂的风险增加(HR,1.15;95%CI,[1.03,1.28];p=0.01),特别是当孩子在诊断时18岁或更年轻时(HR,1.25;95%CI,[1.08,1.46];p=0.004),当孩子被诊断出患有高度侵袭性癌症(HR,1.60;95%CI,[1.05,2.43];p=0.03),或当孩子因癌症死亡时(HR,1.63;95%CI,[1.29,2.06];p<0.001)。增加的风险没有,然而,此后保持(HR,0.86;95%CI:[0.75,0.98];p=0.03),在孩子被诊断出癌症后,父母自杀死亡的风险没有改变。兄弟姐妹比较证实了这些发现。这项研究的主要局限性是潜在的残留混杂因素,这些因素在完整的兄弟姐妹之间没有共享。
结论:在这项研究中,我们观察到在儿童癌症诊断后的头几年父母自杀企图的风险增加,特别是当孩子在童年被诊断时,或具有侵袭性或致命的癌症。有,然而,在儿童癌症诊断后的任何时候,父母自杀死亡的风险都没有改变。我们的发现表明,癌症儿童父母对自杀未遂的临床意识得到了扩展,特别是在癌症诊断后的头几年。
BACKGROUND: The psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer.
RESULTS: We performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations. The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child\'s cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child\'s cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings.
CONCLUSIONS: In this study, we observed an increased risk of parental suicide attempt during the first years after a child\'s cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child\'s cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.