Supportive Care in Cancer

, Volume 22, Issue 2, pp 331–337 | Cite as

Suicide ideation in stomach cancer survivors and possible risk factors

  • Ye-Ni Choi
  • Young-Ae Kim
  • Young Ho Yun
  • Sung Kim
  • Jae-Moon Bae
  • Young-Woo Kim
  • Keun Won Ryu
  • Jun Ho Lee
  • Jae-Hyung Noh
  • Tae-Sung Sohn
Original Article



Although the suicide rate of cancer survivors is higher than that of the general population, few studies have examined the potential risk factors. We assessed suicide ideation (SI) and investigated its correlates among survivors of stomach cancer, which is one of the most prevalent cancers in Korea.


We surveyed 378 stage I–III stomach cancer survivors who had been disease free for at least 1 year. The survey contained demographic questions and quality of life assessments from the European Organization for Research and Treatment of Cancer QLQ-C30 and its stomach cancer-specific module, the McGill Quality of Life Questionnaire, the Brief Fatigue Inventory, and one question from the Beck Depression Inventory.


We found that 131/378 stomach cancer survivors (34.7 %) experienced SI. Univariate analyses showed that SI was significantly associated with income, comorbidity, smoking, and the following quality of life factors: general health status, emotional functioning, fatigue, nausea/vomiting, dyspnea, appetite loss, constipation, diarrhea, financial problems, eating restriction, anxiety, dry mouth, trouble belching, hair loss, body image, existential well-being, and social support. Multivariate logistic regression confirmed that SI was independently associated with diarrhea (adjusted odds ratio (aOR) 2.84; 95 % confidence interval (CI) 1.44–5.62), hair loss (aOR 2.77; 95 % CI 1.04–7.36), existential well-being (aOR 6.18; 95 % CI 2.91–13.1), and usual fatigue (aOR 2.29; 95 % CI 1.30–4.06).


Our findings reveal a high prevalence of SI among stomach cancer survivors and identify health-related quality of life issues such as diarrhea, hair loss, existential well-being, and fatigue as important risk factors of SI.


Stomach cancer survivors Suicide ideation Correlates Risk factors Quality of life 



This work was supported by the National Cancer Center grants 0410150 and 1010081.

Conflict of interest

None disclosed.


