Chronic or advanced medical illness is a significant risk factor for suicidality.
The rate of suicide in patients with terminal conditions is unknown. What is evident is that advancing age and psychiatric comorbidity are risk factors for suicide along with: being the male sex, have in AIDS diagnosis, having a family history of suicide, and uncontrolled pain. Cancer patients have nearly twice the incidence of suicide than the general population (rate of 31.4 versus 16.7 per 100,000 patient-years) and the first year after diagnosis carries a higher risk. Lung, prostate, pancreatic, and head and neck cancers have the highest suicide rates among all cancer types. Up to 8.5% of advanced cancer patients express a sustained and pervasive wish for an early death.
All patients with life-limiting illnesses should be routinely assessed for depression and mood disorders; depressed patients should be investigated for suicidal thoughts. Patients who admit to suicidal thoughts or a desire for hastened death should be asked about specific plans for self-harm, past history of suicide attempts, access to lethal means to carry out a suicidal act, and level of support and/or supervision available in the home.
All patients who are seriously threatening self-harm, or who have pervasive thoughts of ending their life, should be evaluated urgently — depending on the available resources — by a proven psychiatrist, medical or psychiatric urgent care services, or hospital admission.
Options include voluntary psychiatric treatment, organizing 24-hour safety monitoring by the patient’s family and friends, introducing home hospice or home nursing support, removing the means to carry out a suicidal act, and imposing emergency detention.
For disabled patients close to death, tactics may include removing the means of self-harm (e.g., limiting access to pain medications) and providing close supervision.
Adapted from Marks S and Rosielle DA. Suicide attempts in the terminally ill. Palliative Care Network of Wisconsin. Fast facts and concepts #210. Internet. Accessed on February 24, 2020.