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DeSerisy M, Salas L, Akhundova E, Pena D, Cohen JW, Pagliaccio D, Herbstman J, Rauh V, Margolis AE. Polycyclic aromatic hydrocarbon exposure effects on trajectories of maternal and adolescent mental health. Child Adolesc Psychiatry Ment Health 2024; 18:114. [PMID: 39261930 PMCID: PMC11391764 DOI: 10.1186/s13034-024-00804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Parental psychological distress is a well-known risk factor for developmental psychopathology, with longer term parental distress associated with worse youth mental health. Neurotoxicant exposure during pregnancy is a risk factor for both poor maternal and youth mental health. The impact of one class of pollutant, polycyclic aromatic hydrocarbons (PAH), on long-term trajectories of maternal distress and youth self-reported mental health symptoms in adolescence has been understudied. METHODS PAH exposure was measured by DNA adducts in maternal blood sampled during the third trimester of pregnancy. Maternal distress, operationalized as maternal demoralization, was measured at 11 timepoints (prenatal to child age 16). Adolescent mental health symptoms were measured at age 13-15. Follow up analyses examined a subset of measures available at age 15-20 years. Structural equation modeling examined associations between PAH exposure during pregnancy and latent growth metrics of maternal distress, and between maternal distress (intercept and slope) and youth mental health symptoms in a prospective longitudinal birth cohort (N = 564 dyads). RESULTS Higher prenatal PAH exposure was associated with higher concurrent maternal distress. Prenatal maternal distress was associated with adolescent's self-reported anxiety, depression, and externalizing problems. On average, maternal distress declined over time; a slower decline in mother's distress across the course of the child's life was associated with greater self-reported anxiety and externalizing problems in youth. CONCLUSIONS Our findings are consistent with an intergenerational framework of environmental effects on mental health: PAH exposure during pregnancy affects maternal mental health, which in turn influences mental health outcomes for youth well into adolescence. Future research is necessary to elucidate the possible social and biological mechanisms (e.g., parenting, epigenetics) underlying the intergenerational transmission of the negative effects of pollution on mental health in caregiver-child dyads.
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Affiliation(s)
- Mariah DeSerisy
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Leilani Salas
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Emiliya Akhundova
- Columbia College, Columbia University, 1130 Amsterdam Ave, New York, NY, 10027, USA
| | - Dahiana Pena
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jacob W Cohen
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - David Pagliaccio
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Virginia Rauh
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Amy E Margolis
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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Fang S, Xu L, Liu J, Zhang X, Li M, Zhang T, Lu M. Self-rated health and health-related quality of life among cancer patients: the serial multiple mediation of anxiety and depression. BMC Psychol 2024; 12:415. [PMID: 39080782 PMCID: PMC11290125 DOI: 10.1186/s40359-024-01919-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) in cancer patients has attracted increasing attention, which may be associated with self-rated health (SRH), anxiety, and depression. However, limited studies have focused on the mediating role of anxiety and depression in the relationship between SRH and HRQOL among cancer patients. Therefore, this study aims to explore the serial multiple mediating effects of anxiety and depression between SRH and HRQOL in cancer patients. METHODS This cross-sectional study investigated a total of 565 hospitalized cancer patients in Anhui province in China from November 2020 to October 2021. SRH was assessed using a single-item measure, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and HRQOL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Socio-demographic and clinical characteristics were analyzed using descriptive statistics. The relationships between SRH, anxiety, depression, and HRQOL were evaluated by Pearson correlation analysis. The serial multiple mediation of anxiety and depression was assessed by SPSS PROCESS macro. RESULTS SRH, anxiety, depression and HRQOL were significantly correlated(P < 0.001). In comparison to the fair SRH, the good SRH exhibited a significantly positive direct effect (Effect = 0.2366, Bootstrap 95%CI: 0.0642 ~ 0.4090) and total effect on HRQOL (Effect = 0.4761, Bootstrap 95%CI: 0.2975 ~ 0.6546). Conversely, the poor SRH demonstrated a significantly negative total effect on HRQOL (Effect= -0.4321, Bootstrap 95%CI: -0.7544~ -0.1099). When considering the fair SRH as the reference group, the poor SRH displayed a negative indirect effect on HRQOL through the single mediation of anxiety (Effect= -0.1058, Bootstrap 95%CI: -0.2217~ -0.0107) and the serial mediation of anxiety and depression (Effect= -0.0528, Bootstrap 95%CI: -0.1233~ -0.0035). Conversely, the good SRH had a positive indirect impact on HRQOL through the single mediation of anxiety (Effect = 0.1153, Bootstrap 95%CI: 0.0583 ~ 0.1900) and depression (Effect = 0.0667, Bootstrap 95%CI: 0.0206 ~ 0.1234), as well as the serial mediation of anxiety and depression (Effect = 0.0575, Bootstrap 95%CI: 0.0192 ~ 0.1030). CONCLUSION SRH can improve HRQOL through the decrease of anxiety and depression in cancer patients. Focusing on SRH would be beneficial for their mental health and HRQOL in cancer patients.
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Affiliation(s)
- Shuowen Fang
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Lingfeng Xu
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Jingsong Liu
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Xinzhou Zhang
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Mimi Li
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Tao Zhang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Manman Lu
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China.
