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Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis

Published online by Cambridge University Press:  23 November 2020

Vera Yu Men Open the ORCID record for Vera Yu Men [Opens in a new window] ,
Clifton Robert Emery ,
Tai-Chung Lam  and
Paul Siu Fai Yip
Vera Yu Men
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
Clifton Robert Emery
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
Tai-Chung Lam
Affiliation:
Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR
Paul Siu Fai Yip*
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR
*
Author for correspondence: Paul Siu Fai Yip, E-mail: [email protected]
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Abstract

Background

Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors.

Methods

Patients aged 10 or above who received their first cancer-related hospital admission (2002–2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender.

Results

In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender.

Conclusions

Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.

Keywords

palliative carepsycho-oncologysuicide prevention
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 12 , September 2022 , pp. 2342 - 2351
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Abgrall-Barbry, G., & Consoli, S. M. (2006). L'approche psychologique dans le traitement de l'hypertension artérielle. La Presse Médicale, 35(6), 1088–1094. https://doi.org/10.1016/S0755-4982(06)74753-4.CrossRefGoogle Scholar
Aboumrad, M., Shiner, B., Riblet, N., Mills, P. D., & Watts, B. V. (2018). Factors contributing to cancer-related suicide: A study of root-cause analysis reports. Psycho-Oncology, 27(9), 2237–2244. https://doi.org/10.1002/pon.4815.CrossRefGoogle ScholarPubMed
Ahmedani, B. K., Peterson, E. L., Hu, Y., Rossom, R. C., Lynch, F., Lu, C. Y., … Simon, G. E. (2017). Major physical health conditions and risk of suicide. American Journal of Preventive Medicine, 53(3), 308–315. https://doi.org/10.1016/j.amepre.2017.04.001.CrossRefGoogle ScholarPubMed
Anderson, C., Park, E. M., Rosenstein, D. L., & Nichols, H. B. (2018). Suicide rates among patients with cancers of the digestive system. Psycho-Oncology, 27(9), 2274–2280. https://doi.org/10.1002/pon.4827.CrossRefGoogle ScholarPubMed
Anguiano, L., Mayer, D. K., Piven, M. L., & Rosenstein, D. (2012). A literature review of suicide in cancer patients. Cancer Nursing, 35(4), E14–E26. https://doi.org/10.1097/NCC.0b013e31822fc76c.CrossRefGoogle ScholarPubMed
Arnold, M., Rutherford, M. J., Bardot, A., Ferlay, J., Andersson, T. M. L., Myklebust, T. Å., … Bray, F. (2019). Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): A population-based study. The Lancet Oncology, 20(11), 1493–1505. https://doi.org/10.1016/S1470-2045(19)30456-5.CrossRefGoogle ScholarPubMed
Austin, P. C., & Fine, J. P. (2017). Practical recommendations for reporting Fine-Gray model analyses for competing risk data. Statistics in Medicine, 36(27), 4391–4400. https://doi.org/10.1002/sim.7501.CrossRefGoogle ScholarPubMed
Barbas, A. S., Turley, R. S., Ceppa, E. P., Reddy, S. K., Blazer, D. G., Clary, B. M., … Lagoo, S. A. (2012). Comparison of outcomes and the use of multimodality therapy in young and elderly people undergoing surgical resection of pancreatic cancer. Journal of the American Geriatrics Society, 60(2), 344–350. https://doi.org/10.1111/j.1532-5415.2011.03785.x.CrossRefGoogle Scholar
