Predictive factors for suicidal ideation in patients with unresectable lung carcinoma

To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research

Psychological variables substantially shape the risk of suicidal thoughts and behaviours (STBs). However, it is unclear to what extent they are considered in individuals with cancer. We synthesized the quantitative research landscape concerning psychological risk/protective factors of STBs in the (psycho-) oncological context. This pre-registered review (PROSPERO-ID CRD42022331484) systematically searched the databases PubMed/Medline, CINAHL, PsycInfo, Cochrane Library, and Web of Science (as well as the grey literature and preprints). Risk of bias (RoB) was estimated using the ROBINS-I tool. Of 11,159 retrieved records, 319 studies were eligible for inclusion. Of those, 163 (51.1%) had investigated psychological factors (affective: n = 155; social: n = 65; cognitive: n = 63; personality/individual differences: n = 37; life events: n = 6), in a combined 3,561,741 participants. The most common STBs were suicidal ideation (n = 107) or death wishes (n = 20) rather than behaviour (suicide deaths: n = 26; attempts: n = 14). Most studies had a serious RoB. Thus, a large body of research investigated STBs in cancer patients/survivors, but it rarely aligned with the theoretical or clinical developments in suicide research. We propose a conceptual model of STBs in cancer delineating moderation and mediation effects to advance the integration of the fields, and to inform future research and practice.

Suicide risk among patients with cancer by sex in Japan: A population-based study

BACKGROUND

In Japan, few studies have examined suicide risk for five-year relative survival rates for cancer sites. Since five-year relative survival rates differ by sex, we aim to examine suicide risk for patients with cancer separately for men and women.

METHODS

We estimated the risk of suicide among patients with cancer by sex in Japan compared to the general population, using standardized mortality ratios (SMRs). Patients with cancer diagnosed between January 1, 1985-December 31, 2013 and registered in the Osaka Cancer Registry were followed-up with for up to 10 years. The outcome was suicide death. In addition, cancer sites were classified into three prognosis groups based on five-year relative survival rates: good (> 70%), moderate (40-70%), poor (< 40%).

RESULTS

Among 623 995 patients with cancer observed for 2 349 432 person-years, 1210 patients died by suicide (867 men and 343 women). The SMRs were almost equal for men (1.66, 95% CI, 1.55-1.77) and women (1.65, 95% CI, 1.48-1.83). SMRs for cancer prognosis groups were 1.01 (95% CI, 0.84-1.22) for men and 1.47 (95% CI, 1.24-1.73) for women in the good group, 1.53 (95% CI, 1.39-1.68) for men and 1.74 (95% CI, 1.47-2.05) for women in the moderate group, and 2.54 (95% CI, 2.27-2.85) for men and 1.87 (95% CI, 1.43-2.46) for women in the poor group.

CONCLUSIONS

In this population, both sexes had higher suicide risk with poor prognosis, but the difference in SMRs between the good and poor groups was smaller for women than men.

Risk factors associated with suicidal ideation among cancer patients: a systematic review and meta-analysis

Objective

The objective of this review was to provide a comprehensive summary and analysis of the risk factors associated with suicidal ideation among cancer patients.

Methods

This review adhered to the PICO/S framework and guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework (PROSPERO CRD42023433639). We searched Web of Science, PubMed, Embase, Scopus, PsycINFO, and Cochrane Library from the establishment date of the databases until June 9, 2023 for observational studies that reveal risk factors associated with suicidal ideation among cancer patients. Software Review Manager 5 (vision 5.4) was used for Meta-analyses.

Results

4,921 studies were obtained through the search of the databases, 40 of which were eligible. Meta-analysis revealed that suicidal ideation in cancer patients was significantly associated with marital status, living alone, post-traumatic stress disorder (PTSD), panic disorder, education, psychiatric illness history, social functioning, childhood adversity experience, financial problems, pain, depression, demoralization, vomiting, residence and anxiety.

Conclusion

Being unmarried, living alone, less educated, living in rural, financial problems, pain, vomiting, PTSD, psychiatric illness history, lower social functioning, childhood adversity experience, anxiety, depression, demoralization, panic disorder were risk factors for suicidal ideation among cancer patients. This review provided evidence-based information for identifying and reducing the risk of suicide in cancer survivors.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42023433639.

Global Prevalence of Suicide in Patients With Cancer: A Systematic Review and Meta-Analysis

AIM

Given that patients with cancer may commit suicide due to physical and mental problems, the present study objectives were to identify particular risk factors of different subgroup of patients including type of cancer, gender, age, type and time of suicide, and geographical region to facilitate early care and psychosocial support.

METHODS

A comprehensive review of databases including Embase, Scopus, PubMed, and Web of Science was conducted for original articles published in English from January 2000 to March 2022. It is based on the PRISMA checklist.

RESULTS

After reviewing 69 articles selected from 15 countries, the total prevalence rate of suicide among 34,157,856 patients with cancer was estimated 67,169, at 0.013 (95% CI, 0.008-0.021). The highest suicide prevalence was related to gastrointestinal cancer, estimated at 0.204 (95% CI, 0.161-0.255). A gender-based meta-analysis showed that the prevalence of suicide/suicidal ideation was higher among men, estimated at 0.013 (95% CI, 0.008-0.023) compared with women, at 0.006 (95% CI, 0.002-0.017).

CONCLUSION

Based on study results, suicide-prevention strategies should be aimed at patients younger than 40 years of age to effectively resolve their mental health disorders and promote their self-efficacy in successful management of the disease.

Suicide Mortality Risk among Patients with Lung Cancer-A Systematic Review and Meta-Analysis

The risk for suicide in patients with cancer is higher compared to the general population. However, little is known about patients with lung cancer specifically. We therefore implemented a systematic review and random-effects meta-analysis of retrospective cohort studies on suicide in patients with lung cancer. We searched a high number of common databases up to 02/2021. For the systematic review, a total of 23 studies was included. To exclude bias due to patient sample overlap, the meta-analysis was performed on 12 studies. The pooled standardized mortality ratio (SMR) for suicide was 2.95 (95% Confidence Interval (CI) = 2.42-3.60) for patients with lung cancer as compared to the general population. Subgroups with a pronouncedly higher risk for suicide compared to the general population were found for patients living in the USA (SMR = 4.17, 95% CI = 3.88-4.48), with tumors of late stage (SMR = 4.68, 95% CI = 1.28-17.14), and within one year after diagnosis (SMR = 5.00, 95% CI = 4.11-6.08). An increased risk for suicide was found in patients with lung cancer, with subgroups at particular risk. Patients at increased risk should be monitored more closely for suicidality and should receive specialized psycho-oncological and psychiatric care. Further studies should clarify the role of smoking and depressive symptoms on suicidality among lung cancer patients.

