Suicidal Ideation Among Veterans Living with Cancer

The article up for discussion this week is titled “Suicidal Ideation among Veterans Living with Cancer Referred to Mental Health.” This article was written by Johnson, Phillips, & Miller, and was published at the beginning of this month in the journal, Clinical Gerontologist. The authors of this article used data collected from 175 Veterans who had been diagnosed with cancer, who were referred for psychological evaluation to identify factors that may be associated with suicidal ideation.

What did they do?

Participants consisted of Veterans who were diagnosed with cancer, and since referred for psychological services in the southeast. The researchers conducted retrospective record reviews to obtain information related to mental health, as well as other clinical and demographic information. The primary objective of this study was to identify factors associated with current suicidal ideation among Veterans with cancer.

Why did they do it?

Psychological distress is highly prevalent among individuals diagnosed with cancer (as well as other chronic, potentially terminal illnesses), as well as United States Veterans. The combination of Veteran status and a cancer diagnosis may put some individuals at particularly high risk of suicide ideation. As noted by the authors of this study, Veterans often have pre-existing medical conditions, as well as psychiatric conditions which may impact their ability to effectively manage a cancer diagnosis. Also, many Veterans with existing mental health concerns (e.g., PTSD, depression) are at an elevated risk to engage in suicidal behavior.

The authors aimed to evaluate suicidal ideation in a subgroup of Veterans with cancer, a particularly high risk and relatively understudied group of heroes.

How did they do it?

Veterans with cancer (N = 175; Mean age = 61.83 years) referred for psychological evaluation completed measures assessing pain, sleep, depression, anxiety, and PTSD. Pain was assessed using the Pain Numeric Rating Scale, which is a self-report measure that assesses current, average, least, and worst pain levels during the last week. Sleep disturbance was assessed using the Insomnia Severity Index, which assesses the quality of sleep over the past 2 weeks. Depression and Anxiety symptoms were assessed using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. These are both short, self-report measures. PTSD was assessed using the PTSD Checklist, and suicide ideation was defined by endorsing thoughts of killing oneself in the past 2 weeks.

What did they find?

Of the 175 Veterans assessed, 48% had a depressive disorder, 38% had an adjustment disorder, 24% had an anxiety disorder, 16% had PTSD, and 13% had an active substance use disorder. At the time of assessment, 25% of participants endorsed suicide ideation within the last 2 weeks. In addition, 10% of participants who did not report current suicide ideation reported experiencing suicide ideation at some time following their cancer diagnosis.

Compared to Veterans without suicidal ideation, Veterans with suicide ideation reported higher depressed mood and anhedonia, more anxiety symptoms, and more PTSD symptoms. Overall, the findings support the hypothesis that depressed mood and anhedonia predict current suicide ideation above and beyond other factors, in this particular group.

What does it all mean (our take)?

Our Veteran’s are American heroes. We cannot thank them enough for the sacrifices that they make to support us and our country. As research continues to pour out indicating that Veteran’s are at high risk for a multitude of mental health problems, we must continue to develop approaches that can meet their needs. Is this easier said than done? Perhaps. But is it a necessity? Absolutely.