Global incidence, standardized mortality ratio, and risk factors for suicide in head and neck cancer versus other cancer population: a systematic review and meta-analysis.

Abstract

Background: Suicide incidence and risk factors in head and neck cancer (HNC) vary across studies.

Objective: To evaluate suicide incidence, standardized mortality ratio (SMR), and predictors in HNC versus other cancers.

Material and methods: PubMed, Embase, ScienceDirect, and Web of Science were systematically reviewed until February 2025. A random-effects meta-analysis assessed the outcomes.

Results: Out of 1,186 screened articles, 21 studies with 33,768,815 cancer patients (HNC: 2,470,243; non-HNC: 31,298,572) were included (mean age: 66.1 ± 8.82 years). The pooled suicide incidence in HNC was 277.1 per 100,000 (95% CI: 217.5-336.6), the highest among cancer populations, with Asia reporting the highest rate (457.9 per 100,000). The standardized mortality ratio (SMR) for suicide in HNC was 2.62 (95% CI: 2.10-3.26, p < 0.0001), ranking fourth among tumors. Risk factors included age ≥65 years (HR = 1.07, p = 0.03), male gender (HR = 5.55, p < 0.0001), distant metastases (HR = 1.47, 95% CI: 1.14-1.90, p = 0.003), and regional spread (HR = 1.28, p = 0.03).

Conclusion: HNC had the highest suicide incidence and ranked fourth in SMR among cancers. Our meta-analysis identified key positive and negative suicide predictors.

Significance: This meta-analysis provides the current incidence and SMR statistics in HNC compared to the non-HNC population.