Quality of life, anxiety, depression, and distress in patients with advanced and metastatic lung cancer

OBJECTIVE

Lung cancer (LC) patients have shown a predisposition for developing emotional and physical symptoms, with detrimental effects on the quality of life (QoL). This study evaluates the bidirectional relationship between main psychological disorders and clinical/sociodemographic factors with the QoL.

METHODS

In this observational cross-sectional study, patients with a confirmed LC diagnosis from February 2015 to March 2018 were eligible for this study. Each participant completed screening instruments of anxiety, depression, distress, and QoL assessment. Other relevant clinical data were extracted from electronic health records. Then comparisons, correlations, and logistic regression analyses were performed.

RESULTS

Two hundred and four cases were eligible; of them, the median age was 61 (24-84) years, most had clinical stage IV (95%), and most were under first-line therapy (53%). Concerning psychological status, 46% had symptoms of emotional distress, 35% anxiety, and 31% depression. Patients with psychological disorders experienced a worse global QoL than those without psychological impairment (p < 0.001). Increased financial issues and physical symptoms, combined with lower functioning, were also significantly associated with anxiety, depression, and distress. In the multivariate analysis, female sex and emotional distress were positively associated with an increased risk of depression; likewise, female sex, low social functioning, insomnia, and emotional distress were associated with anxiety.

CONCLUSIONS

Emotional symptoms and QoL had a significant bidirectional effect on this study; this underscores the necessity to identify and treat anxiety, depression, and distress to improve psychological well-being and the QoL in LC patients.

Predictive Modeling for Suicide-Related Outcomes and Risk Factors among Patients with Pain Conditions: A Systematic Review

Suicide is a leading cause of death in the US. Patients with pain conditions have higher suicidal risks. In a systematic review searching observational studies from multiple sources (e.g., MEDLINE) from 1 January 2000–12 September 2020, we evaluated existing suicide prediction models’ (SPMs) performance and identified risk factors and their derived data sources among patients with pain conditions. The suicide-related outcomes included suicidal ideation, suicide attempts, suicide deaths, and suicide behaviors. Among the 87 studies included (with 8 SPM studies), 107 suicide risk factors (grouped into 27 categories) were identified. The most frequently occurring risk factor category was depression and their severity (33%). Approximately 20% of the risk factor categories would require identification from data sources beyond structured data (e.g., clinical notes). For 8 SPM studies (only 2 performing validation), the reported prediction metrics/performance varied: C-statistics (n = 3 studies) ranged 0.67–0.84, overall accuracy(n = 5): 0.78–0.96, sensitivity(n = 2): 0.65–0.91, and positive predictive values(n = 3): 0.01–0.43. Using the modified Quality in Prognosis Studies tool to assess the risk of biases, four SPM studies had moderate-to-high risk of biases. This systematic review identified a comprehensive list of risk factors that may improve predicting suicidal risks for patients with pain conditions. Future studies need to examine reasons for performance variations and SPM’s clinical utility.

Incidence and risk factors of suicide in patients with lung cancer: a scoping review

PURPOSE

To explore the high-risk period of the occupation of suicide after diagnosis; and clarify the risk factors of suicidal behaviors (suicidal ideation, suicide attempt, and suicidal death) behind the lung cancer patients during the cancer cure process.

METHODS

This scoping review was conducted through the whole month of April 2021. We extracted data of the suicide mortality after diagnosis and latent risk factors of suicidal behaviors among lung cancer patients where we used to study from the two online databases which are PubMed and Web of Science. Two online databases were searched and written in English without age restriction. To note that the standardized mortality ratio (SMR), person-years, and odds ratio (OR) associated with lung cancer were documented.

RESULTS

Out of 570 records, 23 studies mentioned suicidal behaviors and lung cancer met the included criteria. Eleven (n = 47.8%) of the selected publications reported changes in suicide mortality. None of them reported suicidal ideation or suicide attempt after diagnosis. The individuals with lung cancer have significantly higher rates of suicidal death (SMR, 2.04-13.4) during the first years after diagnosis and decrease over subsequent years (SMR, 0.66-3.17). The median time from cancer diagnosis to suicide death was around 7 months. Across all studies with the 22 studies that examined factors, we extracted the data of the suicidal ideation (n = 3), suicide attempt (n = 1), and suicidal death (n = 18) in individuals. For patients with suicidal ideation, there was a significantly higher incidence in males than in females. Among patients who attempted suicide, the incidence of mental illness is greater than the incidence of physical illness. Factors for suicidal death, including gender (male, 56.3-100%), prognosis tumors (poor, 25.8-66.3%), marital status (widowhood or unmarried, 19-75.7%), and age of patients (> 70 years, 24.5-47%) with lung cancer, play a vital role. Treatment of lung cancer is expected to affect a patient in his/her mental state.

CONCLUSION

Overall, our finding indicates that lung cancer patients have been presented with a higher incidence of suicide death in a specific period, especially the early years after diagnosis. Discovering risk factors for suicide helps prevent potential suicide. It is essential to screen lung cancer patients for suicidal ideation, especially those with high-risk factors. Future prospective studies are necessary to confirm these findings to support care.

Interventions to prevent suicidal behavior and ideation for patients with cancer: A systematic review

OBJECTIVE

This study aimed to summarize interventions for suicide prevention in patients with cancer and highlight any methodological issues.

METHODS

We searched PubMed, PsycINFO, CINAHL, and the Cochrane database from their inception until July 2018. Additionally, we manually searched the references of included studies and recent systematic reviews of psychotherapy, antidepressants, and collaborative care for cancer patients with depression.

