A new study by Yale researchers reports increased rates of suicidal thoughts and attempts by young adults nationwide with general medical illnesses, such as asthma, bronchitis and cancer.
"Suicidal ideation and attempts are quite common and frequently are seen in patients without full-blown depression," says Dr. Benjamin Druss, assistant professor of psychiatry who is also in the Department of Epidemiology and Public Health at the School of Medicine. "It is particularly important that primary care physicians be vigilant in screening for suicidal thoughts or behavior in their patients, since they often occur in patients with medical illnesses."
Published in the current issue of Archives of Internal Medicine, the study included interviews with more than 7,500 young adults to examine the association between presence of a general medical illness and suicidal thoughts or attempts.
Druss and his team found that while 16% of those surveyed said they had suicidal thoughts at some point in their lives, 25% of those with a general medical condition and 35% of those with two or more medical illnesses reported lifetime suicidal thoughts.
The team further found that while 5.5% of study participants have attempted suicide, the number jumped to almost 9% if the respondent had a general medical illness and 16% if they had two or more conditions. Cancer and pulmonary diseases such as asthma and bronchitis were highly associated with thoughts of suicide or suicide attempts.
Druss found that only 29% of those with a lifetime history of suicidal ideation, and only 37% with a history of attempted suicide, met the criteria for major depression set forth by the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Among the survey respondents, Druss says, having asthma or cancer increased the odds of a suicide attempt by four-fold after adjusting for major depression, alcohol use and demographics. This may be due to the fact that chronic disability and potentially life-threatening symptoms characterize asthma and other pulmonary diseases. The symptom pattern seen in these illnesses is similar to that seen in panic disorder, which has been implicated as a risk factor in suicide. Depending on the site of a malignancy, cancer may be associated with pain, disfigurement and risk of death.
"Any of these might lead a patient to consider his or her own mortality, if not suicide," Druss said. "Further work is needed in different populations and over a wider range of illnesses to better understand how particular illnesses or symptoms are associated with suicidality."
Suicide is currently the third leading cause of death in young adults, and the U.S. Surgeon General has identified it as one of the top public health concerns in the United States. Druss said the findings of the current study might have important implications both for medical clinicians and health policy makers.
-- By Karen Peart
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