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Ren XQ, Zhao GM, Fang SW, Xu LF, Wang LD, Zhao LH, Lu MM. Mediating roles of activities of daily living and depression on the relationship between sleep quality and health-related quality of life. Sci Rep 2024; 14:14057. [PMID: 38890451 PMCID: PMC11189409 DOI: 10.1038/s41598-024-65095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 06/17/2024] [Indexed: 06/20/2024] Open
Abstract
This study aimed to explore the mediating effects of ADL and depression on the relationship between sleep quality and HRQOL among older people in rural China, while also exploring the moderating impact of loneliness. The study gathered data from a household survey conducted among 1587 Chinese rural older adults (mean age = 73.63 years). The collected data was analyzed using SPSS version 23.0 software (IBM, New York, USA) and the PROCESS macro version 4.0 program. The findings indicated a significant correlation between sleep quality, ADL, depression, loneliness and HRQOL. ADL and depression exhibited a chain mediation effect on the relationship between sleep quality and HRQOL. Notably, the association between sleep quality and HRQOL was entirely mediated by ADL and depression. Additionally, loneliness acted as a moderator in the relationship between ADL and HRQOL. The findings of this study suggest that interventions focusing on sleep quality should prioritize strategies for enhancing older adults' ADL and depression as integral components of promoting older adults' HRQOL.
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Affiliation(s)
- Xiao-Qing Ren
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
| | - Gong-Ming Zhao
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Shuo-Wen Fang
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
| | - Ling-Feng Xu
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
| | - Li-Dan Wang
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- Health Policy Research Center, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Lin-Hai Zhao
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- Health Policy Research Center, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Man-Man Lu
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China.
- Health Policy Research Center, Anhui Medical University, Hefei, 230032, Anhui, China.
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Yang Q, Yang L, Yang C, Wu X, Xu Z, Wang X. How is work-family conflict linked to nurse-assessed patient safety among intensive care unit nurses? A serial multiple mediation analysis. Aust Crit Care 2024:S1036-7314(24)00078-X. [PMID: 38762342 DOI: 10.1016/j.aucc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 05/20/2024] Open
Abstract
AIM The aim of this study was to test whether rumination and negative affectivity mediate the relationship between work-family conflict and nurse-assessed patient safety among intensive care unit nurses. BACKGROUND Most intensive care unit nurses experience work-family conflicts that jeopardise patient safety. Although prior studies have explored the effect of work-family conflict on patient safety, few have investigated whether work-family conflict is associated with patient safety through rumination and negative affectivity among intensive care unit nurses. DESIGN Cross-sectional study. METHODS This study included 209 intensive care unit nurses from five general hospitals. The Work-Family Conflict Scale, the Ruminative Response Scale, the Positive and Negative Affect Schedule-Negative Affectivity, and three items indicating nurses' perception of overall patient safety were used to gather data. Associations between work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were assessed using correlation and serial multiple mediation analysis. RESULTS Work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were significantly correlated (p < 0.01). Work-family conflict can have not only a direct negative impact on the nurse-assessed patient safety (effect = -0.0234; standard error [SE] = 0.0116; 95% confidence interval [CI]: lower limit [LL] = -0.0464, upper limit [UL] = -0.0005) but also an indirect impact on nurse-assessed patient safety through three paths: the independent mediating role of rumination (effect = -0.0118; SE = 0.0063; 95% CI: LL = -0.0251, UL = -0.0006), the independent mediating role of negative affectivity (effect = -0.0055; SE = 0.0039; 95% CI: LL = -0.0153, UL = -0.0001), and the chain-mediating role of rumination and negative affectivity (effect = -0.0078; SE = 0.0031; 95% CI: LL = -0.0152, UL = -0.0027). CONCLUSION Our findings indicated that work-family conflict could influence nurse-assessed patient safety through increasing rumination and negative affectivity among intensive care unit nurses. Based on the results, interventions aimed at decreasing work-family conflict would be beneficial for intensive care unit nurses' emotional stability and patient safety.
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Affiliation(s)
- Qianqian Yang
- Liaocheng People's Hospital, Medical School of Liaocheng University, Liaocheng, Shandong Province, 252000, China; School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, 250012, China.
| | - Linlin Yang
- Nursing Department of Liaocheng People's Hospital, Liaocheng, Shandong, China.
| | - Chunling Yang
- Nursing Department of Liaocheng People's Hospital, Liaocheng, Shandong, China.
| | - Xia Wu
- Nursing Department of Taian City Central Hospital, Taian, Shandong, China.
| | - Zhen Xu
- Intensive Care Unit of Taian City Central Hospital, Taian, Shandong, China.
| | - Xiaobing Wang
- Obstetrics Department, Liaocheng People's Hospital, China.
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Bellman V. Review of Psilocybin Use for Depression among Cancer Patients after Approval in Oregon. Cancers (Basel) 2024; 16:1702. [PMID: 38730654 PMCID: PMC11083170 DOI: 10.3390/cancers16091702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Despite the legalization of psilocybin therapy for depression in terminal illnesses such as advanced cancer through Oregon's Measure 109 in 2020, significant challenges have impeded its implementation. This review synthesizes the empirical data supporting the utilization of psilocybin therapy for addressing cancer-related depression, including an evaluation of its purported benefits and potential adverse effects. It provides a comprehensive examination of therapeutic strategies, dosing regimens, and barriers to ensuring responsible and equitable access. Salient issues explored include the development of ethical protocols, integration within healthcare systems, ensuring statewide availability, resolving legal ambiguities, and defining clinical standards. Oregon's pioneering role serves as a case study, highlighting the necessity of addressing regulatory, logistical, and ethical obstacles to ensure the establishment of rigorous and equitable psilocybin care models.
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Affiliation(s)
- Val Bellman
- Psychiatry Residency Training Program, University of Missouri Kansas City, Kansas City, MO 64108, USA
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Ernst M, Schwinn T, Hirschmiller J, Cleare S, Robb KA, Brähler E, Zwerenz R, Wiltink J, O'Connor RC, Beutel ME. 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. Clin Psychol Rev 2024; 109:102413. [PMID: 38518584 DOI: 10.1016/j.cpr.2024.102413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/29/2023] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
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.
