0
Correspondence |

Psychiatric Morbidity in Patients With Lung CancerPsychiatric Morbidity in Patients With Lung Cancer FREE TO VIEW

Sundar Gnanavel, MD; Ruby Stella Robert, MBBS
Author and Funding Information

From the Department of Psychiatry (Dr Gnanavel), All India Institute of Medical Sciences; and Division of Physiology and Cardiopulmonary Rehabilitation (Dr Robert), Department of Physiology, Vallabhbhai Patel Chest Institute.

Correspondence to: Sundar Gnanavel, MD, Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India; e-mail: sundar221103@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):665-666. doi:10.1378/chest.13-2488
Text Size: A A A
Published online
To the Editor:

The article by Urban et al1 in CHEST (October 2013) made for an interesting read. We appreciate the authors’ earnest attempt to identify the subpopulation of patients with lung cancer at risk for committing suicide following diagnosis. The authors documented the highest standardized mortality ratios (SMRs) in male patients, older patients, patients with a higher-grade tumor and metastatic disease, and patients who did not receive, or refused, treatment. Despite the higher SMR among patients with metastatic disease, the finding that > 50% of suicides occurred in those with locoregional and potentially curable disease and that a majority of suicides occurred within 3 months of diagnosis raises a great degree of concern.

It is possible that a significant proportion of the subset of patients with lung cancer who committed suicide despite locoregional or potentially curable illness also suffered from comorbid (preexisting) depressive disorder or other psychiatric illnesses. Various studies have reported the presence of psychiatric illness in the majority of suicide completers in the general population, ranging from 81% to 100%.2-4 A few studies have documented depressive disorder as a risk factor for the development of lung cancer. For example, Chen et al5 found depressive disorder in 4.91% of subjects at risk for lung cancer. Hence, it is highly likely that not adjusting for psychiatric disorders, particularly depressive disorder, as a confounding variable in this population would have resulted in an inaccurate estimation of SMR.

It would have been ideal had the authors carried out psychologic autopsy in addition to their study of registry data. Although a cumbersome procedure, psychologic autopsy is a valuable research tool in completed suicides that retrospectively collects all available information on the deceased patient through structured interviews of family members, relatives, friends, and treating health-care personnel. In addition, information is collected from available health-care or psychiatric records, other documents, and forensic examination. Thus, a psychologic autopsy collaterally synthesizes information from various sources, providing clues regarding possible psychiatric morbidity prior to suicide apart from a systematic documentation on the suicidal act.6 These data would have been helpful in addressing the issue of psychiatric morbidity as a potential and significant confounder in the estimation of SMR in this group of patients.

Prompt identification of psychiatric symptoms, particularly self-harm ideation and depressive cognitions like ideas of helplessness and hopelessness, are likely to lead to early referral to psychiatrists. Sensitization of pulmonologists or oncologists is required to avoid this preventable cause of death in patients with lung cancer.

References

Urban D, Rao A, Bressel M, Neiger D, Solomon B, Mileshkin L. Suicide in lung cancer: who is at risk? Chest. 2013;144(4):1245-1252. [CrossRef] [PubMed]
 
Harris EC, Barraclough BM. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205-228. [CrossRef] [PubMed]
 
Baxter D, Appleby L. Case register study of suicide risk in mental disorders. Br J Psychiatry. 1999;175:322-326. [CrossRef] [PubMed]
 
Foster T, Gillespie K, McClelland R, Patterson C. Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland. Br J Psychiatry. 1999;175:175-179. [CrossRef] [PubMed]
 
Chen B, Li W, Jia Y, et al. A cross-sectional investigation on risk factors of lung cancer for residents over 40 years old in Chengdu, Sichuan Province, China [in Chinese]. Zhongguo Fei Ai Za Zhi. 2010;13(11):1021-1026. [PubMed]
 
Isometsä ET. Psychological autopsy studies—a review. Eur Psychiatry. 2001;16(7):379-385. [CrossRef] [PubMed]
 

Figures

Tables

References

Urban D, Rao A, Bressel M, Neiger D, Solomon B, Mileshkin L. Suicide in lung cancer: who is at risk? Chest. 2013;144(4):1245-1252. [CrossRef] [PubMed]
 
Harris EC, Barraclough BM. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205-228. [CrossRef] [PubMed]
 
Baxter D, Appleby L. Case register study of suicide risk in mental disorders. Br J Psychiatry. 1999;175:322-326. [CrossRef] [PubMed]
 
Foster T, Gillespie K, McClelland R, Patterson C. Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland. Br J Psychiatry. 1999;175:175-179. [CrossRef] [PubMed]
 
Chen B, Li W, Jia Y, et al. A cross-sectional investigation on risk factors of lung cancer for residents over 40 years old in Chengdu, Sichuan Province, China [in Chinese]. Zhongguo Fei Ai Za Zhi. 2010;13(11):1021-1026. [PubMed]
 
Isometsä ET. Psychological autopsy studies—a review. Eur Psychiatry. 2001;16(7):379-385. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543