RESULTS

Of the 1365 retrieved articles, 11 randomized controlled trials and 11 intervention studies met the inclusion criteria. These were categorized by type of intervention: psychotherapy, pharmacotherapy, integrated collaborative care, muscle relaxation and therapeutic walking, and cancer treatment. The trials showed little evidence to confirm the effects of suicide prevention strategies. Seven trials were designed to assess the efficacy of interventions treating depression. In all studies, suicidal behavior or ideation was reported as one of the secondary outcomes. Three trials did not report information about suicidal ideation, despite assessing depressive symptoms using scales that contained suicidal ideation items. Most trials demonstrated inadequate study quality.

CONCLUSIONS

Our review summarized interventions for suicide prevention in patients with cancer and revealed methodological issues. The findings highlighted a need to explore new treatment strategies that focus on unique suicide risk factors among patients with cancer.

Suicidal ideation among Chinese cancer inpatients of general hospitals: prevalence and correlates

Cancer patients are at high risk for suicide, particularly when they are informed about the cancer diagnosis or hospitalized for cancer treatment. Therefore, oncology healthcare settings such as large general hospitals in China, may represent an ideal setting to identify and treat suicidality in cancer patients. However, the clinical epidemiology of suicidality of Chinese cancer patients remains largely unknown. This study examined the prevalence and correlates of suicidal ideation among Chinese cancer inpatients of large general hospitals. A total of 517 cancer inpatients were consecutively recruited from two tertiary general hospitals of a metropolitan city in northern China, and administered with standardized questionnaires to collect data on sociodemographics, mental health, and cancer-related clinical characteristics. Suicidal ideation and mental health were measured with a single self-report question “In the past month, did you think about ending your life?” and Hospital Anxiety and Depression Scale, respectively. The one-month prevalence of suicidal ideation was 15.3% in Chinese cancer inpatients. In multivariable Logistic regression, depression, anxiety, moderate-to-severe pain, metastatic cancer, poor performance status, surgery, and palliative care were significantly associated with suicidal ideation. Cancer inpatients of large Chinese general hospitals have high prevalence of suicidal ideation and therefore potentially at high risk for suicide. Suicide prevention efforts for cancer inpatients should include periodic evaluation of suicidality, effective pain management, psychooncological supports, and, when necessary, psychiatric treatment and crisis intervention.

Feasibility of Psychosocial Distress Screening and Management Program for Hospitalized Cancer Patients

OBJECTIVE

Although the diagnosis and treatment of cancer is associated with psychosocial distress, routine distress screening is difficult in hospitalized oncology settings. We developed a consecutive screening program for psychosocial distress to promote psychiatric treatment of cancer patients and evaluated the feasibility of our program by Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS).

METHODS

Among 777 cancer inpatients recruited from the Catholic Comprehensive Institute of Seoul St. Mary's Hospital, 499 agreed to complete primary distress screening through DT. We conducted secondary distress screening through HADS in 229 patients who had high scores of DT.

RESULTS

Of the 499 participants, 270 patients with low scores of DT were included in the distress education program. 229 patients with high scores of DT received secondary distress screening through HADS. Among 115 patients with low scores of HADS, 111 patients received distress management. Among 114 patients with high scores in the secondary distress screening, 38 patients received psychiatric consultation service whereas 76 patients refused psychiatric consultation.

CONCLUSION

Using consecutive screening for psychosocial distress appeared to be feasible in an inpatient oncology setting. Nevertheless, the low participation rate of psychiatric consultation service in cancer patients with high distress level should be improved.

Psychosocial predictors of quality of life in hematological cancer

The improvement of health related Quality of Life (QOL) has become one of the main objectives of psychological interventions in cancer. The aim of this study was to analyze sociodemographic and psychosocial variables that predict the different components of QOL in a sample of 69 hemato-oncological patients. Depression, social support, disease-related stress situations, coping strategies and optimism were taken as psychosocial predictors. QOL was evaluated with the Short-Form Health Survey (SF-36). With respect to sociodemographic variables, results showed that age and time from the diagnosis were associated with a decrease in QOL, while educational level and having a partner were associated with less pain and better mental health. With respect to negative-affecting psychosocial variables, depression was associated with general health and social functioning, the coping strategy of stoicism was associated with physical and emotional roles, the number of disease-related stress situations was associated with pain, and the feeling of negative emotions associated with the illness was associated with mental health. Social support and optimism were positively associated with vitality. These results have clear clinical implications for psychological interventions aimed to improve QOL in hemato-oncological patients.

The lung cancer patient, the pneumologist and palliative care: a developing alliance

Considerable evidence is now available on the value of palliative care for lung cancer patients in all stages and at all times during the course of the disease. However, pneumologists and their institutions seem to be widely in arrears with the implementation of palliative care concepts and the development of integrated structures.

This review focuses on the available evidence and experience of various frequently unmet needs of lung cancer patients, especially psychological, social, spiritual and cultural ones. A PubMed search for evidence on these aspects of palliative care as well as on barriers to the implementation, on outcome parameters and effectiveness, and on structure and process quality was performed with a special focus on lung cancer patients.

As a consequence, this review particularly draws pneumologists’ attention to improving their skills in communication with the patients, their relatives and among themselves, and to establish team structures with more far-reaching competences and continuity than existing multilateral cooperations and conferences can provide. Ideally, any process of structural and procedural improvement should be accompanied by scientific evaluation and measures for quality optimisation.

A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer

PURPOSE

This study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention.

METHODS

Purposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3.

RESULTS

Tobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t = 2.84, p < 0.01). When PHQ-9 ≥ 10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77-0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively.

CONCLUSIONS

Demoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.

Determinants of suicidal ideation in patients with breast cancer

BACKGROUND

Breast cancer survivors are at higher risk of psychological problems including suicidal ideation. However, studies on suicidal ideation in breast cancer survivors have been rare and have not been investigated prospectively. This study aimed to investigate the prevalence and independent risk factors for suicidal ideation within 1 week and at 1 year after breast surgery for breast cancer.

METHODS

A total of 284 patients with breast cancer were evaluated within 1 week after breast surgery, and 244 (84%) were followed up 1 year later. Suicidal ideation was ascertained using the item 'suicidal thoughts' from the Beck Depression Inventory. Various factors potentially related to suicidal ideation were evaluated including sociodemographic and clinical characteristics, and genetic polymorphisms on serotonin and brain-derived neurotrophic factor (BDNF) systems.

RESULTS

Suicidal ideation was present in 10.9% of participants at 1 week and 11.4% at 1 year after breast surgery. Suicidal ideation was independently associated with depression and physical disability at 1 week and with living alone, anxiety, advanced cancer stage, and the BDNF met allele (but not with genetic polymorphisms on serotonergic system) at 1 year after breast surgery.