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Affiliation(s)
- Mareike Ernst
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria; Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Tamara Schwinn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Judith Hirschmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kathryn A Robb
- Cancer Behaviour Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Xu G, Zheng J, Lin X, Wu H, Yang S, Xiao H, Lin X. Existential distress and associated factors in advanced cancer patients: A cross-sectional study. Palliat Support Care 2024:1-8. [PMID: 38362710 DOI: 10.1017/s147895152400018x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Advanced cancer patients often experience existential distress (ED). However, the factors associated with ED remain unclear. This study investigated the current state of ED and identified the associated factors in Chinese patients with advanced cancer. METHODS A cross-sectional study was conducted among 352 advanced cancer patients from 3 tertiary hospitals in Fujian, China. Participants were invited to complete the Existential Distress Scale, Number Rating Scale, Self-Perceived Burden Scale, Quality of Life Concerns in the End-of-Life Questionnaire, and Hospital Anxiety and Depression Scale. OBJECTIVES This study aimed to investigate the level of existential distress among advanced cancer patients in China and identify the associated factors. RESULTS A total of 352 advanced cancer patients were recruited for this study. The average score for ED was 8.48 ± 7.12 among the advanced cancer patients. Multiple regression showed that the associated factors included depression (β = 0.32, p = 0.000), self-perceived burden (SPB) (β = 0.18, p = 0.001), the presence of a spouse (β = -0.10, p = 0.050), and reception of government subsidies (β = 0.17, p = 0.001). The factors accounted for 30.1% of the total variance in ED (F = 8.472, p < 0.001). SIGNIFICANCE OF RESULTS Among the advanced cancer patients queried, ED was found to be positively influenced by depression, SPB, and reception of government subsidies and negatively influenced by the presence of a spouse. Depression was the most important risk factor, and thus future ED interventions should target depression.
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Affiliation(s)
- Guiru Xu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jianwei Zheng
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaodan Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hong Wu
- Fujian Provincial Hospice, Fuzhou, China
| | - Shangwang Yang
- Department of Oncology, Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiaoyan Lin
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
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Kissane DW. Education and assessment of psycho-existential symptoms to prevent suicidality in cancer care. Psychooncology 2024; 33:e5519. [PMID: 33463852 DOI: 10.1002/pon.5519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022]
Affiliation(s)
- David W Kissane
- University of Notre Dame Australia and Cunningham Centre for Palliative Care Research, St Vincent's Sydney, Sydney, Australia
- Cabrini Health Psycho-oncology and Palliative Care, Monash University, Melbourne, Australia
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Wang Y, Sun H, Ji Q, Wu Q, Wei J, Zhu P. Prevalence, Associated Factors and Adverse Outcomes of Demoralization in Cancer Patients: A Decade of Systematic Review. Am J Hosp Palliat Care 2023; 40:1216-1230. [PMID: 36718669 DOI: 10.1177/10499091231154887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Demoralization has been extensively studied in oncology and palliative care settings, and is characterized by a loss of meaning and purpose in life, a sense of powerlessness over life events, and a sense of helplessness. The objective of this systematic review is to synthesize the prevalence, associated factors, and adverse outcomes of demoralization in cancer patients by reviewing the literature of the last decade. Seven databases (PubMed, PsycINFO, Embase, Web of Science, Medline, CINAHL and Cochrane Library databases) were systematically searched from January 2012 to June 2022. Roughly speaking, the prevalence of demoralization in cancer patients ranges from 13.50% to 49.4%. A total of 45 factors are associated with demoralization, of which psychological factors have been studied more frequently in the last decade. There are nine outcomes related to demoralization, with the strongest evidence for the correlation between demoralization and suicidal ideation. The study emphasizes the complexity of factors associated with demoralization in cancer patients. There appears to be a intersection between the constructs of demoralization and depression, anxiety, and suicidal ideation, which may explain the correlation between them.
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Affiliation(s)
- Yuejuan Wang
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Haichao Sun
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Qiaoying Ji
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Qiwei Wu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Jinrong Wei
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Department of Nursing, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, China
| | - Pingting Zhu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
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Fava M, Sorg E, Jacobs JM, Leadbetter R, Guidi J. Distinguishing and treating demoralization syndrome in cancer: A review. Gen Hosp Psychiatry 2023; 85:185-190. [PMID: 37950966 DOI: 10.1016/j.genhosppsych.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/22/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
IMPORTANCE Demoralization, characterized by a persistent inability to cope, as well as helplessness, hopelessness, and despair, is highly prevalent in oncology, with between 36% to 52% of patients exhibiting demoralization syndrome. Given established evidence linking demoralization in patients with cancer to physical symptom burden, quality of life, sleep disturbance, and suicidality, assessment and treatment of demoralization syndrome is critical for optimizing clinical and psychosocial outcomes. OBSERVATIONS The term "demoralization" is highly relevant to the care of patients with cancer facing life-limiting illnesses. Indeed, demoralization can be conceptualized as a feeling state characterized by the perception of being unable to cope with some pressing problems and/or of lack of adequate support from others. Despite a considerable overlap in symptoms, demoralization and depression should be regarded as distinct and independent clinical syndromes. Patients who are demoralized but not clinically depressed often describe a sense of subjective incompetence and do not report anhedonia (i.e., loss of interest and inability to enjoy things). Although the definition of demoralization is now included as a distinct syndrome in the International Classification of Diseases (ICD)-11, it has been neglected by the current U.S. official nosology in psychiatry, such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). As such, demoralization syndrome may be under- or misdiagnosed and treated ineffectively in the oncology setting, potentially prolonging suffering and influencing cancer outcomes. CONCLUSIONS AND RELEVANCE Optimization of methods to diagnose and assess demoralization syndrome is critical to underpin rigorous studies evaluating the efficacy of psychotherapeutic and pharmacological interventions for patients with cancer experiencing demoralization. Our review supports the use of specific diagnostic criteria for demoralization in cancer patients, introduces methodological considerations relevant to treatment studies, and presents a novel measurement approach to the assessment of demoralization severity with the Clinical Interview for Demoralization (CIDE).
