Suicidal ideation endorsed by long-term survivors of blood or marrow transplantation: A BMTSS report

Background: High intensity therapeutic exposures and prolonged immune suppression place blood or marrow transplant (BMT) survivors at a higher risk of long-term physical and psychological morbidity that could lead to suicidal ideation endorsed by survivors. Methods: We examined suicidal ideation in BMT survivors who received autologous or allogeneic BMT between 1974 and 2014 at one of three transplant programs (City of Hope, University of Minnesota, or University of Alabama at Birmingham) and survived ≥2y after BMT. Overall, 3,841 BMT survivors and 1,261 siblings completed a 255-item survey at age ≥18y were included in this analysis. The survey assesses sociodemographics, chronic health conditions, and psychological health. Results: Overall, 5.7% of the BMT survivors and 3.1% of the siblings reported suicidal ideation. BMT survivors were at a 1.9-fold greater odds of endorsing suicidal ideation compared with siblings (95%CI=1.34-2.68, p-value=0.003). Multivariable analysis adjusting for age at survey, sex, income, and insurance, severe/life-threatening chronic health conditions, pain, and depression to the model, mitigated the difference in suicidal ideation between BMT survivors and siblings (OR=1.04; 95%CI=0.71-1.53, p=0.84). Restricting the analysis to BMT survivors, we found that younger age at study (18-34y: OR=2.2, 95%CI=1.4-3.6, p=0.002; reference: age >65y), lower income (<$75,000: OR=1.43, 95%CI=1.0-2.0; reference: ≥$75,000, p=0.04), depression (OR=9.81, 95%CI=7.2-13.4), and pain (OR=1.65, 95%CI=1.2-2.3, p=0.002) were associated with suicidal ideation. Conclusions: The higher prevalence of pain, depression, and chronic health conditions explain the higher odds of suicidal ideation endorsed by BMT survivors compared with siblings. BMT survivors with lower income, depression and pain are at the highest risk of endorsing suicidal ideation. These findings suggest a need for increased surveillance and intervention for suicidal ideation among at-risk BMT survivors.