CONCLUSIONS

Suicidal ideation was common and had similar prevalences in both short-term and longer-term follow-ups after breast cancer. However, associated factors were substantially different between the two evaluation points, which suggest that time-specific programs may be needed for identifying and managing suicidal risk in patients with breast cancer.

Clinical biopsychosocial risk factors for depression in lung cancer patients: a comprehensive analysis using data from the Lung Cancer Database Project

BACKGROUND

Various risk factors for depression in lung cancer patients have been suggested but have been examined separately in studies with relatively small sample sizes. The present study examined the biopsychosocial risk factors of depression in lung cancer patients, focusing on psychological factors in the largest patient sample reported to date.

PATIENTS AND METHODS

A total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, personal characteristics, health behaviors, physical symptoms, and psychological factors were obtained. The participants were divided into groups with or without depression using the Hospital Anxiety and Depression Scale.

RESULTS

Among the recruited patients, 165 (12.4%) manifested depression. The results of a binary logistic regression analysis were significant (overall R2, 36.5%), and a greater risk for depression was strongly associated with psychological factors, such as personality characteristics (neuroticism) and coping style (low fighting spirit, helplessness/hopelessness, and anxious preoccupation). Although the contributions of cancer-related variables, personal characteristics, health behaviors, and clinical state were relatively low, cancer stage, cancer type, sex, and age correlated significantly with depression.

CONCLUSION

Depression was most strongly linked with personality traits and coping style, and using screening instruments to identify these factors may be useful for preventive interventions.

Challenges and opportunities in pain management disparities research: implications for clinical practice, advocacy, and policy

Due to high profile initiatives at the national level, awareness of inadequate pain care affecting many groups in our society has never been greater. Nevertheless, increased awareness of pain disparities and the initiatives to address these disparities have yielded only modest progress, most notably in the form of growing appreciation that pain disparities likely result from multiple factors, including biological, psychological, environmental, health system, and cultural factors. Much less progress has been made in developing interventions that target these multiple determinants to reduce pain management disparities. In this paper we discuss key ethical and methodological challenges that undermine our capacity to investigate and develop meaningful interventions to improve pain outcomes among vulnerable populations. Key challenges in the areas of research engagement, recruitment, design, and measurement are discussed from both scientific and normative standpoints. Specific opportunities within emerging research paradigms to improve designs and measures are also discussed. Finally, we conclude with identifying potential synergies between the pain management disparities research agenda and the broader areas of clinical practice, advocacy, and policy that could help to move the field forward.

PERSPECTIVE

Researchers studying disparities in pain care face a number of ethical and methodological challenges that must be addressed to advance the field towards eliminating disparities. We discuss these ethical and methodological challenges and propose opportunities for paradigmatic revisions in areas of research engagement, design, measurement, advocacy, and policy.

Clinical correlates of suicidal thoughts in patients with advanced cancer

OBJECTIVE

: Cancer patients are at heightened risk of suicide. Clinical correlates of suicidal ideation in advanced cancer patients were examined to identify those at risk and to inform the development of interventions to reduce suicidal ideation in this vulnerable group.

METHODS

: Coping with Cancer (CwC) is an NCI- and NIMH-funded multiinstitutional investigation examining psychosocial influences on the quality of life and care of advanced cancer patients. Baseline face-to-face interviews that assessed mental and physical functioning, coping, spirituality, and use of mental health services were conducted with 700 advanced cancer patients.

RESULTS

: Compared with patients without suicidal ideation, the 8.9% of patients who reported suicidal thoughts were more likely to be white and report no affiliation with an organized religion (p < 0.05). Adjusted analyses revealed that cancer patients who met criteria for current panic disorder (adjusted odds ratio [95% confidence interval] 3.24 [1.01-10.4]) and posttraumatic stress disorder (3.97 [1.13-14.1]), who accessed mental health services (3.70 [2.07-6.67]), particularly psychotherapy (2.62 [1.20-5.71]), who were not feeling well physically, and who lacked a sense of self-efficacy, spirituality, and being supported were more likely than others to report thoughts of suicide (p < 0.05).

CONCLUSIONS

: Advanced cancer patients who report suicidal thoughts are more likely to meet criteria for posttraumatic stress disorder and panic disorder, feel unsupported, lack a religious affiliation, spirituality, and a sense of self-efficacy, and experience more physical distress. Palliative care interventions that promote a sense of self-efficacy, spirituality, and support while minimizing physical distress may offer promise for reducing suicidal thoughts in this at-risk group.

Suicidal ideation in medical inpatients: psychosocial and clinical correlates

OBJECTIVE

To identify psychosocial and clinical correlates of suicidal ideation in medical inpatients.

METHOD

In a cross-sectional study, all adults consecutively admitted to the medical wards of a University Hospital had their names recorded and were randomized and evaluated during the first week of admission. Suicidal ideation was assessed using Item 9 of Patient Health Questionnaire-9. The Beck Depression Inventory, the Beck Anxiety Inventory, the WHO Subjective well-being scale, the Charlson Comorbidity Index and other numerical rating scales (pain and self-reported physical illness severity) were used. Patients with less than four confidants were considered with poor social support. The Student's t test, Mann-Whitney U test, chi-square test and stepwise logistic regression analysis were used.

RESULTS

Of the 1092 patients who composed the sample, 7.2% reported having suicidal ideation. After adjusting for psychosocial and clinical confounders, prior suicide attempts (OR: 4.41; 95% CI: 2.12-9.15; P<.001), depressive symptoms (OR: 1.11; 95% CI: 1.06-1.17; P<.001), severe anxiety symptoms (OR: 3.04; 95% CI: 1.47-6.26; P=.003) and poor social support (OR: 2.02; 95% CI:1.03-3.96; P=.04) were independently associated with suicidal ideation.

CONCLUSIONS

Three out of the four correlates of suicidal ideation in medical inpatients are potentially modifiable factors: severe anxiety, depressive symptoms and poor social support. The fourth variable, prior suicide attempts, is not modifiable but should serve as a red flag to suspect and investigate current suicide risk. These findings highlight the importance of suicidal ideation as a proxy for the distress that is incumbent upon physicians to manage if they wish to provide excellent and comprehensive inpatient care.

