Suicidal Thoughts and Attempts in Adult Survivors of Childhood Cancer Survivors

by Christopher Recklitis, Ph.D., MPH, Monica A. Rothwell, Linda Zame PhD
Source: CCCF Newsletter, Fall/Winter 2007

Background

While most studies show the majority of cancer survivors are emotionally well-adjusted, several studies indicate that survivors may be at risk for emotional problems including suicidal thoughts. We examined the prevalence of suicidal thoughts and attempts in a sample of adult survivors of childhood cancer. Our main goal was to identify risk factors for suicidal symptoms.

Why study suicidal thoughts and not depression?

Suicidal thought is closely related to depression, but people who have thoughts of suicide may not be depressed. This may be especially true for people with serious medical conditions where pain or physical limitations may make some people feel life may not be worth living. Also, suicidal thoughts and prior attempt are significant risk factors for later suicide, and indicators of serious emotional suffering.

Who participated and what did they report?

Participants were 226 adult survivors of childhood cancer seen in a survivor clinic. There were 100 men and 126 women, ages 18-64 years old. Participants completed rating scales including two questions about current thoughts of suicide (in the past week), and one question about any previous suicide attempts. Twenty-nine of the 226 survivors (about 13%) reported suicidal symptoms. Although no national statistics on suicidal thoughts and attempts are readily available, several studies indicate that rates of suicidal symptoms are considerably lower in the general population with rates between 2% and 4%. Compared with these estimates from national studies, our finding 13% of survivors experiencing current suicidal thoughts appears to be quite high and very concerning.

Will all childhood cancer survivors have suicidal thoughts?

No, studies of childhood cancer survivors consistently show that the majority of survivors do not have any significant distress or long-term problems adapting to life after cancer. While some childhood cancer survivors may be at risk, it is important to remember that 87% reported no suicidal symptoms.

What are the differences between cancer survivors with and without suicidal symptoms?

Survivors with suicidal symptoms tended to be younger when their cancer was diagnosed, diagnosed with leukemia, and treated with cranial radiation. Survivors with suicidal thoughts also reported more depression and hopelessness. Physical health variables, including pain, were also associated with suicidal symptoms. In fact, even after accounting for differences in cancer treatment and emotional variables, those with suicidal thoughts reported lower physical health functioning and more pain than those without suicidal thoughts. This is significant because it suggests one of the reasons childhood cancer survivors are at risk for suicidal thoughts is because of health problems they experience as adults.

What are the next steps?

More studies are needed to examine the relationships between suicidal symptoms, cancer treatments and post-treatment health. Currently, the Childhood Cancer Survivor Study is examining a large group of cancer survivors to better understand the relationship of cancer and physical health variables to suicidal thoughts.