‘Better off dead’: thoughts of death and suicide in cancer patients


Session type:

Jane Walker

University of Edinburgh, UK


‘Better off dead’: thoughts of death and suicide in cancer patients

Background and Aim

Cancer is associated with an increased risk of suicide and attempted suicide. However we do not know how many cancer patients have thoughts that they would be better off dead or of hurting themselves. This study therefore aimed to determine: (1) the prevalence of such thoughts in cancer outpatients and (2) which patients are most likely to have them.


A survey of consecutive outpatients attending clinics of a Regional Cancer Centre in Edinburgh, UK. Patients completed the Patient Health Questionnaire-9, which includes an item asking about thoughts of being ‘better off dead’ or of ‘hurting yourself in some way’ (Item-9). Those who reported these thoughts for ‘several days’ or more in the last two weeks were labelled ‘positive responders’. Patients also completed the Hospital Anxiety and Depression Scale and a pain severity score. Matched demographic and clinical variables were obtained from the hospital database.


Data were available on 2,924 patients. 7.8% (229/2924) (95% confidence interval; 6.9 to 8.9%) were ‘positive responders’. Clinically significant emotional distress, substantial pain and, to a lesser extent, older age, were predictors of a positive response. There was strong evidence of interactions between these effects, with emotional distress playing the most important role as a predictor.


Eight percent of cancer outpatients report thoughts of being better off dead or of hurting themselves. Emotional distress and pain are the important predictors of which patients have these thoughts. Identification and treatment of these symptoms in cancer patients should be a central aspect of their clinical care.