Treatment response to psychiatric intervention and predictors of response among cancer patients with adjustment disorders

CONTEXT

Although adjustment disorders (ADs) are common among patients with cancer and such patients are frequently referred to consultation-liaison psychiatrists, little is known about the clinical courses of these patients.

OBJECTIVES

The present study investigated treatment response to psychiatric intervention and predictors of response in a relatively large sampling of cancer patients with ADs.

METHODS

We created a database of all referral cases with ADs that included data on the patients' demographic and medical factors and physician-rated Clinical Global Impression (CGI) scale to assess treatment response and clinical course. A CGI-Improvement scale score of better than "much improved" was regarded as indicating a response to treatment; the number of patients who responded to treatment during a four-week follow-up period was assessed. Also, predictors of treatment response were explored by examining demographic and medical factors using a multivariate analysis.

RESULTS

Among the 238 eligible patients, 136 (57.1%) responded to psychiatric treatment; most of these responders improved to a subthreshold level of illness. On the other hand, 56 patients (23.5%) did not respond to psychiatric treatment, seven patients (2.9%) developed major depressive disorders, and 39 patients (16.4%) discontinued treatment before achieving a response. Among the predictive factors that were explored, suffering from pain significantly predicted a good treatment response, whereas a worse performance status predicted a poor treatment response.

CONCLUSION

Cancer patients with ADs can respond to psychiatric treatment, but a few cases develop major depressive disorders. Several predictors of treatment response were identified.

The risk of suicide in cancer patients: a review of the literature

OBJECTIVES

This review investigates the risk of suicide in people diagnosed with cancer.

METHOD

A literature search of PsycINFO, MEDLINE, EMBASE and CINAHL yielded 677 articles of which the abstracts were reviewed for their relevance. Seventy-one articles were identified as relevant and a further 3 were identified in a search of cited and citing articles; following application of inclusion and exclusion criteria, 39 articles were included in the review.

RESULTS

The reported incidence of completed suicide in cancer patients ranged from standardised mortality ratio of 1 to 11. The reported percentages of suicidal ideation in non-psychiatric populations of cancer patients ranged from 0.8 to 71.4%, compared to a reported prevalence of suicidal ideation in the general population, of between 1.1 and 19.8%. Risk factors identified for completed suicide and suicidal ideation in cancer patients include mental health, socio-demographic and illness factors. Some of these risk factors extend to the general population; however, some are specific to cancer such as cancer site, physical functioning and prognosis.

CONCLUSIONS

Despite the prevalence of suicidal ideation in a cancer population being comparable to the general population, the prevalence of completed suicide is elevated. Although suicidal ideation does not necessarily result in completed suicide, it is important that adequate training be provided for cancer professionals on the risk factors for suicide in cancer patients.

Dyspnea in lung cancer patients: a systematic review

Dyspnea is a common and distressing symptom experienced by 19%-51% of patients with advanced cancer. Higher incidences are reported in patients approaching end of life. While the prevalence of dyspnea has been reported to be as frequent as pain in people with lung cancer, less attention has been paid to the distress associated with dyspnea. This review of the literature was undertaken to investigate how dyspnea has been assessed and whether breathlessness in people with lung cancer is distressing. Using a predetermined search strategy and inclusion criteria, 31 primary studies were identified and included in this review. Different outcome measures were used to assess the experience of dyspnea, with domains including intensity, distress, quality of life, qualitative sensation, and prevalence. Overall, the studies report a high prevalence of dyspnea in lung cancer patients, with subjects experiencing a moderate level of dyspnea intensity and interference with activities of daily living. Distress associated with breathing appears to be variable, with some studies reporting dyspnea to be the most distressing sensation, and others reporting lower levels of distress. However, taking into account the prevalence, intensity, and distress of dyspnea, the general consensus appears to be that the experience of dyspnea in people with lung cancer is common, with varying degrees of intensity, but involves considerable unpleasantness. Thus, if dyspnea and pain are both distressing sensations for people with lung cancer, this has potential implications for both clinical and academic areas with regards to both management strategies and further research.

Risk factors for suicide following hospital discharge among cancer patients

OBJECTIVES

This study aims to examine risk factors associated with 3-month post-discharge suicide among cancer patients using Taiwan's nationwide, population-based datasets.

METHODS

The study cohort comprised all cancer patients discharged from hospitals from 2002 to 2004, inclusive, who committed suicide within 90 days of discharge (n=311). The control group consisted of 1555 cancer patients who did not commit suicide within 90 days of discharge. The dependent variable was whether or not a patient committed suicide within 90 days of discharge, while the independent variables included patient, hospital and physician characteristics at index hospitalization. Cox proportional hazard regression was carried out to compute the 90-day survival rate, adjusting for possible confounding factors.

RESULTS

The mean interval from discharge to suicide was 39.7 days (+/-95.2) and almost half (46.3%) of the 3-month post-discharge suicides occurred within 14 days after discharge. The adjusted hazard of committing suicide for patients who were not hospitalized in the preceding year was 1.68 (p=0.009), 1.61 (p=0.033), and 2.51 (p<0.001) times greater, respectively, than patients who were hospitalized once, twice and more than twice within the year before index hospitalization. The hazard of committing suicide among patients who were unemployed was 1.71 (p<0.001) times that of their employed counterparts.

CONCLUSIONS

We conclude that, while our study was limited to suicides among cancer patients within 90 days of discharge, around 60% of deaths occurred within the first month after discharge. The relevant risk factors include the number of hospitalizations within 1 year and employment status.

Suicide in cancer patients in South East England from 1996 to 2005: a population-based study

BACKGROUND

Studies from around the world have shown that suicide risk is increased in cancer patients, but no previous detailed analysis has been carried out in England.

METHODS

We calculated standardised mortality ratios (SMRs) for suicide in 206,129 men and 211,443 women diagnosed with cancer in South East England between 1996 and 2005, relative to suicide rates in the general population.

RESULTS

We found a significantly increased risk of suicide in men (SMR 1.45, 95% confidence interval (CI) 1.20-1.73) and a moderately increased risk in women (SMR 1.19, 95% CI 0.88-1.57). In both sexes, relative risk of suicide was greatest in the first year after cancer diagnosis (SMR for men 2.42, 95% CI 1.84-3.13; SMR for women 1.44, 95% CI 0.82-2.33), and was also greater in individuals diagnosed with types of cancer with high fatality (SMR for men 2.67, 95% CI 1.71-3.97; SMR for women 2.17, 95% CI 0.80-4.73).

