Thyroid malignancy and suicide risk: An analysis of epidemiologic and clinical factors

Aim: To date, there has been no specific examination of suicide rates and factors associated with suicide in thyroid cancer. The aim of this study is to examine suicide incidence and associated factors in thyroid cancer patients from 1973 to 2013. Materials and methods: The Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute was queried to identify patients with thyroid cancer from 1973 to 2013. Comparison data with the general US population were derived from the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control using the Web-based Injury Statistics Query and Reporting System (WISQARS). Standardized mortality ratios (SMRs) and multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide. Results: Overall, 154 suicides among 168,339 patients were identified. There was no statistically significant difference in suicide rate with respect to age, marital status, median household income, surgical intervention, stage at diagnosis, or histologic subtype. On multivariable analysis male gender and Caucasian race were associated with increased risk of suicide with ORs of 5.39 and 3.17 respectively. Conclusion: Race and gender appear to influence suicide rates in patients with thyroid cancer. Females and whites were more likely to commit suicide as noted previously. There was no statistically significant relationship between suicide and marital status, income, mode of radiation therapy, and the role of surgical intervention. These results, coupled with further studies and analyses, could be used to formulate a comprehensive suicide risk factor scoring system for screening all cancer patients. Clinical significance: Thyroid cancer is very treatable with excellent long-term survival and outcomes. Improved screening and risk factor stratification in these patients could decrease the incidence of suicide in thyroid cancer patients.