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Suicide and Desire for Hastened Death in Cancer Settings Alex Mitchell, Consultant in Psycho-oncology Leicester General Ho...
Introduction
Suicide Statistics in the UK <ul><li>Annual number of Suicides in UK 5,000 => 3500 </li></ul><ul><li>Annual number of Homi...
Suicide Epidemiology I  – By Age Suicide rates previously increased with age, but now are very similar in men and woman ac...
Antidepressants Prescriptions & Suicide
DSH & Suicide Overview DSH (150,000) Suicide (5000) Depressed (30%) Depressed (80%) General Pop’n 0.01% 1% 70% 30% Depress...
In Cancer
Ladder of Suicide Risk Hopelessness & demoralization Desire for a hastened death Suicidal thoughts Suicidal intent Suicida...
Chochinov – DHD Scale (1995) <ul><li>“ Do you ever wish that your illness would progress more rapidly so that your sufferi...
Rating the DHD Scale <ul><li>No information/refusal to answer </li></ul><ul><li>No desire to die soon </li></ul><ul><li>Sl...
 
Rates of DHD <ul><li>44% mild 8% severe in 200 palliative patients </li></ul>
Schedule of Attitudes toward Hastened Death <ul><li>(1) I feel confident that I will be able to cope with the emotional st...
Schedule of Attitudes toward Hastened Death <ul><li>(11) I have stopped treatment for my illness because I would prefer to...
Breitbart et al (2000) <ul><li>92 palliative patients </li></ul><ul><li>45% endorsed 4 or more items </li></ul><ul><li>17%...
 
PHQ9
Leicester Oncology Study – Lord et al <ul><li>We analysed data collected from Leicester Cancer Centre from 2008-2009 invol...
Main Results <ul><li>Of 554 patients 44 had some suicidal thoughts (8%) </li></ul><ul><li>Of 554 patients 12 had regular s...
By Ethnicity <ul><li>BW </li></ul><ul><li>113 people had major or minor depression. 24 had suicidal thoughts (21.2%) </li>...
Suicidal thoughts and desire for help <ul><li>Of 44 with some suicidal thoughts 30 would consider accepting help (68%) </l...
Predictors 1 <ul><li>THERMOMETERS </li></ul><ul><li>depression thermometer b4  = 0.39 z = 3.76 </li></ul><ul><li>MINI-MAC ...
Predictors 2 <ul><li>Insurance problems b2  = -2.62 z = -2.10 P = 0.035 </li></ul><ul><li>Transportation problems b4  = -2...
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Suicide and desire for hastened death (edit)

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This is a very short presentation on suicide and desire for hastened death in cancer settings.

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Suicide and desire for hastened death (edit)