CONCLUSION

There is a critical period immediately after the diagnosis of cancer during which the excess risk of suicide is particularly high. Carers need to be aware of the importance of attending to both the physical and emotional needs of cancer patients and cancer survivors.

Symptom indicator of severity of depression in cancer patients: a comparison of the DSM-IV criteria with alternative diagnostic criteria

OBJECTIVE

The objective of this study was to explore the performances of several diagnostic criteria items for judging the severity of major depression among cancer patients.

METHOD

Using modern item response theory, we examined the performances of the diagnostic criteria outlined by the DSM-IV and two sets of conceptual diagnostic criteria (the Endicott and the Cavanaugh criteria) in a series of 728 cancer patients who had been diagnosed with major depression using an inclusive approach.

RESULTS

While all the DSM-IV diagnostic criteria, including feelings of worthlessness and suicidal ideation, had a low ability for discriminating the severity of depression, two proposed items (not participating in medical care and social withdrawal) appeared to be good markers of moderately severe major depressive disorder among cancer patients. In addition, the items "fearfulness or depressed appearance in face or body posture" and "brooding, self-pity or pessimism" may be good markers for mild major depressive disorders, while the item "cannot be cheered up, doesn't smile, no response to good news or funny situations" may be a good marker for severe major depressive disorder.

CONCLUSIONS

The findings of the present study suggest that alternative criteria may have utility in diagnosing depression severity in cancer patients.

Illness-related hopelessness in advanced cancer: influence of anxiety, depression, and preparatory grief

The growing interest in the psychological distress in patients with cancer has been the major reason for the conduction of this study. The aims were to assess the relationship of hopelessness, anxiety, distress, and preparatory grief, as well as their predictive power to hopelessness. Ninety-four patients with advanced cancer completed the study at a palliative care unit in Athens, Greece. Beck Hopelessness Scale, the Greek version of the Hospital Anxiety and Depression (HAD) scale, and the Preparatory Grief in Advanced Cancer Patients scale were administered. Information concerning patients' treatment was acquired from the medical records, whereas physicians recorded their clinical condition. Hopelessness correlated significantly with preparatory grief (r = .630, P < .0005), anxiety (r = .539, P < .0005), depression (r = .642, P < .0005), HAD-Total (r = .686, P < .0005), and age (r = -.212, P = .040). Multiple regression analyses showed that preparatory grief (P < .0005), depression (P < .0005), and age (P = .003) were predictors of hopelessness, explaining 58.8% of total variance. In this patient sample, depression, preparatory grief, and patients' age were predictors of hopelessness.

Suicidality and self-harm among sexual minorities in Japan

In this study, I used ethnographic methods to examine suicidality and nonsuicidal self-harm among gay, lesbian, bisexual, and transgender persons in Japan. Participants (N = 84) indicated that suicidality and self-harm are serious problems among sexual minorities and tend to be driven by (a) a homophobic/transphobic environment and the negative consequences of sexual minorities either disclosing their true selves or remaining hidden and silent within such an environment; (b) various antecedents to poor mental health; and (c) factors not directly related to being a sexual minority, particularly unemployment and debt in the context of a protracted national economic decline in Japan prior to the study period of 2003--2004. Participants also perceived a potentially higher risk for suicidality and self-harm among sexual minority adolescents and persons in their early 20s; those who work in the entertainment, bar, or sex industries; and survivors of violence perpetrated by intimate partners or family members.

Revisiting depression in palliative care settings: the need to focus on clinical utility over validity

OBJECTIVE

To review the literature on depression in palliative care patients to identify implications for development of clinical practice and individual patient care.

METHOD

A qualitative review of depression prevalence studies in palliative care settings. We explore the utility of existing prevalence studies for clinical practice through testing two hypotheses: that high prevalence rates are associated with increased risk factors in study samples, and that poor methodological quality of the studies artefactually inflate prevalence estimates. Eighteen studies were identified in the search and included in this review.

RESULTS

Risk factors may contribute to depression prevalence but through a complex interaction of factors making individual risk levels hard to determine. Measurement artefact cannot, alone, account for elevated levels of depression in this population but may contribute to imprecision. The importance of organic decline as a potential confounding variable is highlighted.

CONCLUSION

Future research into the causes and prevalence of depression should adopt longitudinal approaches using large samples, and consider the impact of organic disorder as an important confounding factor. Clinical practice and care of individual patients may be better supported by development of a prognostic index considering the predictive power of depressive symptoms and risk factors on well-being.

The experience of hopelessness in a population of Greek cancer patients receiving palliative care

BACKGROUND

Beck Hopelessness Scale (BHS) has been translated and validated in many languages.

AIM

The validation of the English version of BHS in advanced cancer patients receiving palliative treatment in Greece.

METHODS

The final sample was 112 advanced cancer patients. Internal consistency, item-total correlations, and test-retest using four different approaches were calculated for the assessment of the reliability. Construct validity was used by examining correlations between BHS, Hospital Anxiety and Depression Scale (HAD-Depression) and the Schedule of Attitudes toward Hastened Death (SAHD). Known-groups validity was also assessed by detecting group differences according to disease severity as measured by the Eastern Cooperative Oncology Group (ECOG) performance status. Univariate and multivariate analyses were constructed to explore the relationship between hopelessness, depression, hastened death and the patients' demographic and clinical characteristics.

RESULTS

One factor solution was yielded accounted for 46.64% of the variance. The test-retest reliability was satisfactory (p < 0.0005). Validity as performed using known-group analysis showed good results. Most significant correlations were found between BHS, ECOG (p = 0.018) and gender (p = 0.08). The strongest predictors were gender (p = 0.050) and ECOG (p = 0.045).

CONCLUSIONS

BHS seemed to be a useful instrument to assess pessimistic attitude and hopelessness in a Greek cancer population, with valid psychometric properties.

Can psychiatric intervention improve major depression in very near end-of-life cancer patients?

Objective: Although depression is a prevalent and burdensome psychiatric problem in end-of-life cancer patients, little is known about its susceptibility to treatment, especially when patients reach very close to the end of life. This study was conducted to evaluate response rate of that end-of-life depression to psychiatric intervention and to assess the feasibility of conventional evidence-based pharmacological therapy for depression.

