Cancer diagnosis in children ups risk of parental suicide attempt

The risk of suicide attempts among parents of children with cancer is higher during the first years following cancer diagnosis, particularly when the child is diagnosed at age 18 years or below, or with an aggressive or fatal form of cancer, a study has found.

“There was, however, no altered risk of parental death by suicide at any time after a child’s cancer diagnosis,” the authors said. “Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.”

The study included 106,005 exposed parents matched to 1,060,050 unexposed parents (median age 56 years, 46.9 percent male). Overall, 613 (incidence rate [IR], 58.8 per 100,000 person-years [PY]) and 5,888 (IR, 57.1 per 100,000 PY) first-onset suicide attempts occurred among the exposed and unexposed parents, respectively, during a median follow-up of 7.3 and 7.2 years. [PLoS Med 2024;21:e1004322]

Parental suicide attempt risk increased during the initial years following a child’s cancer diagnosis (hazard ratio [HR], 1.15, 95 percent confidence interval [CI], 1.03‒1.28; p=0.01), especially when the child was 18 years of age or younger at diagnosis (HR, 1.25, 95 percent CI, 1.08‒1.46; p=0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60, 95 percent CI, 1.05‒2.43; p=0.03), or when the child  died due to cancer (HR, 1.63, 95 percent CI, 1.29‒2.06; p<0.001).

However, this increased risk did not persist afterwards (HR, 0.86, 95 percent CI, 0.75‒0.98; p=0.03). In addition, no change was seen in the risk of parental death by suicide at any time following the child’s cancer diagnosis. These findings were confirmed in sibling comparisons.

Severe stress

“Having a child with cancer is a severely stressful life event,” the authors said. “The observed increased risk of parental suicide attempt within the first years after a child cancer diagnosis might be attributed to the psychological distress of having a child receiving a cancer diagnosis and the subsequent treatment of cancer.” [J Pediatr Psychol 2012;37:185-197]

The observed increase in parent suicide attempt risk could also be attributed to the changes in financial and marital status as a result of a child’s cancer diagnosis. [Cancer 2017;123:1238-1248; Cancer 2017;123:1238-1248]

“Our findings suggest the need [for] extended clinical awareness for the risk of suicide attempt among parents of children with cancer, primarily during the first years after cancer diagnosis,” the authors said. “Vigilance and interventions for severe psychological distress and psychiatric symptoms might be important and effective.”

In this binational population-based and sibling-controlled cohort study, 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) were recruited.

The authors identified suicide attempt using the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden. They also identified death by suicide through the Danish Causes of Death Register and the Swedish Causes of Death Register.

Cox regression was used in the population comparison to estimate the HRs of suicide attempt and death by suicide associated with a child’s cancer diagnosis. Adjustments were made for sex, age, country of residence, calendar year, martial status, highest attained educational level, household income, cancer history, psychiatric disorder history, and family history of psychiatric disorder.

Finally, the authors performed sibling comparison to explore the role of familial confounding the associations assessed.