Borges, G., Chiu, W. T., Hwang, I., Panchal, B., Ono, Y., Sampson, N. A., … Nock, M. K. (2012). Prevalence, onset, and transitions among suicidal behaviors. In Nock, M. K., Borges, G., & Ono, Y. (Eds.), Suicide: Global perspectives from the WHO world mental health surveys (p. 66). Cambridge, United Kingdom: Cambridge University Press.Google Scholar
Bowden, M. B., Walsh, N. J., Jones, A. J., Talukder, A. M., Lawson, A. G., & Kruse, E. J. (2017). Demographic and clinical factors associated with suicide in gastric cancer in the United States. Journal of Gastrointestinal Oncology, 8(5), 897–901. https://doi.org/10.21037/jgo.2017.08.02.CrossRefGoogle ScholarPubMed
Butow, P., Price, M. A., Shaw, J. M., Turner, J., Clayton, J. M., Grimison, P., … Kirsten, L. (2015). Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psycho-Oncology, 24(9), 987–1001. https://doi.org/10.1002/pon.3920.CrossRefGoogle ScholarPubMed
Camidge, D. R., Stockton, D. L., Frame, S., Wood, R., Bain, M., & Bateman, D. N. (2007). Hospital admissions and deaths relating to deliberate self-harm and accidents within 5 years of a cancer diagnosis: A national study in Scotland, UK. British Journal of Cancer, 96(5), 752–757. https://doi.org/10.1038/sj.bjc.6603617.CrossRefGoogle ScholarPubMed
Carr, M. J., Ashcroft, D. M., Kontopantelis, E., Awenat, Y., Cooper, J., Chew-Graham, C., … Webb, R. T. (2016). The epidemiology of self-harm in a UK-wide primary care patient cohort, 2001–2013. BMC Psychiatry, 16(1), 53. https://doi.org/10.1186/s12888-016-0753-5.CrossRefGoogle Scholar
Centers for Disease Control and Protection. (2019). Risk and Protective Factors for Suicide. Retrieved from https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html.Google Scholar
Chai, Y., Luo, H., Wong, G. H. Y., Tang, J. Y. M., Lam, T.-C., Wong, I. C. K., & Yip, P. S. F. (2020). Risk of self-harm after the diagnosis of psychiatric disorders in Hong Kong, 2000–10: A nested case-control study. The Lancet Psychiatry, 7(2), 135–147. https://doi.org/10.1016/S2215-0366(20)30004-3.CrossRefGoogle Scholar
Chang, S.-S., Sterne, J. A. C., Lu, T.-H., & Gunnell, D. (2010). ‘Hidden’ suicides amongst deaths certified as undetermined intent, accident by pesticide poisoning and accident by suffocation in Taiwan. Social Psychiatry and Psychiatric Epidemiology, 45(2), 143–152. https://doi.org/10.1007/s00127-009-0049-x.CrossRefGoogle ScholarPubMed
Chen, Y. Y., Wu, K. C.-C., Yousuf, S., & Yip, P. S. F. (2012). Suicide in Asia: Opportunities and challenges. Epidemiologic Reviews, 34(1), 129–144. https://doi.org/10.1093/epirev/mxr025.CrossRefGoogle ScholarPubMed
Cheung, G., Douwes, G., & Sundram, F. (2017). Late-life suicide in terminal cancer: A rational act or underdiagnosed depression? Journal of Pain and Symptom Management, 54(6), 835–842. https://doi.org/10.1016/j.jpainsymman.2017.05.004.CrossRefGoogle ScholarPubMed
Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. The Journal of Alternative and Complementary Medicine, 15(5), 593–600. https://doi.org/10.1089/acm.2008.0495.CrossRefGoogle ScholarPubMed
Chou, C.-L., Chang, S.-C., Lin, T.-C., Chen, W.-S., Jiang, J.-K., Wang, H.-S., … Lin, J.-K. (2011). Differences in clinicopathological characteristics of colorectal cancer between younger and elderly patients: An analysis of 322 patients from a single institution. The American Journal of Surgery, 202(5), 574–582. https://doi.org/10.1016/j.amjsurg.2010.10.014.CrossRefGoogle ScholarPubMed
Dinas, P. C., Koutedakis, Y., & Flouris, A. D. (2011). Effects of exercise and physical activity on depression. Irish Journal of Medical Science, 180(2), 319–325. https://doi.org/10.1007/s11845-010-0633-9.CrossRefGoogle ScholarPubMed
