Suicidal Ideation, Suicide Attempts, and Suicide Mortality in Cancer: An Overview of Systematic Reviews with Meta-Analysis

Our plain-English summary of Suicidal Ideation, Suicide Attempts, and Suicide Mortality in Cancer: An Overview of Systematic Reviews with Meta-Analysis, by J. Martinez-Calderon, M. Infante-Cano, J. Matias-Soto, et al (Cancers, 2025).

The study

• Authors: J. Martinez-Calderon, M. Infante-Cano, J. Matias-Soto, A. Galan-Mercant, S. Pineda-Escobar, O. Villar-Alises, V. Perez-Cabezas, C. Garcia-Muñoz, J.C. Hernandez-Rodriguez
• Journal: Cancers
• Published: 2025;17(11)
• Type of article: Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: this overview of systematic reviews with meta-analysis summarized the epidemiology of suicide in cancer, mainly focused on prevalence, incidence, and risk.

Methods: the CINAHL (via EBSCOhost), Embase, PsycINFO (via ProQuest), and PubMed databases were searched from inception to February 2024. AMSTAR 2 evaluated the methodological quality of reviews. The degree of overlap between reviews was calculated.

Results: Twelve systematic reviews with meta-analysis were included. The prevalence of suicidal ideation in prostate cancer was 9.85% (95%CI 7.31-12.70%). The relative risk of suicidal ideation in prostate cancer was 2.01 (95%CI: 1.52-2.64) in comparison to controls without this type of cancer during the first 12 months after diagnosis. Furthermore, the risk of suicidal ideation was higher among individuals with bladder cancer in comparison to people without this clinical condition (HR 1.90, 95%CI 1.29-2.81). The crude suicide mortality rate per 100,000 person-years in prostate cancer was 47.1 per 100,000 person-years (95%CI 39.85-54.96). Incidence suicide death per 100,000 person-years was higher in sarcoma (60.99 per 100,000 person-years, 95%CI 17.37-214.19), esophagus (87.71 per 100,000 person-years, 95%CI 27.42-280.54), and pancreas (75.39 per 100,000 person-years, 95%CI 41.80-135.97). Finally, the standardized mortality ratio by suicide was higher in the pancreas (SMR 6.42, 95%CI 1.60-25.76), bone and cartilage (SMR 9.59, 95%CI 1.54-59.77), and mesothelioma (SMR 13.07, 95%CI 1.61-105.80).

Conclusions: overall, meta-analyses underlined the relevance of suicide mortality in different cancer sites and geographical regions. Some meta-analyses also found suicidal ideation may be important in prostate or bladder cancer.

In plain English

This article was an overview of reviews and collected no new patient data. The authors assessed 12 published systematic reviews with meta-analysis on suicide in people with cancer, found in four databases searched up to 12 February 2024. These reviews reported that 9.85% (95% confidence interval 7.31 to 12.70%) of people with prostate cancer had suicidal ideation. Their relative risk of suicidal ideation was 2.01 (1.52 to 2.64) compared with people without this cancer in the first 12 months after diagnosis. Compared with people without bladder cancer, those with it had a hazard ratio for suicidal ideation of 1.90 (1.29 to 2.81). Among the cancer sites reported, the esophagus had the highest suicide death incidence, 87.71 per 100,000 person-years (confidence interval 27.42 to 280.54). Mesothelioma had the highest standardized mortality ratio for suicide, 13.07 (1.61 to 105.80). The article did not discuss asbestos or say which type of mesothelioma. No data were found for Africa. The authors concluded that the meta-analyses underlined the relevance of suicide mortality in different cancer sites. They noted that only one co-author selected studies and extracted data.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Overview of systematic reviews with meta-analysis (a review of reviews; no new patient data)
• Who was studied: 12 systematic reviews with meta-analysis on people diagnosed with any type of cancer, identified by searching CINAHL, Embase, PsycINFO and PubMed from inception to 12 February 2024
• Exposure: Diagnosis of any type of cancer, including mesothelioma among many other sites. Outcomes were suicidal ideation, suicide attempt and suicide death. The article does not study asbestos or any fiber exposure.
• Main results:
  • Prevalence of suicidal ideation in prostate cancer was 9.85% (95%CI 7.31–12.70%), from one included review
  • Relative risk of suicidal ideation in prostate cancer was 2.01 (95%CI 1.52–2.64), compared with individuals without this cancer, during the first 12 months after diagnosis
  • Hazard ratio for suicidal ideation in people with bladder cancer, compared with people without it, was 1.90 (95%CI 1.29 to 2.81). The pooled studies varied substantially (I2 = 81.2%).
  • Of the cancer sites reported, the esophagus had the highest suicide death incidence, 87.71 per 100,000 person-years (27.42–280.54). The uterus was lowest at 6.19 per 100,000 person-years (4.41–8.70).
  • Suicide death incidence in sarcoma was 60.99 per 100,000 person-years (95%CI 17.37–214.19), as stated in the article's abstract
  • Crude suicide mortality rate in prostate cancer was 47.1 per 100,000 person-years (95%CI 39.85–54.96)
  • Of all cancer sites, mesothelioma had the highest standardized mortality ratio for suicide, 13.07 (1.61–105.80). Endometrium was lowest at 1.21 (0.68–2.16).
  • The abstract within the article also gives standardized mortality ratios for suicide of 9.59 (95%CI 1.54–59.77) for bone and cartilage cancer and 6.42 (95%CI 1.60–25.76) for pancreatic cancer
  • No data were found for African countries for any outcome
  • No included review met all AMSTAR 2 quality items
• The authors' conclusion: The authors concluded that the meta-analyses underlined the relevance of suicide mortality in different cancer sites. They added that some meta-analyses found suicidal ideation may be important in prostate or bladder cancer.
• Limitations the authors state:
  • Only reviews written in English or Spanish were included, which may help explain the lack of information from Africa
  • None of the included reviews used the GRADE approach, which could affect the certainty of the results
  • Only one co-author performed study selection and data extraction
  • The overview relied entirely on secondary data, with no access to primary study-level information
  • Four of the twelve included reviews did not report the cancer site, so they were left out of the main text

Topics

Medical terms in this study, explained in our Lexicon: Systematic Review, Meta-Analysis, Epidemiology, Relative Risk, Sarcoma, standardized mortality ratio (SMR), Mesothelioma.

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