Akechi et al identified risk factors for suicidal ideation in a patient with unresectable lung carcinoma. These can help identify a patient who may benefit from interventions to reduce the risk of suicide. The authors are from the National Cancer Center Research Institute East in Chiba and the National Cancer Center Hospital in Tokyo, Japan.


Prevalence: approximately 15% over 6 months


Risk factors identified in multivariate analysis:

(1) pain at baseline, even if mild

(2) development of a depressive disorder


Additional risk factor from univariate analysis but of marginal significance in the multivariate model:

(3) declining physical function, with loss of independence and autonomy


Additional factor indicated by Fishbain:

(4) duration of pain (with risk higher if pain chronic)


Ways of mitigating the risk of suicide:

(1) careful attention to pain control

(2) antidepressants

(3) provide social support with opportunities for open communication

(4) try to instill a sense of meaning or transcendence

(5) provide other palliative care, including assistance for physical impairments


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