Georg Hsu, L. K., Wan, Y. M., Chang, H., Summergrad, P., Tsang, B. Y. P., & Chen, H. (2008). Stigma of depression is more severe in Chinese Americans than Caucasian Americans. Psychiatry: Interpersonal and Biological Processes, 71(3), 210–218. https://doi.org/10.1521/psyc.2008.71.3.210.CrossRefGoogle ScholarPubMed
Henson, K. E., Brock, R., Charnock, J., Wickramasinghe, B., Will, O., & Pitman, A. (2019). Risk of suicide after cancer diagnosis in England. JAMA Psychiatry, 76(1), 51–60. https://doi.org/10.1001/jamapsychiatry.2018.3181.CrossRefGoogle ScholarPubMed
Hinz, A., Weis, J., Faller, H., Brähler, E., Härter, M., Keller, M., … Mehnert, A. (2018). Quality of life in cancer patients – a comparison of inpatient, outpatient, and rehabilitation settings. Supportive Care in Cancer, 26(10), 3533–3541. https://doi.org/10.1007/s00520-018-4211-4.CrossRefGoogle ScholarPubMed
Hong Kong Cancer Registry. (2017). Overview of 2009 Hong Kong Cancer Statistics. Retrieved from https://www3.ha.org.hk/cancereg/pdf/overview/SummaryofCanStat 2009.pdf.Google Scholar
Hong Kong Hospital Authority. (2020). Palliative Care Service. Retrieved from https://www.ha.org.hk/visitor/ha_visitor_text_index.asp?Content_ID=10096&Lang=ENG&Dimension=100.Google Scholar
Hu, W.-S., & Lin, C.-L. (2020). A retrospective study of suicide attempts in patients with pulmonary hypertension. Heart, Lung and Circulation, 29(9), e231–e237. https://doi.org/10.1016/j.hlc.2020.02.005.CrossRefGoogle ScholarPubMed
Joo, E.-H., Rha, S.-Y., Ahn, J. B., & Kang, H.-Y. (2011). Economic and patient-reported outcomes of outpatient home-based versus inpatient hospital-based chemotherapy for patients with colorectal cancer. Supportive Care in Cancer, 19(7), 971–978. https://doi.org/10.1007/s00520-010-0917-7.CrossRefGoogle ScholarPubMed
Kam, D., Salib, A., Gorgy, G., Patel, T. D., Carniol, E. T., Eloy, J. A., … Park, R. C. W. (2015). Incidence of suicide in patients with head and neck cancer. JAMA Otolaryngology – Head and Neck Surgery, 141(12), 1075–1081. https://doi.org/10.1001/jamaoto.2015.2480.CrossRefGoogle ScholarPubMed
Kassianos, A. P., Ioannou, M., Koutsantoni, M., & Charalambous, H. (2018). The impact of specialized palliative care on cancer patients’ health-related quality of life: A systematic review and meta-analysis. Supportive Care in Cancer, 26(1), 61–79. https://doi.org/10.1007/s00520-017-3895-1.CrossRefGoogle ScholarPubMed
Klaassen, Z., Arora, K., Wilson, S. N., King, S. A., Madi, R., Neal, D. E., … Terris, M. K. (2018). Decreasing suicide risk among patients with prostate cancer: Implications for depression, erectile dysfunction, and suicidal ideation screening. Urologic Oncology: Seminars and Original Investigations, 36(2), 60–66. https://doi.org/10.1016/j.urolonc.2017.09.007.CrossRefGoogle ScholarPubMed
Komic, A., Taludker, A., Walsh, N., Jones, A., Lawson, A., Bateson, B., & Kruse, E. J. (2017). Suicide risk in melanoma: What do we know? The American Surgeon, 83(11), e435–e437. http://www.ncbi.nlm.nih.gov/pubmed/30454229.CrossRefGoogle ScholarPubMed
Law, S. C., & Mang, O. W. (2011). Cancer survival in Hong Kong SAR, China, 1996–2001. In Sankaranarayanan, R., & Swaminathan, R. (Eds.), Cancer survival in Africa, Asia, the Caribbean and Central America (p. 40). Lyon, France: International Agency for Research on Cancer, World Health Organization.Google Scholar
Leong, J. C. Y. (n.d.). Hospital Authority of Hong Kong. Retrieved from https://www.ha.org.hk/haho/ho/hesd/attachments/oppo_HospitalAuthority-Overview.pdf.Google Scholar
Ma, Y., & Mak, K. (2012). Management of depression in cancer patients. The Hong Kong Practitioner, 34(4), 154–159.Google Scholar
