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Individuals married to patients who are diagnosed with cancer had an increased risk of suicide, according to a nationwide cohort study in Denmark.

A study of more than 2 million people found that spouses of cancer patients had an increased risk of attempting suicide (HR 1.28, 95% CI 1.23-1.34) and death by suicide (HR 1.47, 95% CI 1.35-1.60) compared to people with spouses who were not diagnosed with cancer, according to Qianwei Liu, MD, PhD, of Nanfang Hospital and the Southern Medical University in Guangzhou, China, and co-authors.

The risk was higher in the first year following a spouse's cancer diagnosis for both suicide attempts (HR 1.45, 95% CI 1.27-1.66) and death by suicide (HR 2.56, 95% CI 2.03-3.22), they reported in .

"To our knowledge, this nationwide cohort study is the first to show that spouses of patients with cancer have an elevated risk of both suicide attempt and suicide death," Liu and co-authors wrote.

They added that these findings suggest a need for greater clinical and societal awareness so providers can work to prevent suicidal behaviors in this vulnerable population.

The overall incidence rate was 62.6 per 100,000 person-years for suicide attempts in spouses of cancer patients compared with 50.5 per 100,000 person-years in individuals who did not have a partner diagnosed with cancer. For death by suicide, overall incidence rate was 16.3 vs 11.4 per 100,000 person-years, respectively.

The authors noted that the risk of both outcomes for individuals was also greater when their spouse's cancer was diagnosed at an advanced stage or when they died after the cancer diagnosis. An increased risk of suicide attempt and suicide death was seen for most cancer types studied, though not always statistically significant.

Cancers with the highest risk of suicide death included pancreatic (HR 3.01, 95% CI 2.08-4.38), liver and biliary passage (HR 3.00, 95% CI 1.83-4.91), esophageal (HR 2.74, 95% CI 1.42-5.27), kidney (HR 2.70, 95% CI 1.79-4.07), and central nervous system (HR 2.46, 95% CI 1.55-3.92).

"A greater burden of the disease may contribute to a higher level of psychological distress of the patient with cancer and a greater need of support and caregiving from their loved ones, particularly the spouse," study authors wrote.

In , Casey Crump, MD, PhD, of The University of Texas Health Science Center, and Weiva Sieh, MD, PhD, of The University of Texas MD Anderson Cancer Center, both in Houston, wrote that these findings show spouses of cancer patients need to be considered during follow-up care.

"These latest findings add to other recent evidence showing increased risks of depression or hospitalization for new onset psychiatric disorders (especially depression and stress-related disorders) in spouses of patients with any cancer," they wrote.

Crump and Sieh concluded that this research shows the need for greater awareness around the psychological challenges faced by the loved ones of cancer patients.

"At health visits in either oncology or primary care clinics, spouses should be screened for psychosocial distress and connected to resources that will support their long-term mental health and well-being," they wrote.

For this cohort study, researchers collected data from the Danish Civil Registration System and Danish Cancer Registry on 409,338 individuals who had a spouse with a cancer diagnosis and 2,046,682 individuals whose spouse did not have a cancer diagnosis from 1986 through 2016.

All study individuals were randomly selected from the general population and matched by birth year and sex. Median age at cohort entry was 63 (IQR 54-70) years in both groups, and the majority were women (55.4%).

During the follow-up period, there were a total of 2,714 incidents of attempted suicide and 711 cases of death by suicide among individuals who had a spouse with a cancer diagnosis. Among individuals whose spouse did not have a cancer diagnosis, there were 9,994 incidents of attempted suicide and 2,270 cases of death by suicide.

The researchers used ICD codes to determine both cancer and suicide-related outcomes.

The authors noted that the study had several limitations, including the potential for residual confounding factors. They also used a specific definition for counting suicide attempts and deaths by suicide, such as not including "fatal or nonfatal events with undetermined intent."

Finally, they only identified registered heterosexual spouses, which means these findings do not represent other spousal caregivers such as unregistered partners and homosexual partners.

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