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Affiliation(s)
- Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Bulfinch 351 - 55 Fruit Street, Boston, MA 02114, United States of America.
| | - Emily Sorg
- Center for Psychiatric Oncology & Behavioral Sciences, Department of Psychiatry & Mass General Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States of America
| | - Jamie M Jacobs
- Center for Psychiatric Oncology & Behavioral Sciences, Department of Psychiatry & Mass General Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States of America
| | - Robert Leadbetter
- Reset Pharmaceuticals, Massachusetts General Hospital MA United States of America
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
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Shaygan M, Hosseini FA, Shemiran M, Hedayati A. The effect of mobile-based logotherapy on depression, suicidal ideation, and hopelessness in patients with major depressive disorder: a mixed-methods study. Sci Rep 2023; 13:15828. [PMID: 37740006 PMCID: PMC10516998 DOI: 10.1038/s41598-023-43051-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
Major depressive disorder is one of the most common psychiatric disorders in the world. It is essential to study and use effective, available, and affordable psychotherapy methods along with drug therapy to manage the symptoms of this disease. Therefore, the current study aimed to determine the effect of mobile phone-based logotherapy on depression, suicidal ideation, and hopelessness in patients with major depressive disorder by using a mixed-methods approach. In the first phase of this mixed-methods study, 70 patients completed the quantitative phase (control group = 35, intervention group = 35). The intervention group received an 8-week mobile-based logotherapy program via WhatsApp (one 180-min module per week) combined with sertraline, while the control group received just sertraline plus education about pharmacotherapy. Data was collected before, immediately after the intervention, and 3 months later using the Beck depression inventory short form items (BDI-13), the Beck hopelessness scale (BHS), and the Beck scale for suicide ideation (BSSI). Then, a qualitative study on the intervention group was conducted to explain the findings of the quantitative phase. The repeated measure MANOVA revealed a significant interaction effect of time and group on the set of dependent variables (F(6,63) = 25.218, P < 0.001). Qualitative analysis confirmed the efficacy of sertraline plus mobile-based logotherapy on depression, suicidal ideation, and hopelessness in the intervention group. Three key themes extracted from the participants' experiences of mobile-based logotherapy were "efficient instruction", "user-friendly intervention" and "constructive change". Mobile-based logotherapy through WhatsApp was an effective psychotherapy method for decreasing depression, hopelessness, and suicidal ideation in patients with major depressive disorder. It is suggested that educational, institutional, and technological infrastructure for providing and using mobile-based logotheapy for patients with major depressive disorder be considered in the mental health care system.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fahimeh Alsadat Hosseini
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Shemiran
- Student Research Committee, Department of Psychiatric Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arvin Hedayati
- Research Center for Psychiatry and Behavior Science, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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DeSerisy M, Cohen JW, Dworkin JD, Stingone JA, Ramphal B, Herbstman JB, Pagliaccio D, Margolis AE. Early life stress, prenatal secondhand smoke exposure, and the development of internalizing symptoms across childhood. Environ Health 2023; 22:58. [PMID: 37620883 PMCID: PMC10463722 DOI: 10.1186/s12940-023-01012-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Prior findings relating secondhand tobacco smoke (SHS) exposure and internalizing problems, characterized by heightened anxiety and depression symptoms, have been equivocal; effects of SHS on neurodevelopment may depend on the presence of other neurotoxicants. Early life stress (ELS) is a known risk factor for internalizing symptoms and is also often concurrent with SHS exposure. To date the interactive effects of ELS and SHS on children's internalizing symptoms are unknown. We hypothesize that children with higher exposure to both prenatal SHS and ELS will have the most internalizing symptoms during the preschool period and the slowest reductions in symptoms over time. METHODS The present study leveraged a prospective, longitudinal birth cohort of 564 Black and Latinx mothers and their children, recruited between 1998 and 2006. Cotinine extracted from cord and maternal blood at birth served as a biomarker of prenatal SHS exposure. Parent-reported Child Behavior Checklist (CBCL) scores were examined at four timepoints between preschool and eleven years-old. ELS exposure was measured as a composite of six domains of maternal stress reported at child age five. Latent growth models examined associations between SHS, ELS, and their interaction term with trajectories of children's internalizing symptoms. In follow-up analyses, weighted quintile sum regression examined contributions of components of the ELS mixture to children's internalizing symptoms at each time point. RESULTS ELS interacted with SHS exposure such that higher levels of ELS and SHS exposure were associated with more internalizing symptoms during the preschool period (β = 0.14, p = 0.03). The interaction between ELS and SHS was also associated with a less negative rate of change in internalizing symptoms over time (β=-0.02, p = 0.01). Weighted quintile sum regression revealed significant contributions of maternal demoralization and other components of the stress mixture to children's internalizing problems at each age point (e.g., age 11 WQS β = 0.26, p < 0.01). CONCLUSIONS Our results suggest that prior inconsistencies in studies of SHS on behavior may derive from unmeasured factors that also influence behavior and co-occur with exposure, specifically maternal stress during children's early life. Findings point to modifiable targets for personalized prevention.
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Affiliation(s)
- Mariah DeSerisy
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Jacob W Cohen
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jordan D Dworkin
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Bruce Ramphal
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - David Pagliaccio
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Amy E Margolis
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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13
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Mozumder MK, Jasmine UH, Haque MA, Haque S. Mental health and suicide risk among homosexual males in Bangladesh. PLoS One 2023; 18:e0289597. [PMID: 37582101 PMCID: PMC10426927 DOI: 10.1371/journal.pone.0289597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Homosexual individuals are at high risk of suicide, but there is a shortage of data from developing countries to confirm this. Estimates on mental health and suicide risk among male homosexuals in Bangladesh are needed to generate awareness and to plan services accordingly. METHOD We assessed mental health and suicidal behavior of 102 self-identified homosexual males from a community-based organization that works with the sexual minority population. RESULTS One-third of the participants (32.4%) had experienced attempted suicide, and almost half (47.1%) had a history of suicidal ideation and self-harm (40.2%). Compared to a heterosexual sample, homosexual males had poorer mental health as they scored higher on Beck Hopelessness Scale (Cohen's d = 0.29) and General Health Questionnaire (GHQ) (Cohen's d = 0.57). The results revealed positive correlations between self-harm, suicidal ideation and suicide attempt scores. Participants with history of suicide attempt, suicide ideation and self-harm reported worse general health, more social dysfunction, and severe depression than those without such history. CONCLUSION Suicidality and mental health conditions among homosexual males in Bangladesh have appeared to be alarming. Given the concerns, we offer some recommendations for practitioners and social workers who are serving this population in Bangladesh.
