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- Hu, Kejia, et al.
(författare)
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Risk of Psychiatric Disorders Among Spouses of Patients With Cancer in Denmark and Sweden
- 2023
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Ingår i: JAMA Network Open. - : American Medical Association. - 2574-3805. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: There is emerging evidence that spouses of patients with cancer may have a higher prevalence of mental illness, but these studies have been limited by pre-post designs, focus on a single mental illness, and short follow-up periods. OBJECTIVES: To assess the overall burden of psychiatric disorders among spouses of patients with cancer vs spouses of individuals without cancer and to describe possible changes in this burden over time.DESIGN, SETTING, AND PARTICIPANTS: This population based cohort study included spouses of patients with cancer (diagnosed 1986-2016 in Denmark and 1973-2014 in Sweden; exposed group) and spouses of individuals without cancer (unexposed group). Members of the unexposed group were individually matched to individuals in the exposed group on the year of birth, sex, and country. Spouses with and without preexisting psychiatric morbidity were analyzed separately. Data analysis was performed between May 2021 and January 2022. EXPOSURES: Being spouse to a patient with cancer.MAIN OUTCOMES AND MEASURES: The main outcome was a clinical diagnosis of psychiatric disorders through hospital-based inpatient or outpatient care. Flexible parametric models and Cox models were fitted to estimate hazard ratios (HRs) with 95% CIs, adjusted for sex, age and year at cohort entry, country, household income, and cancer history.RESULTS: Among 546 321 spouses in the exposed group and 2 731 574 in the unexposed group who had no preexisting psychiatry morbidity, 46.0% were male participants, with a median (IQR) age at cohort entry of 60 (51-68) years. During follow-up (median, 8.4 vs 7.6 years), the incidence rate of first-onset psychiatric disorders was 6.8 and 5.9 per 1000 person-years for the exposed and unexposed groups, respectively (37 830 spouses of patients with cancer [6.9%]; 153 607 of spouses of individuals without cancer [5.6%]). Risk of first-onset psychiatric disorders increased by 30% (adjusted HR, 1.30; 95% CI, 1.25-1.34) during the first year after cancer diagnosis, especially for depression (adjusted HR, 1.38; 95% CI, 1.30-1.47) and stress-related disorders (adjusted HR, 2.04; 95% CI, 1.88-2.22). Risk of first-onset psychiatric disorders increased by 14% (adjusted HR, 1.14; 95% CI, 1.13-1.16) during the entire follow-up, which was similar for substance abuse, depression, and stress-related disorders. The risk increase was more prominent among spouses of patients diagnosed with a cancer with poor prognosis (eg, pancreatic cancer: adjusted HR, 1.41; 95% CI, 1.32-1.51) or at an advanced stage (adjusted HR, 1.31; 95% CI, 1.26-1.36) and when the patient died during follow-up (adjusted HR, 1.29; 95% CI, 1.27-1.31). Among spouses with preexisting psychiatric morbidity, the risk of psychiatric disorders (first-onset or recurrent) increased by 23% during the entire follow-up (adjusted HR, 1.23; 95% CI, 1.20-1.25).CONCLUSIONS AND RELEVANCE: In this cohort study of 2 populations in Denmark and Sweden, spouses of patients with cancer experienced increased risk of several psychiatric disorders that required hospital-based specialist care. Our results support the need for clinical awareness to prevent potential mental illness among the spouses of patients with cancer.
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| 2. |
- Liu, Qianwei, et al.