  1. 1.
    Jemal A, Siegel R, Ward E, Hao YP, Xu JQ, Thun MJ (2009) Cancer statistics. CA Cancer J Clin 59(4):225–249PubMedCrossRefGoogle Scholar
  2. 2.
    Siegel R, Naishadham D, Jemal A (2012) Cancer statistics. CA Cancer J Clin 62(1):10–29PubMedCrossRefGoogle Scholar
  3. 3.
    Recklitis CJ, Lockwood RA, Rothwell MA, Diller LR (2006) Suicidal ideation and attempts in adult survivors of childhood cancer. J Clin Oncol 24(24):3852–3857PubMedCrossRefGoogle Scholar
  4. 4.
    Recklitis CJ, Diller LR, Li X, Najita J, Robison LL, Zeltzer L (2010) Suicide ideation in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol 28(4):655–661PubMedCrossRefGoogle Scholar
  5. 5.
    Ahn E, Shin DW, Cho SI, Park S, Won YJ, Yun YH (2010) Suicide rates and risk factors among Korean cancer patients, 1993–2005. Cancer Epidem Biomar 19(8):2097–2105CrossRefGoogle Scholar
  6. 6.
    Walker J, Waters RA, Murray G, Swanson H, Hibberd CJ, Rush RW, Storey DJ, Strong VA, Fallon MT, Wall LR et al (2008) Better off dead: suicidal thoughts in cancer patients. J Clin Oncol 26(29):4725–4730PubMedCrossRefGoogle Scholar
  7. 7.
    Schneider KL, Shenassa E (2008) Correlates of suicide ideation in a population-based sample of cancer patients. J Psychosoc Oncol 26(2):49–62PubMedCrossRefGoogle Scholar
  8. 8.
    Madeira N, Albuquerque E, Santos T, Mendes A, Roque M (2011) Death ideation in cancer patients: contributing factors. J Psychosoc Oncol 29(6):636–642PubMedCrossRefGoogle Scholar
  9. 9.
    Fang F, Fall K, Mittleman MA, Sparen P, Ye WM, Adami HO, Valdimarsdottir U (2012) Suicide and cardiovascular death after a cancer diagnosis. New Engl J Med 366(14):1310–1318PubMedCrossRefGoogle Scholar
  10. 10.
    Hem E, Loge JH, Haldorsen T, Ekeberg O (2004) Suicide risk in cancer patients from 1960 to 1999. J Clin Oncol 22(20):4209–4216PubMedCrossRefGoogle Scholar
  11. 11.
    Massie MJ, Gagnon P, Holland JC (1994) Depression and suicide in patients with cancer. J Pain Symptom Manag 9(5):325–340CrossRefGoogle Scholar
  12. 12.
    Bartels SJ, Coakley E, Oxman TE, Constantino G, Oslin D, Chen H, Zubritsky C, Cheal K, Durai UNB, Gallo JJ et al (2002) Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Am J Geriatr Psychiatr 10(4):417–427Google Scholar
  13. 13.
    Quan H, Arboleda-Florez J, Fick GH, Stuart HL, Love EJ (2002) Association between physical illness and suicide among the elderly. Soc Psych Psych Epid 37(4):190–197CrossRefGoogle Scholar
  14. 14.
    Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Seo HG, Lee JS (2012) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2009. Cancer Res Treat 44(1):11–24PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Hahn HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ (1986) A standardization study of Beck Depression Inventory in Korea. J Korean Neuropsychiatr Assoc 25:487–502Google Scholar
  16. 16.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, Dehaes JCJM et al (1993) The European Organization for Research and Treatment of Cancer Qlq-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376PubMedCrossRefGoogle Scholar
  17. 17.
    Kim SH, Gu SK, Yun YH, Lee CG, Choi YS, Lee WS, Kim SY, Heo DS (2007) Validation study of the Korean version of the McGill Quality of Life Questionnaire. Palliative Med 21(5):441–447CrossRefGoogle Scholar
  18. 18.
    Leiberich P, Averbeck M, Grote-Kusch M, Schroeder A, Olbrich E, Kalden JR (1993) The quality of life of tumor patients as a multidimensional concept. Z Psychosom Med Psychoanal 39(1):26–37PubMedGoogle Scholar
  19. 19.
    Yun YH, Wang XS, Lee JS, Roh JN, Lee CG, Lee WS, Lee KS, Bang SM, Mendoza TR, Cleeland CS (2005) Validation study of the Korean version of the brief fatigue inventory. J Pain Symptom Manag 29(2):165–172CrossRefGoogle Scholar
  20. 20.
    Kessler RC, Berglund P, Borges G, Nock M, Wang PS (2005) Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA 293(20):2487–2495PubMedCrossRefGoogle Scholar
  21. 21.
    Jeon HJ, Lee JY, Lee YM, Hong JP, Won SH, Cho SJ, Kim JY, Chang SM, Lee D, Lee HW et al (2010) Lifetime prevalence and correlates of suicidal ideation, plan, and single and multiple attempts in a Korean nationwide study. J Nerv Ment Dis 198(9):643–646PubMedCrossRefGoogle Scholar
  22. 22.
    Fox BH, Stanek EJ, Boyd SC, Flannery JT (1982) Suicide rates among cancer-patients in Connecticut. J Chron Dis 35(2):89–100PubMedCrossRefGoogle Scholar
  23. 23.
    Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R (2000) Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284(22):2907–2911PubMedCrossRefGoogle Scholar
  24. 24.
