Suicide, palliative care, matter of life and death

We begin tomorrow, Wednesday, February 1, the second period of the second legislative year in the Congress of the Union and the “legislative agendas” of the different parliamentary groups are diverse in security, electoral and economic issues, to name a few. In particular, I will insist on the reforms approved in the Chamber of Deputies that are pending in the Senate of the Republic regarding palliative care. In this column I will put a magnifying glass on the risk of suicide in patients who require palliative care.

Suicide is a phenomenon that is growing rapidly in Mexico, having tripled in the last three decades, with the Inegi registering 2,603 ​​suicides in 1994, 4,117 in 2004, 6,637 in 2014 and 8,432 in 2021. In 2021, the suicide rate in for men it was 10.9 and for women it was 2.4 per 100,000 inhabitants. The Inegi also reports the percentage of household members aged 12 and over who have had feelings of depression, reporting that 32.5% have felt depressed and 66.9% have never felt depressed.

Various Mexican researchers have published articles on suicide risk factors in recent years, such as mental health and the quality of primary care, the effect of the pandemic, modifiable factors to prevent firearm injuries, gender differences, and the relationship with work among others.

In England and Wales there were more than 5,500 suicides in 2021 (three thousand less than in Mexico). Vahé Nafilyan and colleagues from the Health and Life Events Analysis Division at the Newport Office of National Statistics in the United Kingdom investigated with colleagues the risk of suicide after diagnosis of serious physical health conditions, which can cause distress. psychological and lead to severe depression.

They used 2011 English census records linked to hospital records and death records covering 47 million people, aged 6 years and over, alive on 1 January 2017, covering 89.2% of the English population. They then paired patients diagnosed with low-survival cancer -5-year survival rate less than 20%-, chronic ischemic heart disease, chronic obstructive pulmonary disease -COPD- or degenerative neurological disease with individuals without these pathologies but who had identical sociodemographic characteristics called “controls”. The cumulative incidence of death by suicide that occurred between January 1, 2017 and December 31, 2021 between “patients” and “controls” was then estimated, adjusting for possible confounding factors.

Death by suicide was defined as any death from intentional self-harm. The findings were that one year after diagnosis, the suicide rate was 21.6 per 100,000 in poor-surviving cancer patients compared with 9.5 per 100,000 matched controls. For COPD patients, the suicide rate was 22.4 versus 10.6 per 100,000 in controls. For ischemic heart disease it was 16.1 versus 8.8 per 100,000 in controls. For degenerative neurological conditions it was 114.5 per 100,000; however, the estimate was imprecise due to the low number of suicides. The increased risk of suicide was most pronounced in the first months after diagnosis or first treatment.

The association between the diagnosis of severe physical health conditions and an increased risk of suicide underscores, dear readers, the well-established need for access to palliative care as a component of universal health coverage. The integration of palliative care at the time of diagnosis of serious illness along with curative treatment is recommended to optimize quality of life outcomes.

In our country, building on the minimal existing palliative care infrastructure of the national health system to provide whole-person interventions, including mental health care, would be a cost-effective and resource-conscious approach to better assess the individual needs and discriminate between depression, suicidal tendencies and adaptation to illness.

Having health professionals trained in palliative care – general skills – in primary health care can help identify critical caregivers and community-based social supports while clarifying patients’ concerns and anticipating potential existential crises. Palliative care also provides a model that can implement short-term therapies such as dignity therapies in rapidly changing clinical circumstances, especially for patients diagnosed with advanced or end-stage disease. The minutes pending ruling in the Senate, expand with this focus on palliative care in the population that requires it.

I agree with the point made by William E. Rosa, from the department of psychiatry at Memorial Sloan Kettering Cancer Center in New York, who says that the provision of palliative care is a moral obligation for all health professionals to protect public safety and well-being. amid the diagnosis of serious illnesses and the increased risk of suicide. In fact, he emphasizes, it is a matter of life and death. What do you think?

*The author is a surgeon, a certified specialist in general surgery and public health, a doctorate in health sciences and public administration, and is a re-elected deputy of the PAN in the LXV Legislature.