(författare)
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Cardiovascular Diseases And Psychiatric Disorders During The Diagnostic Workup Of Suspected Hematological Malignancy
- 2019
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Ingår i: Clinical Epidemiology. - 1179-1349. ; 11, s. 1025-1034
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little attention has been given to the risk of cardiovascular and psychiatric comorbidities during the clinical evaluation of a suspected hematological malignancy.Methods: Based on Skåne Healthcare Register, we performed a population-based cohort study of 1,527,449 individuals residing during 2005-2014 in Skåne, Sweden. We calculated the incidence rate ratios (IRRs) of cardiovascular diseases or psychiatric disorders during the diagnostic workup of 5495 patients with hematological malignancy and 18,906 individuals that underwent a bone marrow aspiration or biopsy or lymph node biopsy without receiving a diagnosis of any malignancy ("biopsied individuals"), compared to individuals without such experience (i.e., reference).Results: There was a higher rate of cardiovascular diseases during the diagnostic workup of patients with hematological malignancy (overall IRR, 3.3; 95% CI, 2.9 to 3.8; greatest IRR for embolism and thrombosis, 8.1; 95% CI, 5.2 to 12.8) and biopsied individuals (overall IRR, 4.9; 95% CI, 4.6 to 5.3; greatest IRR for stroke, 37.5; 95% CI, 34.1 to 41.2), compared to reference. Similarly, there was a higher rate of psychiatric disorders during the diagnostic workup of patients with hematological malignancy (IRR, 2.1; 95% CI, 1.5 to 2.8) and biopsied individuals (IRR, 3.1; 95% CI, 2.9 to 3.4). The rate increases were greater around the time of diagnosis or biopsy, compared to thereafter, for both outcomes.Conclusion: There were higher rates of cardiovascular diseases and psychiatric disorders during the diagnostic workup of a suspected hematological malignancy, regardless of the final diagnosis.
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| 3. |
- Liu, Qianwei
(författare)
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Mental disorders as risk factors, comorbidities, and consequences of cancer
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cancer and mental disorders are both heterogenous groups of diseases and with substantial public health burden. Accumulating evidence has supported an elevated risk of mental disorders among patients with cancer. Different explanations might underlie the association of cancer with the subsequent risk of mental disorders, including cancer-related inflammation, cancer treatment, and psychological distress in relation to receiving a diagnosis of and being treated for a life-threatening disease. The association of mental disorders with the subsequent risk of cancer is on the other hand largely unclear, though several hypotheses have been proposed to support such an association, including chronic inflammation, dysregulation of neurotransmitters (e.g., monoamine), and altered activity of hypothalamic–pituitary–adrenal axis and neuroplasticity. This thesis work aimed therefore to understand the role of mental disorders on cancer, as risk factors, comorbidities, and consequences. In Paper I, we assessed whether there was an association between clinical diagnosis of autism spectrum disorder (ASD) and risk of cancer. Based on the Swedish national population and health registers, we conducted a nationwide population-based cohort study during 1987-2016 and found an elevated risk of cancer at early life among individuals with ASD, compared with individuals without ASD. The risk elevation was predominantly ascribable to ASD with co-occurring intellectual disability (ID) and/or birth defects, whereas ASD without these comorbidities was not related to an elevated risk of cancer. In Paper II, we examined the association between clinical diagnosis of ID and risk of cancer, based on a nationwide population-based cohort study during 1973-2016 using Swedish national population and health registers. We found an elevated risk of overall cancer and eleven subtypes of cancer in individuals with ID (age ≤43 years), compared with individuals free of ID. The risk elevation was more pronounced for syndromic ID and not likely attributable to familial confounding. In Paper III, we estimated risk of psychiatric disorders and cardiovascular diseases among individuals undergoing a diagnostic work-up of potential hematological malignancy during 2005-2014, based on the Skåne Healthcare Register. We observed highly increased risks of psychiatric disorders and cardiovascular diseases among individuals undergoing a diagnostic work-up of suspected hematological malignancy, irrespective of the ultimate diagnosis. In Paper IV, we evaluated the relationship between precancer psychiatric disorders and risk of subsequent sepsis among individuals with cancer during 2006-2014, based on the Swedish Cancer Register. We found an association between precancer psychiatric disorders and elevated risk of sepsis among individuals with cancer, calling for expanded surveillance and prevention of sepsis among cancer patients with precancer psychiatric disorders. In conclusion, Papers I and II showed that ID, as well as ASD when comorbid with ID and/or birth defect, were risk factors of cancer. Paper III showed that individuals undergoing diagnostic work-up of suspected hematological malignancy were at highly increased risks of psychiatric disorders and cardiovascular diseases, irrespective of the ultimate diagnosis. Paper IV showed that precancer psychiatric disorders were related to an elevated risk of sepsis subsequent to cancer diagnosis.
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| 5. |
- Liu, Qianwei, et al.
(författare)
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Suicide attempt and death by suicide among parents of young individuals with cancer : A population-based study in Denmark and Sweden
- 2024
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer.Methods and findingsWe performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations.The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child’s cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child’s cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings.ConclusionsIn this study, we observed an increased risk of parental suicide attempt during the first years after a child’s cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child’s cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.
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