Methods: The medical records of 20 patients who were referred to the psychiatry division for major depressive disorder and died within 3 months after the referral were reviewed. The Clinical Global Impression–Improvement (CGI-I) Scale was used for each case, and responders were defined as patients whose scores were much or very much improved. All pharmacological treatments were extracted, and the doses of the antidepressant prescribed were compared to their evidence-based-defined therapeutic doses.

Results: Of the 20 patients, seven were responders, but no response was achieved when the survival time was less than 3 weeks. Most patients were treated with antidepressants, but the doses prescribed were far less than the defined doses, especially the doses of the tricyclic antidepressants (TCAs).

Significance of results: These results suggested that patients' survival time largely determines susceptibility to psychiatric treatment, and it is hard to achieve response in patients whose survival time was less than about 1 month. Implementation of conventional evidence-based pharmacological treatment is difficult, especially with TCAs, and various antidepressants, which can be administrated by other routes, are needed when oral intake is impossible.

Multifaceted psychosocial intervention program for breast cancer patients after first recurrence: feasibility study

We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) (p = 0.15), the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 (p = 0.005). The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted.

The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients

The current study assessed the attitudes of the desire for hastened death in terminally ill cancer patients and whether these are determined by their physical and psychological symptoms. The final sample consisted of 106 terminally ill cancer patients attending a Palliative Care Unit, in University of Athens, Greece, between June and October 2004. Significant associations were found between the desire for hastened death (D.H.D.) and 'pain' (r=0.469, p<0.005), 'fatigue' (r=0.591, p<0.0005), 'loss of appetite' (r=0.622, p<0.0005) and 'feeling sad' (r=0.635, p<0.0005). Statistically significant associations were also found between Schedule of Attitudes towards Hastened Death (SAHD) scores, age (r=0.300, p=0.002) and ECOG (p<0.0005). Twenty-six percent of the patients reported high D.H.D. while 41% reported moderate desire. In the prediction of SHAD the contribution of 'pain' (p=0.011), 'lack of appetite' (p=0.012) and 'sadness' (p=0.011) is high (42% of variance). Further findings suggest that D.H.D. is significantly related to 'feeling sad', 'lack of appetite', 'pain' and 'fatigue' after controlling for age, gender and performance status according to ECOG in terminally ill cancer patients.

Suicidal ideation and attempts in adult survivors of childhood cancer

PURPOSE

This study examined the prevalence of suicidal ideation and past suicide attempt in adult survivors of childhood cancer and investigated the relationship of suicidal symptoms to cancer treatment and current health. The hypothesis that poor physical health would be significantly associated with suicidality after adjusting for mental health variables was specifically tested.

METHODS

Two hundred twenty-six adult survivors of childhood cancer (mean age, 28 years) seen in a survivor clinic completed the Short Form-36 and the Beck Depression Inventory (BDI), as well as suicide items from the Symptom Checklist-90 Revised, and Beck Scale for Suicide Ideation. Participants reporting current suicide ideation or any past suicide attempt were classified as suicidal.

RESULTS

Twenty-nine participants (12.83%) reported suicidality, although only 11 of these were significantly depressed by BDI criteria. Univariate analyses found suicidality unrelated to age or sex but positively associated with younger age at diagnosis, longer time since diagnosis, cranial radiation treatment, leukemia diagnosis, depression, hopelessness, pain, and physical appearance concern. A hierarchical logistic regression showed that current physical functioning, including pain, was significantly associated with suicidality even after adjusting for treatment and depression variables.

CONCLUSION

Suicidal symptoms, which are reported by a significant minority of adult survivors of childhood cancer, are related to cancer treatments and post-treatment mental and physical health. Association of suicidal symptoms with physical health problems is important because these represent treatable conditions for which survivors may seek follow-up care. The relationship of physical well-being to suicidality underscores the need for a multidisciplinary approach to survivor care.

Course of psychological distress and its predictors in advanced non-small cell lung cancer patients

This study investigated longitudinal changes and predictive factors for psychological distress among 85 newly diagnosed advanced non-small cell lung cancer (NSCLC) patients. Whereas tension-anxiety after diagnosis (T1) was significantly reduced at two months (T2) and six months (T3) after diagnosis and depression-dejection at T1 was significantly reduced at T2, other forms of psychological distress, including anger-hostility, vigor, fatigue, and confusion, did not show significant changes. Total mood disturbance did not show significant change. Only a higher total mood disturbance at T1 was a significant predictor of total mood disturbance at T3. These findings demonstrate that most types of psychological distress experienced by advanced NSCLC patients is likely to persist during the subsequent clinical course. The findings also suggest that initial psychological distress itself after cancer diagnosis is the most important predictor for subsequent psychological distress and that early intervention beginning immediately after the disclosure of a diagnosis of cancer is one way to prevent and/or reduce subsequent psychological distress in advanced NSCLC patients.

Psychosocial aspects of lung cancer

BACKGROUND

Lung cancer is one of the commonest cancers in the industrialised world, and persons with this grave disease must deal not only with the physical effects but also with the psychosocial aspects.

METHODS

This review is based on an examination of intervention, prospective and case-control studies with more than 50 participants published between 1966 and 2003.

RESULTS

The studies show that on average one out of four persons with lung cancer experience periods of depression or other psychosocial problems during their illness. Persons who are not offered treatment for their cancer and persons with small-cell lung cancer have a higher risk compared to other groups of lung cancer patients. The degree of depression can be reduced by psychosocial interventions.

CONCLUSIONS

We suggest that psychosocial screening of persons with lung cancer could prevent depression and might result in improved quality of care.

Suicide Risk in Cancer Patients From 1960 to 1999

Purpose

Suicide risk is reportedly higher for cancer patients than for the general population, but estimates vary and analyses of trends are few. The aim of the present study was to determine whether cancer patients had a higher suicide risk between 1960 and 1999.

Patients and Methods

A cohort comprising patients from the Cancer Registry of Norway 1960 to 1997 was linked to suicide diagnosis in the Register of Deaths at Statistics Norway and observed during 1960 to 1999. The cohort consisted of all cancer patients registered in the Cancer Registry of Norway 1960 to 1997 (N = 490,245 patients with 520,823 cancer diagnoses). Suicide was defined according to death certificates based on the International Classification of Diseases (versions 7, 8, 9, and 10).