  1. 1. Suicide and Desire for Hastened Death in Cancer Settings Alex Mitchell, Consultant in Psycho-oncology Leicester General Hospital LOROS 2011
  2. 2. Introduction
  3. 3. Suicide Statistics in the UK <ul><li>Annual number of Suicides in UK 5,000 => 3500 </li></ul><ul><li>Annual number of Homicides in UK 1,000 </li></ul><ul><li>Annual number of Suicides in USA 30,000 </li></ul><ul><li>Annual number of Homicides in USA 15,000 </li></ul><ul><li>Suicide (all ages) is the 8 th commonest cause of death </li></ul><ul><li>Suicide in adolescents is the 3 rd commonest cause of death </li></ul><ul><li>Annual Suicide rate is 10 per 100,000 population </li></ul>
  4. 4. Suicide Epidemiology I – By Age Suicide rates previously increased with age, but now are very similar in men and woman across age groups
  5. 5. Antidepressants Prescriptions & Suicide
  6. 6. DSH & Suicide Overview DSH (150,000) Suicide (5000) Depressed (30%) Depressed (80%) General Pop’n 0.01% 1% 70% 30% Depressed (5%)
  7. 7. In Cancer
  8. 8. Ladder of Suicide Risk Hopelessness & demoralization Desire for a hastened death Suicidal thoughts Suicidal intent Suicidal plans
  9. 9. Chochinov – DHD Scale (1995) <ul><li>“ Do you ever wish that your illness would progress more rapidly so that your suffering could be over sooner?” </li></ul><ul><li>  If the patient responds affirmatively ask: </li></ul><ul><ul><li>“ Do you wish you were already dead?” </li></ul></ul><ul><ul><li>“ Do you pray for an early death?” </li></ul></ul><ul><ul><li>“ Have you discussed with anyone that your desire is to have an early death?” </li></ul></ul>
  10. 10. Rating the DHD Scale <ul><li>No information/refusal to answer </li></ul><ul><li>No desire to die soon </li></ul><ul><li>Slight desire </li></ul><ul><ul><li>has had occasional fleeting thoughts </li></ul></ul><ul><li>Mild desire </li></ul><ul><ul><li>often feels that he/she would like to die, but not always) </li></ul></ul><ul><li>Moderate desire </li></ul><ul><ul><li>has a genuine desire for death; has discussed this desire with others, but is not consumed with the prospect) </li></ul></ul><ul><li>Strong desire </li></ul><ul><ul><li>has difficulty diverting thoughts from the desire to die; prays for death) </li></ul></ul><ul><li>Extreme desire </li></ul><ul><ul><li>obsessed with the wish for death; talks of little else; asks for euthanasia; prays for death almost constantly) </li></ul></ul>
  11. 12. Rates of DHD <ul><li>44% mild 8% severe in 200 palliative patients </li></ul>
  12. 13. Schedule of Attitudes toward Hastened Death <ul><li>(1) I feel confident that I will be able to cope with the emotional stress of my illness. </li></ul><ul><li>(2) I expect to suffer a great deal from emotional problems in the future because of my illness. </li></ul><ul><li>(3) My illness has drained me so much that I do not want to go on living. </li></ul><ul><li>(4) I am seriously considering asking my doctor for help in ending my life. </li></ul><ul><li>(5) Unless my illness improves I will consider taking steps to end my life. </li></ul><ul><li>(6) Dying seems like the best way to relieve the pain and discomfort my illness causes. </li></ul><ul><li>(7) Despite my illness my life still has purpose and meaning. </li></ul><ul><li>(8) I am careless about my treatment because I want to let the disease run its course. </li></ul><ul><li>(9) I want to continue living no matter how much pain or suffering my disease causes. </li></ul><ul><li>(10) I hope my disease will progress rapidly because I would prefer to die rather than continue living with this illness. </li></ul>
  13. 14. Schedule of Attitudes toward Hastened Death <ul><li>(11) I have stopped treatment for my illness because I would prefer to let the disease run its course. </li></ul><ul><li>(12) I enjoy my present life even with my illness and would not consider ending it. </li></ul><ul><li>(13) Because my illness cannot be cured I would prefer to die sooner rather than later. </li></ul><ul><li>(14) Dying seems like the best way to relieve the emotional suffering my illness causes. </li></ul><ul><li>(15) Doctors will be able to relieve most of the discomfort my illness causes. </li></ul><ul><li>(16) Because of my illness the idea of dying seems comforting. </li></ul><ul><li>(17) I expect to suffer a great deal from physical problems in the future because of my illness. </li></ul><ul><li>(18) I plan to end my own life when my illness becomes too much to bear. </li></ul><ul><li>(19) I am aggressively pursuing all possible treatments because I'll do anything possible to continue living. </li></ul><ul><li>(20) I am able to cope with the symptoms of my illness and have no thoughts of ending my life. </li></ul>
