Psychiatric Utilization Prior to Cancer Diagnosis: Implications for Survival Outcomes and Suicidal Death Among Incident Solid Organ Cancer Patients

Background: A cancer diagnosis is associated with psychiatric morbidity. I assessed the impact of pre-cancer psychiatric utilization (PU) on cancer-specific mortality (CSM), and the effect of cancer on suicidal death. Methods: Solid-organ cancer patients were assigned a PU gradient (PUG) score, 0 – none; 1 – outpatient; 2 – emergency department; 3 – admission. A multivariable cause-specific hazard model (CSHM) assessed the effect of PUG score on CSM. To assess the effect of cancer on suicide, patients were matched to non-cancer controls and compared using marginal CSHM. Results: Compared to PUG 0, PUG 1 patients had increased risk of CSM (HR 1.05, 95%CI 1.04-1.06), as did PUG 2 (HR 1.36, 95%CI 1.30-1.42) and 3 (HR 1.73, 95%CI 1.63-1.84). Cancer patients were more likely to die of suicide than controls (HR 1.34, 95%CI 1.22-1.48). Conclusions: Pre-cancer PU is independently associated with worse CSM. A cancer diagnosis is associated with increased suicide risk compared to controls.M.Sc