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Affiliation(s)
| | | | | | - Shamsul Haque
- Department of Psychology, Monash University Malaysia, Sunway, Malaysia
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14
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Siraji MA, Jahan N, Borak Z. Validation of the Bangla Communication Scale among Bangladeshi adolescents: A Classical Test Theory and Item Response Theory approach. Asian J Psychiatr 2023; 84:103586. [PMID: 37079986 DOI: 10.1016/j.ajp.2023.103586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Assessing communication skills is necessary to facilitate pro-communication skills development programs. The 23-item Communication Scale (CS) is the most widely used tool for this purpose. Since there is a scarcity of validated tools to assess communication skills among Bangladeshi adolescents, we translated this questionnaire into Bangla and validated it on a Bangladeshi adolescent sample. METHODS We conducted two independent rounds of large-scale surveys that yielded data from 621 Bangladeshi adolescents (AgeMean ± SD = 16.44 ± 1.32), of which 378 were males, and 244 were females. The participants completed the Bangla CS. A subset of the participants (n = 160) also completed the Bangla Beck's Hopelessness Scale (BBHS)-a measure of hopelessness. RESULTS Exploratory factor analysis on the first-round data (n = 340) discarded six items and retained 17 items and revealed a unidimensional factor structure. Confirmatory Factor Analysis on the second-round data (n = 281) supported the unidimensional structure (CFI = 0.94, TLI = 0.93). Measurement invariance analysis indicated that the unidimensional structure was robust across gender (143 males vs 139 females). The scale exhibited a negative correlation with BBHS revealing the scale's concurrent validity (r = - 0.16, p < 0.01). The scale exhibited satisfactory reliability (ωt = 0.79). The Item Response Theory-based analysis revealed that the scale was reliable (> 0.70) across a sizable range of communication skills continuum (θ = - 5.3 to 2.3) and had excellent marginal reliability (0.80). All items had adequate discriminating power (0.90 ± 0.20). CONCLUSION The psychometric analysis of the 17-item Bangla-CS indicated that the scale is reliable and valid. We recommend that researchers and mental health practitioners utilize this scale to evaluate communication skills among Bangladeshi adolescents.
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Affiliation(s)
- Mushfiqul Anwar Siraji
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia; Intelligent Lighting Lab, Monash University, Malaysia
| | - Nusrat Jahan
- Department of Educational and Counselling Psychology, University of Dhaka, Bangladesh
| | - Zinnatul Borak
- Department of Educational and Counselling Psychology, University of Dhaka, Bangladesh.
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15
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Guo Z, Yang T, He Y, Tian W, Wang C, Zhang Y, Liu J, Liu X, Zhu X, Wu S. The Relationships Between Suicidal Ideation, Meaning in Life, and Affect: a Network Analysis. Int J Ment Health Addict 2023:1-20. [PMID: 36776916 PMCID: PMC9904259 DOI: 10.1007/s11469-023-01019-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
Transitioning from holistic analysis to a fine-grained level analysis may provide further understanding of psychopathology. This study aimed to explore dimension-level relationships between suicidal ideation, meaning in life, and affect in a joint framework using network analysis and to identify potential prevention and intervention targets to address suicidal ideation. A total of 852 healthy adults aged 18-35 years completed self-report scales to assess suicidal ideation, meaning in life, and affect. A regularized partial correlation network was then built to examine the links between these dimensions. Expected influence and bridge expected influence values were calculated for each node. The prevalence of suicidal ideation was 4.2%. The search for and presence of meaning in life and positive and negative affect exhibited distinct and complex links to the three dimensions of suicidal ideation (pessimism, sleep, and despair). The important central nodes were search for meaning in life, sleep, despair, and positive affect, while the critical bridge nodes were positive affect, negative affect, and presence of meaning in life. These findings provide further understanding of the specific roles of meaning in life and affect in suicidal ideation. The identified nodes may be promising targets for prevention and intervention for suicidal ideation.
