Suicide ideation and associated mortality in adult survivors of childhood cancer

Cancer. 2014 Jan 15;120(2):271-7. doi: 10.1002/cncr.28385. Epub 2013 Oct 7.


Background: Adult survivors of childhood cancer are at risk for suicide ideation, although longitudinal patterns and rates of recurrent suicide ideation are unknown. This study investigated the prevalence of late report (ie, after initial assessment) and recurrent suicide ideation in adult survivors of childhood cancer, identified predictors of suicide ideation, and examined associations among suicide ideation and mortality.

Methods: Participants included 9128 adult survivors of childhood cancer and 3082 sibling controls enrolled in the Childhood Cancer Survivor Study who completed a survey question assessing suicide ideation on one or more occasions between 1994 and 2010. Suicide ideation was assessed using the Brief Symptom Inventory-18 instrument. Mortality data was ascertained from the National Death Index.

Results: Survivors were more likely to report late (odds ratio [OR] =1.9, 95% confidence interval [CI] =1.5-2.5) and recurrent suicide ideation (OR=2.6, 95% CI=1.8-3.8) compared to siblings. Poor physical health status was associated with increased risk of suicide ideation in survivors (late report: OR=1.9, 95% CI=1.3-2.7; recurrent: OR=1.9, 95% CI=1.2-2.9). Suicide ideation was associated with increased risk for all-cause mortality (hazard ratio=1.3, 95% CI=1.03-1.6) and death by external causes (hazard ratio=2.4, 95% CI=1.4-4.1).

Conclusions: Adult survivors of childhood cancer are at risk for late-report and recurrent suicide ideation, which is associated with increased risk of mortality. Routine screening for psychological distress in adult survivors appears warranted, especially for survivors who develop chronic physical health conditions.

Keywords: childhood cancer; late effects; mortality; suicide; survivorship.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Case-Control Studies
  • Child
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Male
  • Neoplasms / mortality
  • Neoplasms / psychology*
  • Neoplasms / therapy
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Siblings
  • Stress, Psychological / etiology
  • Suicide / psychology*
  • Suicide / statistics & numerical data
  • Survivors / psychology*