    Holland JC (1982) American Cancer Society working conference on the psychological, social and behavioral medicine aspects of cancer: research and professional education needs and directions for the 1980s—overview of conference. Cancer 50(9):1919–1920CrossRefGoogle Scholar
  25. 25.
    Misono S, Weiss NS, Fann JR, Redman M, Yueh B (2008) Incidence of suicide in persons with cancer. J Clin Oncol 26(29):4731–4738PubMedCrossRefGoogle Scholar
  26. 26.
    Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP et al (1999) Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 29(1):9–17PubMedCrossRefGoogle Scholar
  27. 27.
    Kim MH, Jung-Choi K, Jun HJ, Kawachi I (2010) Socioeconomic inequalities in suicidal ideation, parasuicides, and completed suicides in South Korea. Soc Sci Med 70(8):1254–1261PubMedCrossRefGoogle Scholar
  28. 28.
    Nakao M, Yamanaka G, Kuboki T (2002) Suicidal ideation and somatic symptoms of patients with mind/body distress in a Japanese psychosomatic clinic. Suicide Life Threat Behav 32(1):80–90PubMedCrossRefGoogle Scholar
  29. 29.
    Vilhjalmsson R, Kristjansdottir G, Sveinbjarnardottir E (1998) Factors associated with suicide ideation in adults. Soc Psych Psych Epid 33(3):97–103CrossRefGoogle Scholar
  30. 30.
    Yoshimasu K, Fukumoto J, Takemura S, Shiozaki M, Yamamoto H, Miyashita K (2011) Subjective symptoms related to suicide risk in Japanese male police officers. Suicidology 2:38–47Google Scholar
  31. 31.
    Beckett A, Shenson D (1993) Suicide risk in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Harvard Rev Psychiat 1(1):27–35CrossRefGoogle Scholar
  32. 32.
    Akechi T, Okamura H, Yamawaki S, Uchitomi Y (2001) Why do some cancer patients with depression desire an early death and others do not? Psychosomatics 42(2):141–145PubMedCrossRefGoogle Scholar
  33. 33.
    Fehring RJ, Brennan PF, Keller ML (1987) Psychological and spiritual well-being in college students. Res Nurs Health 10(6):391–398PubMedCrossRefGoogle Scholar
  34. 34.
    Coleman CL, Holzemer WL (1999) Spirituality, psychological well-being, and HIV symptoms for African Americans living with HIV disease. J Assoc Nurses AIDS Care 10(1):42–50PubMedCrossRefGoogle Scholar
  35. 35.
    Fry PS (2001) The unique contribution of key existential factors to the prediction of psychological well-being of older adults following spousal loss. The Gerontologist 41(1):69–81PubMedCrossRefGoogle Scholar
  36. 36.
    Picardi A, Abeni D, Melchi CF, Puddu P, Pasquini P (2000) Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Brit J Dermatol 143(5):983–991CrossRefGoogle Scholar
  37. 37.
    Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A et al (2005) Suicide prevention strategies—a systematic review. JAMA 294(16):2064–2074PubMedCrossRefGoogle Scholar
  38. 38.
    Szanto K, Kalmar S, Hendin H, Rihmer Z, Mann JJ (2007) A suicide prevention program in a region with a very high suicide rate. Arch Gen Psychiat 64(8):914–920PubMedCrossRefGoogle Scholar
  39. 39.
    Aseltine RH, James A, Schilling EA, Glanovsky J (2007) Evaluating the SOS suicide prevention program: a replication and extension. BMC Public Health 7:161PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Katz I (2012) Lessons learned from mental health enhancement and suicide prevention activities in the Veterans Health Administration. Am J Public Health 102:S14–S16PubMedCrossRefGoogle Scholar
  41. 41.
    Wyman PA, Brown CH, LoMurray M, Schmeelk-Cone K, Petrova M, Walsh E, Wang W, Tu X, Yu Q (2010) An outcome evaluation of the sources of strength suicide prevention program delivered by adolescent peer leaders in high schools. Am J Public Health 100(9):1653–1661PubMedCrossRefGoogle Scholar
  42. 42.
    Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92(17):1422–1429PubMedCrossRefGoogle Scholar
  43. 43.
    Sarna L, Padilla G, Holmes C, Tashkin D, Brecht ML, Evangelista L (2002) Quality of life of long-term survivors of non-small-cell lung cancer. J Clin Oncol 20(13):2920–2929PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ye-Ni Choi
    • 2
  • Young-Ae Kim
    • 3
  • Young Ho Yun
    • 1
    • 2
  • Sung Kim
    • 4
  • Jae-Moon Bae
    • 4
  • Young-Woo Kim
    • 3
  • Keun Won Ryu
    • 3
  • Jun Ho Lee
    • 3
  • Jae-Hyung Noh
    • 4
  • Tae-Sung Sohn
    • 4
  1. 1.Cancer Research InstituteSeoul National University HospitalSeoulSouth Korea
  2. 2.Department of Biomedical Science, College of MedicineSeoul National UniversitySeoulSouth Korea
  3. 3.Research Institute and HospitalNational Cancer CenterGoyangSouth Korea
  4. 4.Department of Surgery, Samsung Medical CenterSungkyunkwan UniversitySeoulSouth Korea

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