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Affiliation(s)
- Zhihua Guo
- Department of Military Medical Psychology, Air Force Medical University, No. 169 West Changle Road, Xi’an, Shaanxi Province, 710032 China
| | - Tianqi Yang
- Department of Military Medical Psychology, Air Force Medical University, No. 169 West Changle Road, Xi’an, Shaanxi Province, 710032 China
| | - Yang He
- Department of Military Medical Psychology, Air Force Medical University, No. 169 West Changle Road, Xi’an, Shaanxi Province, 710032 China
| | - Wenqing Tian
- Department of Military Medical Psychology, Air Force Medical University, No. 169 West Changle Road, Xi’an, Shaanxi Province, 710032 China
| | - Chaoxian Wang
- 94995 Troops of People’s Liberation Army, Beijing, China
| | - Yinling Zhang
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Jianjun Liu
- Outpatient Department, PLA Air Force 986 Hospital, Xi’an, China
| | - Xufeng Liu
- Department of Military Medical Psychology, Air Force Medical University, No. 169 West Changle Road, Xi’an, Shaanxi Province, 710032 China
| | - Xia Zhu
- Department of Military Medical Psychology, Air Force Medical University, No. 169 West Changle Road, Xi’an, Shaanxi Province, 710032 China
| | - Shengjun Wu
- Department of Military Medical Psychology, Air Force Medical University, No. 169 West Changle Road, Xi’an, Shaanxi Province, 710032 China
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16
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Woźniewicz A, Cosci F. Clinical utility of demoralization: A systematic review of the literature. Clin Psychol Rev 2023; 99:102227. [PMID: 36462221 DOI: 10.1016/j.cpr.2022.102227] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Demoralization is a complex clinical phenomenon which has raised a growing interest in clinical and research realms. The present systematic review of the literature aimed at (1) updating on demoralization prevalence in different populations, (2) identifying the instruments more largely used to assess demoralization, and (3) verifying whether new tools of assessment have been proposed. PubMed and Web of Science were searched from inception to April 2022. Search terms were: demoralization/demoralized/demoralizing/demoralised/demoralising. PRISMA guidelines were followed. GRADE rating system was used. A total of 188 papers were included. Demoralization appeared to be a distinctive psychological state common in medical, psychiatric, and non-clinical settings, thus not limited to life-threatening diseases. Diagnostic Criteria for Psychosomatic Research (DCPR) and Demoralization Scale (DS) are the most commonly used tools to assess it. DCPR allow to diagnose demoralization as a manifestation of dealing with chronic stress. DS captures dimensionally a psychological distress related to end of life. Demoralization is associated with clinical features encompassing allostatic overload, quality of life, wellbeing/euthymia. Implications on health outcomes and treatment are discussed. Demoralization warrants careful consideration in clinical contexts through valid assessment procedures. DCPR are recommended to diagnose it, DS can be helpful to capture clinical details.
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Affiliation(s)
- Agnieszka Woźniewicz
- Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jurija Gagarina 11, 87-100 Toruń, Poland
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, via di San salvi n. 12, Florence, Italy; Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 6200, MD, Maastricht, The Netherlands.
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17
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Hong YT, Lin YA, Pan YX, Lin JL, Lin XJ, Zhang J, Huang FF. Understanding factors influencing demoralization among cancer patients based on the bio-psycho-social model: A systematic review. Psychooncology 2022; 31:2036-2049. [PMID: 36016470 DOI: 10.1002/pon.6023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/14/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Demoralization is a prevalent psychological problem among cancer patients and reflects a sense of subjective incompetence. This systematic review aims to identify factors influencing demoralization among cancer patients. METHODS Eleven databases were systematically searched from database inception to 31 December 2020. Google Scholar and relevant reference lists were supplementarily searched. Studies reporting demoralization measured by Demoralization Scale and its influencing factors among cancer patients were included. A qualitative synthesis was conducted owing to the heterogeneity of the study outcome. RESULTS A total of 49 studies involving 10,712 participants were included in this review. The results showed substantial effect size variation, but the psychological factors showed the strongest magnitude of association. Among the biological factors, the number of physical symptoms (mean r values [rs]: 0.331) was associated with increased demoralization. Among the psychological factors, negative psychological factors include hopelessness (mean rs: 0.633), desire for death (mean rs: 0.620), dignity-related distress (mean rs: 0.595), depression (mean rs: 0.593), anxiety (mean rs: 0.589), psychological distress (mean rs: 0.465), and suicidal ideation (mean rs: 0.460) were related to increased demoralization; whereas positive psychological factors including hope (mean rs: -0.565), attachment security (mean rs: -0.530), and sense of coherence (mean rs: -0.453) were related to decreased demoralization. Among the social factors, social support (mean rs: -0.330) was negatively related to demoralization, and the demographic factors were still controversial. Quality of life was considered to be at the intersection of biopsychosocial factors and negatively associated with demoralization (mean rs: -0.599). CONCLUSIONS Demoralization is a consequence of the interaction of physical, psychological, and social factors among cancer patients. Factors with a significant effect should not be overlooked when designing an intervention to reduce demoralization. It is necessary to distinguish demoralization from other negative psychological states and further explore positive psychological factors influencing demoralization among cancer patients.
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Affiliation(s)
- Yu Ting Hong
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yu-An Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yu Xin Pan
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jia Ling Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiu Jing Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Juan Zhang
- The 900th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Fuzhou, China
| | - Fei Fei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
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18
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Demoralization profiles and their association with depression and quality of life in Chinese patients with cancer: a latent class analysis. Support Care Cancer 2022; 30:10019-10030. [DOI: 10.1007/s00520-022-07412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022]
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19
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Gan LL, Gong S, Kissane DW. Mental state of demoralisation across diverse clinical settings: A systematic review, meta-analysis and proposal for its use as a 'specifier' in mental illness. Aust N Z J Psychiatry 2022; 56:1104-1129. [PMID: 34879712 DOI: 10.1177/00048674211060746] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Demoralisation is a state of poor coping characterised by low morale, hopelessness, subjective incompetence, and loss of meaning and purpose in life. While studied extensively in oncology and palliative care, there has been recent exploration in broader medical and mental health settings. The aim was to investigate the prevalence of demoralisation and associated sociodemographic and psychological factors across these clinical settings. METHOD Six electronic databases were used to locate articles from January 2014 to March 2020. A pre-publication update of non-oncology populations was completed in September 2021. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence of demoralisation was determined through % prevalence and mean demoralisation score; this was synthesised through meta-analysis of single means to determine pooled mean prevalence of Demoralisation Scale scores using the 'R' statistical software. RESULTS Demoralisation has been examined in 52 studies (n = 11,670) and found to be prevalent in 24-35% of oncology and non-oncology, including mental health, populations. The mean score on the Demoralisation Scale was 24.3 (95% confidence interval, CI = [21.3, 27.3]). There was evidence of divergent validity in addition to significant comorbidity between depression, demoralisation and suicidal ideation. Burdensome physical symptoms, and psychological and demographic factors are strongly correlated with demoralisation. CONCLUSION There remains a need to recognise demoralisation in various clinical and cultural settings and to strongly consider its inclusion as a 'specifier' within formal nosological systems for adjustment and depressive disorders. This is important to initiate targeted interventions and prevent significant morbidity.