Mako, C., Galek, K., & Poppito, S. R. (2006). Spiritual pain among patients with advanced cancer in palliative care. Journal of Palliative Medicine, 9(5), 1106–1113. https://doi.org/10.1089/jpm.2006.9.1106.CrossRefGoogle ScholarPubMed
McPherson, C. J., Wilson, K. G., & Murray, M. A. (2007). Feeling like a burden to others: A systematic review focusing on the end of life. Palliative Medicine, 21(2), 115–128. https://doi.org/10.1177/0269216307076345.CrossRefGoogle Scholar
Misono, S., Weiss, N. S., Fann, J. R., Redman, M., & Yueh, B. (2008). Incidence of suicide in persons with cancer. Journal of Clinical Oncology, 26(29), 4731–4738. https://doi.org/10.1200/JCO.2007.13.8941.CrossRefGoogle ScholarPubMed
Mix, J. M., Granger, C. V., LaMonte, M. J., Niewczyk, P., DiVita, M. A., Goldstein, R., … Freudenheim, J. L. (2017). Characterization of cancer patients in inpatient rehabilitation facilities: A retrospective cohort study. Archives of Physical Medicine and Rehabilitation, 98(5), 971–980. https://doi.org/10.1016/j.apmr.2016.12.023.CrossRefGoogle ScholarPubMed
Mystakidou, K., Parpa, E., Katsouda, E., Galanos, A., & Vlahos, L. (2004). Influence of pain and quality of life on desire for hastened death in patients with advanced cancer. International Journal of Palliative Nursing, 10(10), 476–483. https://doi.org/10.12968/ijpn.2004.10.10.16211.CrossRefGoogle ScholarPubMed
Normand, C. L., & Mishara, B. L. (1992). The development of the concept of suicide in children. OMEGA – Journal of Death and Dying, 25(3), 183–203. https://doi.org/10.2190/7TG9-NVG3-1RBJ-UDAH.CrossRefGoogle Scholar
Olden, M., Pessin, H., Lichtenthal, W. G., & Breitbart, W. (2012). Suicide and desire for hastened death in the terminally ill. In Chochinov, H. M., & Breitbart, W. (Eds.), Handbook of psychiatry in palliative medicine (p. 103). Oxford, United Kingdom: Oxford University Press.Google Scholar
Parker, G., Gladstone, G., & Chee, K. T. (2001). Depression in the planet's largest ethnic group: The Chinese. American Journal of Psychiatry, 158(6), 857–864. https://doi.org/10.1176/appi.ajp.158.6.857.CrossRefGoogle ScholarPubMed
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.-C., … Ghali, W. A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care, 43(11), 1130–1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83.CrossRefGoogle ScholarPubMed
Rahouma, M., Kamel, M., Abouarab, A., Eldessouki, I., Nasar, A., Harrison, S., … Port, J. L. (2018). Lung cancer patients have the highest malignancy-associated suicide rate in USA: A population-based analysis. Ecancermedicalscience, 12, 1–12. https://doi.org/10.3332/ecancer.2018.859.CrossRefGoogle ScholarPubMed
Ravaioli, A., Crocetti, E., Mancini, S., Baldacchini, F., Giuliani, O., Vattiato, R., … Falcini, F. (2020). Suicide death among cancer patients: New data from northern Italy, systematic review of the last 22 years and meta-analysis. European Journal of Cancer, 125, 104–113. https://doi.org/10.1016/j.ejca.2019.08.019.CrossRefGoogle ScholarPubMed
Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies. British Journal of Psychiatry, 212(5), 279–286. https://doi.org/10.1192/bjp.2018.27.CrossRefGoogle ScholarPubMed
Riechelmann, R. P., Krzyzanowska, M. K., O'Carroll, A., & Zimmermann, C. (2007). Symptom and medication profiles among cancer patients attending a palliative care clinic. Supportive Care in Cancer, 15(12), 1407–1412. https://doi.org/10.1007/s00520-007-0253-8.CrossRefGoogle ScholarPubMed
Roy, S., Vallepu, S., Barrios, C., & Hunter, K. (2018). Comparison of comorbid conditions between cancer survivors and age-matched patients without cancer. Journal of Clinical Medicine Research, 10(12), 911–919. https://doi.org/10.14740/jocmr3617w.CrossRefGoogle ScholarPubMed
