Depression, non-medical pain prescriptions, and suicidal behavior in cancer survivors

A cancer diagnosis results in significant distress and adverse psychosocial sequelae, including suicide, the 10th leading cause of death in the USA. Primary risks for death by suicide include depression and opioid abuse, which are prevalent among cancer survivors. Yet, it remains unclear whether they are also associated with other suicidal outcomes, such as ideation, planning, and suicidal attempt.

We used cross-sectional data from the National Survey on Drug Use and Health (2015-2019, N = 214,271), a nationwide study in the USA that provides data on mental health and other health concerns. Outcome of interest was suicidality (suicidal ideation, planning, and attempt). Main exposures were history of depression and non-medical use of pain prescriptions. Using weighted logistic regression analyses adjusted for sociodemographic factors and substance use, we estimated odds of suicidal ideation, planning, and attempt.

There were 7635 cancer survivors in our study, which was our analytic sample. We found an associations between a history of cancer and suicidal ideation (aOR = 1.32, 95% CI 1.10, 1.58). Among cancer survivors, depression and non-medical use of pain prescriptions were consistently associated with suicidal ideation (aOR_depression = 7.37, 95% CI 4.52, 12.03; aOR_{pain prescriptions} = 3.36, 95% CI 1.27, 8.91, planning (aOR_depression = 10.31, 95% CI 5.79, 18.34; and aOR_{pain prescriptions} = 3.77, 95% CI 1.20, 11.85), and attempt (aOR_depression = 4.29, 95% CI 1.41, 13.06).

Both depression and non-medical pain prescriptions are independently associated with increased odds of suicidal behavior among cancer survivors. Routinely assessing for depression and history of non-medical use of pain prescriptions could be an important suicide prevention strategy in oncology.

Given the increased risk of suicide mortality among cancer survivors, it is critical that risk factors for suicidal behavior, such as depression and use of non-medical pain prescriptions, are routinely screened for as part of cancer care.