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Affiliation(s)
- Lucy L Gan
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Susanna Gong
- Department of Psychiatry, Monash Health, Clayton, VIC, Australia
| | - David W Kissane
- Department of Psychiatry, Monash Health, Clayton, VIC, Australia.,School of Medicine, University of Notre Dame Australia and Cunningham Centre for Palliative Medicine Research, St Vincent's Sydney, Sydney, NSW, Australia.,Cabrini Health, Monash University, Clayton, VIC, Australia
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20
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Tang PL, Lin HS, Wang HH, Hu LY, Chou FH. Demoralization level fluctuated at various time frame of radiotherapy for patients with different cancers: a longitudinal observational study. BMC Palliat Care 2022; 21:143. [PMID: 35948925 PMCID: PMC9364497 DOI: 10.1186/s12904-022-01033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. It is affected by national characteristics, culture, disease characteristics and general conditions of the patient such as individual cultural features, nature of stress, personal expression preferences and social behavior. Compared with the results of previous studies on demoralization syndrome, patients with cancer in Taiwan exhibit a higher prevalence of demoralization. We aimed to investigate the prevalence of high demoralization and the changes in the level of demoralization in cancer patients during radiotherapy to explore the associated factors and the contributing factors to the high level of demoralization. Methods We used the Demoralization Scale-Mandarin Version to evaluate the demoralization level at six-time points in patients admitted for radiotherapy in a 3-month observational period. 101 patients allocated to three groups by cancer region completed the study. We applied the generalized estimating equation (GEE) to analyze the changes in the demoralization level among the three groups. The variables associated with the changes in the demoralization level were also investigated. Results In the analysis using univariate GEE, only patients in the chest and breast group exhibited significant changes at two different time points. The results obtained using multivariate GEE revealed that sociodemographic variables, stage of disease and use of surgery or chemotherapy had no impact on the changes in demoralization across three months. Conclusion The demoralization level certainly fluctuated in an extremely high range. The higher prevalence of demoralized patients may indicate that if medical staff neglect the importance of demoralization, demoralized patients with cancer may not receive appropriate care.
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Affiliation(s)
- Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC).,School of Nursing, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC).,School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC)
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC)
| | - Hsiu-Hung Wang
- School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC)
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, 201, Sec.2, ShihPai Rd., Beitou District., Taipei City, 11217, Taiwan (ROC).,Division of Psychiatry, National Yang-Ming University, 155, Sec.2, Linong St., Beitou District, Taipei City, 11221, Taiwan (ROC)
| | - Fan-Hao Chou
- School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC).
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Sauer C, Grapp M, Bugaj TJ, Maatouk I. Suicidal ideation in patients with cancer: Its prevalence and results of structural equation modelling. Eur J Cancer Care (Engl) 2022; 31:e13650. [PMID: 35801643 DOI: 10.1111/ecc.13650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patients with cancer have a higher risk of suicidal ideation (SI) and suicidality than the general population. This study was designed to investigate the prevalence of SI and its association with psychosocial and sociodemographic factors and tumour entity. METHODS In this observational cross-sectional study, 4372 adult patients with different cancer entities were enrolled. We assessed the outcome variables (i.e. SI, depressive and anxiety symptoms, mental and physical fatigue and sociodemographic data) using self-report questionnaires. Data were analysed via descriptive statistics, binomial logistic regression and structural equation modelling (SEM). RESULTS Among all patients, 627 (14.3%) reported SI, of whom 12.8% reported SI on several days, 0.9% on half of the days and 0.6% nearly every day. Age, anxiety, mental fatigue and the Patient Health Questionnaire-9 items 'feeling down, depressed and hopeless', 'feeling bad about oneself' and 'slowing or agitation' were significant predictors of SI. SEM, including all significant predictors with a latent depressiveness-demoralisation variable, explained 30.3% variance of SI, showing a good fit. CONCLUSIONS Our results showed that a significant number of patients with cancer show SI. Future long-term studies are needed to address the differential contribution of depression and demoralisation on SI in patients with cancer.
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Affiliation(s)
- Christina Sauer
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Miriam Grapp
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Till J Bugaj
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian University Würzburg, Würzburg, Germany
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Costanza A, Vasileios C, Ambrosetti J, Shah S, Amerio A, Aguglia A, Serafini G, Piguet V, Luthy C, Cedraschi C, Bondolfi G, Berardelli I. Demoralization in suicide: A systematic review. J Psychosom Res 2022; 157:110788. [PMID: 35334350 DOI: 10.1016/j.jpsychores.2022.110788] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In psychiatric literature, few original studies exist on the topic of demoralization in suicide. In this review, we aim to identify original studies on suicidal ideation (SI)/suicidal behavior (SB) and demoralization in populations of community-dwellers and patients with somatic or psychiatric disorders. METHODS We employed a systematic approach that followed PRISMA guidelines, searching through four major electronic databases (PubMed/MEDLINE, Scopus, Science Direct, and PsychINFO) for relevant titles/abstracts published from January 1980-June 2021. We included original studies that explicitly mentioned the investigation of a potential association between SI/SB and demoralization. RESULTS A total of 18 studies met our inclusion criteria. Their synthesis revealed that demoralization can be associated with SI/SB in a wide range of populations (community dwellers, patients with somatic or psychiatric disorders) and lead to significantly higher suicide risk (odds ratios of >6 were encountered in community dwellers experiencing financial hardship or isolation). Moreover, demoralization alone (about half the patients who were demoralized did not meet the criteria for an affective disorder nor were they clinically depressed) or together with depression has been identified as a major risk factor for SI/SB. Regarding the crucial issue of progression from SI to SA, in the context of the "ideation-to-action" frame, some authors found that the interaction of demoralization and over-arousal could be a useful predictor for this progression, while others found that depression alone was sufficient to differentiate attempters from non-attempters or the interaction with shutdown (helplessness and low positive emotions). CONCLUSION These results emphasize the possibility to identify demoralization as an independent risk factor for suicide. In patients with psychiatric disorders, the association between demoralization and SI/SB may be transnosographic. Overall, from the clinical implications perspective, our findings highlight that: i. Assessment of demoralization may contribute to a more comprehensive suicide risk detection. This appears particularly relevant in Emergency Departments (EDs) where heterogeneous population typologies are usually admitted and a clinical diagnosis of depression is often difficult to be defined. ii. Additionally, since meaninglessness is considered one of the demoralization subcomponents, meaning-centered psychotherapeutic approaches prove to be indicated and they can be initiated already at the EDs upon first contact with the patient. Further studies are necessary to confirm these findings.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.
