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

Caroline J Violette; Rachel S Mandelbaum; David J Nusbaum; Christina J Duval; Shinya Matsuzaki; Hiroko Machida; Lynda D Roman; Koji Matsuo

doi:10.1016/j.gore.2019.100510

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

Gynecol Oncol Rep. 2019 Oct 24:30:100510. doi: 10.1016/j.gore.2019.100510. eCollection 2019 Nov.

Authors

Caroline J Violette^{1

2}, Rachel S Mandelbaum¹, David J Nusbaum¹, Christina J Duval¹, Shinya Matsuzaki¹, Hiroko Machida³, Lynda D Roman^{1

4}, Koji Matsuo^{1

4}

Affiliations

¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States.
² Emory University School of Medicine, Atlanta, GA, United States.
³ Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
⁴ Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States.

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.

Keywords: Cervical cancer; Characteristics; Ovarian cancer; Suicide; Trend; Uterine cancer.

Publication types

Case Reports