Samawi, H. H., Shaheen, A. A., Tang, P. A., Heng, D. Y. C., Cheung, W. Y., & Vickers, M. M. (2017). Risk and predictors of suicide in colorectal cancer patients: A surveillance, epidemiology, and end results analysis. Current Oncology, 24(6), e513–e517. https://doi.org/10.3747/co.24.3713.CrossRefGoogle ScholarPubMed
Sarfati, D., Gurney, J., Lim, B. T., Bagheri, N., Simpson, A., Koea, J., & Dennett, E. (2016). Identifying important comorbidity among cancer populations using administrative data: Prevalence and impact on survival. Asia-Pacific Journal of Clinical Oncology, 12(1), e47–e56. https://doi.org/10.1111/ajco.12130.CrossRefGoogle ScholarPubMed
Sarkar, S., & Balhara, Y. P. (2014). Diabetes mellitus and suicide. Indian Journal of Endocrinology and Metabolism, 18(4), 468. https://doi.org/10.4103/2230-8210.137487.Google ScholarPubMed
Schneider, K. L., & Shenassa, E. (2008). Correlates of suicide ideation in a population-based sample of cancer patients. Journal of Psychosocial Oncology, 26(2), 49–62. https://doi.org/10.1300/J077v26n02_04.CrossRefGoogle Scholar
Semlitsch, T., Jeitler, K., Hemkens, L. G., Horvath, K., Nagele, E., Schuermann, C., … Siebenhofer, A. (2013). Increasing physical activity for the treatment of hypertension: A systematic review and meta-analysis. Sports Medicine, 43(10), 1009–1023. https://doi.org/10.1007/s40279-013-0065-6.CrossRefGoogle ScholarPubMed
Sheldon, K. M., Houser-Marko, L., & Kasser, T. (2006). Does autonomy increase with age? Comparing the goal motivations of college students and their parents. Journal of Research in Personality, 40(2), 168–178. https://doi.org/10.1016/j.jrp.2004.10.004.CrossRefGoogle Scholar
Siracuse, B. L., Gorgy, G., Ruskin, J., & Beebe, K. S. (2017). What is the incidence of suicide in patients with bone and soft tissue cancer?: Suicide and sarcoma. Clinical Orthopaedics and Related Research, 475(5), 1439–1445. https://doi.org/10.1007/s11999-016-5171-y.CrossRefGoogle ScholarPubMed
Smailyte, G., Jasilionis, D., Kaceniene, A., Krilaviciute, A., Ambrozaitiene, D., & Stankuniene, V. (2013). Suicides among cancer patients in Lithuania: A population-based census-linked study. Cancer Epidemiology, 37(5), 714–718. https://doi.org/10.1016/j.canep.2013.05.009.CrossRefGoogle ScholarPubMed
Song, Q.-H., Xu, R.-M., Zhang, Q.-H., Ma, M., & Zhao, X.-P. (2013). Relaxation training during chemotherapy for breast cancer improves mental health and lessens adverse events. International Journal of Clinical and Experimental Medicine, 6(10), 979–984. http://www.ncbi.nlm.nih.gov/pubmed/24260607.Google ScholarPubMed
Steinberg, L., Albert, D., Cauffman, E., Banich, M., Graham, S., & Woolard, J. (2008). Age differences in sensation seeking and impulsivity as indexed by behavior and self-report: Evidence for a dual systems model. Developmental Psychology, 44(6), 1764–1778. https://doi.org/10.1037/a0012955.CrossRefGoogle ScholarPubMed
Sullivan, D. R., Forsberg, C. W., Golden, S. E., Ganzini, L., Dobscha, S. K., & Slatore, C. G. (2018). Incidence of suicide and association with palliative care among patients with advanced lung cancer. Annals of the American Thoracic Society, 15(11), 1357–1359. https://doi.org/10.1513/AnnalsATS.201805-299RL.CrossRefGoogle ScholarPubMed
Tang, S. T. (2000). Meanings of dying at home for Chinese patients in Taiwan with terminal cancer. Cancer Nursing, 23(5), 367–370. https://doi.org/10.1097/00002820-200010000-00007.CrossRefGoogle ScholarPubMed