Results

During the period, 589 cancer patients (407 males and 182 females) committed suicide. The relative risk was elevated for males and females, with standardized mortality ratios (SMRs) of 1.55 (95% CI, 1.41 to 1.71) and 1.35 (95% CI, 1.17 to 1.56), respectively. Risk was highest in the first months after diagnosis. For both sexes, there was a significant decrease in the relative suicide risk over decades. The risk was markedly increased among male patients with cancer of respiratory organs (SMR, 4.08; 95% CI, 2.96 to 5.47). Otherwise, the SMRs varied from 0.76 to 3.67 across cancer types.

Conclusion

Cancer may be a risk factor for suicide, particularly shortly after diagnosis. However, the relative risk gradually decreased during the period 1960 to 1999.

Major Depression, Adjustment Disorders, and Post-Traumatic Stress Disorder in Terminally Ill Cancer Patients: Associated and Predictive Factors

Purpose

Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally.

Patients and Methods

Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated.

Results

The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up.

Conclusion

The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.

Daily omega-3 fatty acid intake and depression in Japanese patients with newly diagnosed lung cancer

The aim of the present study was to examine the association between daily omega-3 fatty acid intake and depression in Japanese cancer patients. Omega-3 fatty acid intake in 771 patients with newly diagnosed primary lung cancer was evaluated using a food-frequency questionnaire, and the prevalence of depression was examined using the cutoff values for the depression subscale included in the Hospital Anxiety and Depression Scale. After adjustment for potential confounding factors, the odds ratio (OR) for depression among patients in the highest quartile of the total eicosapentaenoic acid- (C20:5n-3) and docosapentaenoic acid (C22:6n-3)-intake group compared with patients in the lowest quartile was not significantly different. On the other hand, the OR among the highest quartile of α-linolenic acid (C18:3n-3) intake (adjusted OR=0.50, 95% CI: 0.31–0.71, P for trend=0.004) and the highest quartile of total omega-3 fatty acid intake (adjusted OR=0.55, 95% CI: 0.35–0.88, P for trend=0.022) were significantly different. These results suggest that total eicosapentaenoic acid and docosapentaenoic acid intake might not be associated with depression in Japanese patients with newly diagnosed lung cancer, but that α-linolenic acid intake and total omega-3 fatty acid intake might be.

Suicidality in terminally ill Japanese patients with cancer

BACKGROUND

The risk of suicide is higher in patients with cancer than in the general population, making end-of-life care of suicidal terminal patients with cancer critical. To identify factors and longitudinal changes associated with suicidality among terminally ill Japanese patients with cancer, a prospective cohort study was performed.

METHODS

Consecutive outpatients with cancer who registered with a palliative care unit participated. Structured interviews (e.g., Structured Clinical Interview for DSM- III-R [SCID]) were conducted to assess patient suicidal ideation (Ideation) and interest in requesting euthanasia (Interest) as main outcome measures of suicidality. Possible correlated factors also were investigated. The authors analyzed the data from 140 terminally ill patients with cancer at initial study participation (baseline) whose subsequent survival time was < 6 months. Of these 140 patients, 57 (40.7%) completed the follow-up assessment after admission to the unit.

RESULTS

At baseline, 8.6% of the patients had Ideation and 5.0% had Interest. Self-reported anxiety and depression was significantly associated with Ideation (P= 0.003). Changes in Ideation and Interest occurred in 38.6% and 15.8% of the patients, respectively. Ideation was more likely to change than Interest (P = 0.006). The current study did not identify factors that predict changes and occurrences of suicidal ideation and interest in requesting euthanasia.

CONCLUSIONS

Suicidality can change even in terminally ill patients. End-of-life care that focuses on the psychologic distress of dying individuals may be a way of preventing suicide.

Effects of depression on parameters of cell-mediated immunity in patients with digestive tract cancers

AIM: To evaluate the effects of depression on parameters of cell-mediated immunity in patients with cancers of the digestive tract.

METHODS: One hundred and eight adult patients of both sexes with cancers of the digestive tract admitted between March 2001 and February 2002 in the Department of Medical Oncology, First Affiliated Hospital of Xi’an Jiaotong University were randomly enrolled in the study. The Zung self-rating depression scale (SDS), Zung self-rating anxiety scale (SAS), numeric rating scale (NRS) and social support rating scale (SSRS) were employed to evaluate the degree of depression and their contributing factors. In terms of their SDS index scores, the patients were categorized into depression group (SDS ≥ 50) and non-depression group (SDS < 50). Immunological parameters such as T-lymphocyte subsets and natural killer (NK) cell activities in peripheral blood were determined and compared between the two groups of patients.

RESULTS: The SDS index was from 33.8 to 66.2 in the 108 cases, 50% of these patients had a SDS index more than 50. Similarly, the SAS index of all the patients ranged from 35.0 to 62.0 and 46.3% of the cases had a SAS index above 50. Cubic curve estimation showed that the depression was positively correlated with anxiety and negatively with social support. Furthermore, the depression correlated with the tumor type, which manifested in a descending order as stomach, gallbladder, pancreas, intestine, esophagus, duodenum and rectum, according to their correlativity. Step-wise regression analysis suggested that hyposexuality, dispiritment, agitation, palpitation, low CD₅₆ and anxiety were the significant factors contributing to depression. More severe anxiety (49.7 ± 7.5 vs 45.3 ± 6.9, P < 0.05), pain (6.5 ± 2.8 vs 4.6 ± 3.2, P < 0.05), poor social support (6.8 ± 2.0 vs 7.6 ± 2.1, P < 0.05), as well as decline of lymphocyte count (0.33 ± 0.09 vs 0.39 ± 0.87, P < 0.05) and CD₅₆ (0.26 ± 0.11 vs 0.29 ± 0.11, P < 0.05) were noted in the depression group compared with those of the non-depression patients. However, fewer obvious changes in CD₄/CD₈ ratio and other immunological parameters were found between the two groups.

CONCLUSION: Depression occurs with a high incidence in patients with cancers of the digestive tract, which probably is not the sole factor leading to the impairment of immunological functions in these cases. However, comprehensive measures including psychological support should be taken in order to improve the immunological function, quality of life and clinical prognosis of these patients.