  14. 15. Breitbart et al (2000) <ul><li>92 palliative patients </li></ul><ul><li>45% endorsed 4 or more items </li></ul><ul><li>17% had high DHD </li></ul>
  15. 17. PHQ9
  16. 18. Leicester Oncology Study – Lord et al <ul><li>We analysed data collected from Leicester Cancer Centre from 2008-2009 involving approximately 1000 people approached by a research nurse and two therapeutic radiographers. Of those approached we collected data on 738 presentations, that is people seen up to three times over 9 months during treatment for cancer. We had complete data regarding suicidality on 554 (411 BW 143 BSA). We examined the following factors: treatment intent (radical vs palliative), gender, ethnicity, cancer type, cancer duration. </li></ul><ul><li>We measured suicidal thoughts using the PHQ9, using the scale: not at all 0; several days 1; more than half the days 2; nearly every day 3. We report here, the proportion of people with any suicidal thoughts (non zero scores). </li></ul>
  17. 19. Main Results <ul><li>Of 554 patients 44 had some suicidal thoughts (8%) </li></ul><ul><li>Of 554 patients 12 had regular suicidal thoughts (2%) </li></ul><ul><li>Of 69 people with major depression, 24 had suicidal thoughts (36.2%) </li></ul><ul><li>95 people had minor depression 7 had suicidal thoughts (7.4%) </li></ul><ul><li>205 people had distress on the DT. 37 had suicidal thoughts (18.0%) </li></ul>
  18. 20. By Ethnicity <ul><li>BW </li></ul><ul><li>113 people had major or minor depression. 24 had suicidal thoughts (21.2%) </li></ul><ul><li>Of 40 people with major depression, 18 had suicidal thoughts (45%) </li></ul><ul><li>73 people had minor depression 6 had suicidal thoughts (8.2%) </li></ul><ul><li>127 people had distress on the DT. 24 had suicidal thoughts (18.9%) </li></ul><ul><li>BSA </li></ul><ul><li>52 people had major or minor depression. 8 had suicidal thoughts (15.4%) </li></ul><ul><li>Of 30 people with major depression, 7 had suicidal thoughts (23.3%) </li></ul><ul><li>23 people had minor depression 1 had suicidal thoughts (4.3%) </li></ul><ul><li>78 people had distress on the DT, 13 had suicidal thoughts (16.6%) </li></ul>
  19. 21. Suicidal thoughts and desire for help <ul><li>Of 44 with some suicidal thoughts 30 would consider accepting help (68%) </li></ul><ul><li>Of 12 with regular suicidal thoughts only 8 wanted help (67%) </li></ul><ul><li>Of 7 with suicidal thoughts nearly every day 5 wanted help (71%) </li></ul><ul><li>Of 24 with suicidal thoughts & major depression, 18 wanted help (75%) </li></ul><ul><li>Of 7 people had minor depression & suicidal thought, 4 wanted help (57%) </li></ul><ul><li>Of 37 with distress & suicidal thoughts, 29 wanted help (78.4%) </li></ul>
  20. 22. Predictors 1 <ul><li>THERMOMETERS </li></ul><ul><li>depression thermometer b4 = 0.39 z = 3.76 </li></ul><ul><li>MINI-MAC </li></ul><ul><li>helplessness hopelessness b1 = 0.24 z = 3.07 p = 0.0021 </li></ul><ul><li>anxious preoccupation b2 = 0.50 z = 4.13 p < 0.0001 </li></ul><ul><li>Low fighting spirit b3 = -1.06 z = -5.35 p < 0.0001 </li></ul><ul><li>HADS </li></ul><ul><li>depression total b2 = 0.16 z = 2.92 p = 0.0034 </li></ul><ul><li>PHQ9 </li></ul><ul><li>PHQ9 total b1 = 0.58 z = 5.41 P < 0.0001 </li></ul><ul><li>  </li></ul>
  21. 23. Predictors 2 <ul><li>Insurance problems b2 = -2.62 z = -2.10 P = 0.035 </li></ul><ul><li>Transportation problems b4 = -2.19 z = -2.23 P = 0.025 </li></ul><ul><li>Partner problems b6 = 1.79 z = 2.18 P = 0.028 </li></ul><ul><li>Sadness b10 = 2.43 z = 2.62 P = 0.008 </li></ul><ul><li>Depression b11 = 2.65 z = 3.38 P = 0.000 </li></ul><ul><li>Self-care problems b20 = 2.72 z = 2.695 P = 0.007 </li></ul><ul><li>Eating problems b23 = 2.06 z = 2.84 P = 0.004 </li></ul><ul><li>Diarrhoea b26 = 1.59 z = 2.2 P = 0.026 </li></ul><ul><li>Urination problems b27 = 1.57 z = 2.27 P = 0.022 </li></ul>

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