A range of population-level epidemiological studies across multiple countries confirm that people diagnosed with cancer are at increased risk of subsequent suicide. This elevated risk persists despite advances in both psychiatric and cancer care and an examination of the cancer-suicide implicate both clinical and socio-demographic risk factors. Much of our understanding comes from epidemiological research that suggest the cancer itself is an important stress, but the nature of the cancer-suicide link cannot be appreciated amidst the broad brush strokes of these population level studies. The psychological autopsy method provides a more nuanced understanding of the mindset of the deceased, and studies in the cancer-suicide population catalogue suffering and loss of independence. These studies gather detailed information from multiple sources, but are flawed by informant bias and the confounding effects of the relationship between the deceased and the informants, who squint for meaning in the aftermath of the final act.
We report a mixed methods study utilizing a novel database, the Victorian Suicide Register in collaboration between St Vincent’s Hospital and the Coroners Court of Victoria. Contextual information gathered during coronial investigations has been studied in a 5-year cohort of Victorians with cancer where there was a finding of suicide. We examined the strength of the cancer-suicide link, and the clinical and socio-demographic factors associated with this. The findings suggest clinically important differences within this cohort, with implications for psychosocial service delivery in the cancer setting.