Tang, G. X., Yan, P. P., Yan, C. L., Fu, B., Zhu, S. J., Zhou, L. Q., … Lei, J. (2016). Determinants of suicidal ideation in gynecological cancer patients. Psycho-Oncology, 25(1), 97–103. https://doi.org/10.1002/pon.3880.CrossRefGoogle ScholarPubMed
Urban, D., Rao, A., Bressel, M., Neiger, D., Solomon, B., & Mileshkin, L. (2013). Suicide in lung cancer: Who is at risk? Chest, 144(4), 1245–1252. https://doi.org/10.1378/chest.12-2986.CrossRefGoogle ScholarPubMed
Vyssoki, B., Gleiss, A., Rockett, I. R. H., Hackl, M., Leitner, B., Sonneck, G., & Kapusta, N. D. (2015). Suicide among 915303 Austrian cancer patients: Who is at risk? Journal of Affective Disorders, 175(2015), 287–291. https://doi.org/10.1016/j.jad.2015.01.028.CrossRefGoogle ScholarPubMed
Walker, J., & Sharpe, M. (2009). Depression care for people with cancer: A collaborative care intervention. General Hospital Psychiatry, 31(5), 436–441. https://doi.org/10.1016/j.genhosppsych.2009.05.010.CrossRefGoogle ScholarPubMed
Wang, B., An, X., Shi, X., & Zhang, J. (2017). Management of Endocrine Disease: Suicide risk in patients with diabetes: A systematic review and meta-analysis. European Journal of Endocrinology, 177(4), R169–R181. https://doi.org/10.1530/EJE-16-0952.CrossRefGoogle ScholarPubMed
Weinberger, M. I., Roth, A. J., & Nelson, C. J. (2009). Untangling the complexities of depression diagnosis in older cancer patients. The Oncologist, 14(1), 60–66. https://doi.org/10.1634/theoncologist.2008-0147.CrossRefGoogle ScholarPubMed
Wilson, K. G., Chochinov, H. M., Graham Skirko, M., Allard, P., Chary, S., Gagnon, P. R., … Clinch, J. J. (2007). Depression and anxiety disorders in palliative cancer care. Journal of Pain and Symptom Management, 33(2), 118–129. https://doi.org/10.1016/j.jpainsymman.2006.07.016.CrossRefGoogle ScholarPubMed
Wong, G. L., Wong, V. W., Yuen, B. W., Tse, Y., Luk, H. W., Yip, T. C., … Chan, H. L. (2020). An aging population of chronic hepatitis B with increasing comorbidities: A territory-wide study from 2000 to 2017. Hepatology, 71(2), 444–455. https://doi.org/10.1002/hep.30833.CrossRefGoogle ScholarPubMed
Yeung, S. L. (2015). Assessing and managing potentially suicidal patients: Practical guidelines for doctors. Retrieved from https://csrp.hku.hk/wp-content/uploads/2015/06/DoctorGuidelines.pdf.Google Scholar
Yip, P. S. F, & Zheng, Y.. (2020). The impact of suicide on life expectancy: A Hong Kong experience. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 1–7. https://doi.org/10.1027/0227-5910/a000695.Google Scholar
Yung, N. C. L., Wong, C. S. M., Chan, J. K. N., Or, P. C. F., Chen, E. Y. H., & Chang, W. C. (2020). Mortality in patients with schizophrenia admitted for incident ischemic stroke: A population-based cohort study. European Neuropsychopharmacology, 31, 152–157. https://doi.org/10.1016/j.euroneuro.2019.12.107.CrossRefGoogle ScholarPubMed
Zaorsky, N. G., Zhang, Y., Tuanquin, L., Bluethmann, S. M., Park, H. S., & Chinchilli, V. M. (2019). Suicide among cancer patients. Nature Communications, 10(1), 1–7. https://doi.org/10.1038/s41467-018-08170-1.Google ScholarPubMed
Zhong, B. L., Li, S. H., Lv, S. Y., Tian, S. L., Liu, Z. D., Li, X. B., … Zhuo, C. J. (2017). Suicidal ideation among Chinese cancer inpatients of general hospitals: Prevalence and correlates. Oncotarget, 8(15), 25141–25150. https://doi.org/10.18632/oncotarget.15350.CrossRefGoogle ScholarPubMed
Zimmermann, C., Swami, N., Krzyzanowska, M., Leighl, N., Rydall, A., Rodin, G., … Hannon, B. (2016). Perceptions of palliative care among patients with advanced cancer and their caregivers. Canadian Medical Association Journal, 188(10), E217–E227. https://doi.org/10.1503/cmaj.151171.CrossRefGoogle ScholarPubMed