Introduction
Suicide is the tenth leading cause
of death in the US, claiming the lives of more than 48,000 individuals
in 20181. It not only represents an individual tragedy
but also takes a staggering toll on global public health. The hitherto
unknown suicidal deaths may have been classified as death from
accidental or unintentional injury23. Both suicide and accidental death are regarded as
external causes of death, and they share common risk factors such as
physical, social, and emotional dysfunction4. Though
the 5-year survival rates of cancer patients have increased over the
past decades, the risk of dying from suicide and accidental death for
those patients remains elevated over time 5.
Epidemiological studies have shown that the rate of death from suicide
and unintentional injury in cancer patients was 1.9 5and 1.6 6 times those of the general population,
respectively.
Gynaecologic cancers represent a major problem affecting women’s health.
Kristy et al. reported that women with gynaecological malignancies were
at a higher risk of suicide compared with those diagnosed with
non-gynaecological malignancies 7. Among gynaecologic
cancers, the patients with ovarian cancer had the highest suicidal rate
among patients with gynaecological malignancies 8. It
was estimated that approximately 75% of ovarian cancer occurs as an
advanced disease 9 because of the lack of effective
screening methods and non-specific symptoms 10. This
resulted in a high recurrence and mortality rate in ovarian cancer
patients. Severe pain, high recurrence rate, intense treatment, and
inferior quality of life from the disease itself and adverse effects of
treatment often caused serious depression and anxiety among patients
with ovarian cancer, which could put them at high risk for suicide and
accidental death 11.
Previous studies have shown higher suicide rates in ovarian cancer
patients compared with other gynaecological malignancies8, however, a direct comparison of the risk of suicide
and accident injury especially among ovarian cancer with the general
population has not been undertaken, and there is currently no literature
on characteristics, incidence, and risk factors for suicide and
accidental death in women with ovarian cancers in details.
As such, to address the current lack of evidence, we conducted a
population-based analysis of the suicide and accidental death among
patients with ovarian cancer. The objective of this study was
to determine the relative risk of
suicide and accidental deaths among ovarian cancer patients compared
with the general population and to identify demographic and
tumour-related characteristics, such as age at diagnosis and
histological subtypes, that is associated with a particularly high risk
of suicide and accidental deaths among ovarian cancer patients.