| | - Chytas Vasileios
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre (MPC), University Hospitals of Geneva (HUG), Switzerland
| | - Julia Ambrosetti
- Department of Psychiatry and Department of Emergency, Emergency Psychiatric Unit (UAUP), Geneva University Hospitals (HUG), 1211 Geneva, Switzerland
| | - Sanam Shah
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm U1018, Paris, France
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valérie Piguet
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre (MPC), University Hospitals of Geneva (HUG), Switzerland
| | - Christophe Luthy
- Division of General Medical Rehabilitation, Geneva University Hospitals (HUG), Switzerland; Department of Geriatrics and Rehabilitation, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Christine Cedraschi
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre (MPC), University Hospitals of Geneva (HUG), Switzerland; Division of General Medical Rehabilitation, Geneva University Hospitals (HUG), Switzerland; Department of Geriatrics and Rehabilitation, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Luo Y, Lai Q, Huang H, Luo J, Miao J, Liao R, Yang Z, Zhang L. Risk factor analysis and nomogram construction for predicting suicidal ideation in patients with cancer. BMC Psychiatry 2022; 22:353. [PMID: 35610595 PMCID: PMC9128228 DOI: 10.1186/s12888-022-03987-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Suicidal ideation in cancer patients is a critical challenge. At present, few studies focus on factors associated with suicidal ideation, and predictive models are still lacking. This study aimed at investigating the risk factors for suicidal ideation among cancer patients, and developed a predictive nomogram to screen high risk cancer patients for early prevention and intervention. METHODS A questionnaire survey was conducted among cancer patients between May 2021 and January 2022. The factors associated with suicidal ideation were used to construct a multivariate logistic regression model, which was visualized as a predictive nomogram to evaluate the risk of suicidal ideation. Areas under the curve, calibration plot, decision curve analysis, and internal and external validation were used to validate the discrimination, calibration and clinical usefulness of the model. RESULTS A total of 820 patients with cancer were recruited for this study and 213 (25.98%) developed suicidal ideation. Levels of demoralization, depression and cancer staging, marital status, residence, medical financial burden, and living condition were influence factors for suicidal ideation. Comparing nomogram with Self-rating Idea of Suicide Scale (SIOSS), the nomogram had a satisfactory discrimination ability with an AUC of 0.859 (95% CI: 0.827-0.890) and 0.818 (95% CI: 0.764-0.873) in the training and validation sets, respectively. The calibration plot and decision curve analysis revealed that this nomogram was in good fitness and could be beneficial in clinical applications. CONCLUSIONS Suicidal ideation is common in cancer patients. Levels of demoralization, depression and cancer staging were independent predictors of suicidal ideation. The nomogram is an effective and simple tool for predictive suicidal ideation in cancer patients.
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Affiliation(s)
- Yuanyuan Luo
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023 Sha Tai South road, Baiyun district, Guangzhou, 510515 China
| | - Qianlin Lai
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023 Sha Tai South road, Baiyun district, Guangzhou, 510515 China
| | - Hong Huang
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023 Sha Tai South road, Baiyun district, Guangzhou, 510515 China
| | - Jiahui Luo
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, No. 1023 Sha Tai South road, Baiyun district, Guangzhou, 510515 China
| | - Jingxia Miao
- grid.416466.70000 0004 1757 959XDepartment of Medical Oncology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Baiyun District, Guangzhou, 510515 China
| | - Rongrong Liao
- grid.284723.80000 0000 8877 7471First Nursing Unit of Tumor Ward, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No. 13, Pomegranate Gang Road, Haizhu District, Guangzhou, 510315 China
| | - Zhihui Yang
- School of Nursing, Southern Medical University, No. 1023 Sha Tai South road, Baiyun district, Guangzhou, 510515, China.
| | - Lili Zhang
- School of Nursing, Southern Medical University, No. 1023 Sha Tai South road, Baiyun district, Guangzhou, 510515, China.
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Scandurra C, Mangiapia F, La Rocca R, Di Bello F, De Lucia N, Muzii B, Cantone M, Zampi R, Califano G, Maldonato NM, Longo N. A cross-sectional study on demoralization in prostate cancer patients: the role of masculine self-esteem, depression, and resilience. Support Care Cancer 2022; 30:7021-7030. [PMID: 35585203 PMCID: PMC9213347 DOI: 10.1007/s00520-022-07145-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/11/2022] [Indexed: 01/22/2023]
Abstract
Purpose
The current cross-sectional study had three objectives: (1) to assess the prevalence of depression and demoralization in a sample of prostate cancer (PCa) patients; (2) to examine whether masculine self-esteem and depression were associated with demoralization; and (3) to evaluate the role of resilience as a factor buffering the effects of masculine self-esteem and depression on demoralization. Methods 197 PCa patients aged 48 to 79 years (M = 67.19; SD = 6.83) answered questions about masculine self-esteem, depression, resilience, and demoralization. An ANOVA was conducted to examine whether the association between demoralization and depressive symptoms was linear. A chi-square test was calculated to determine differences between depression and demoralization. Finally, a hierarchical multiple linear regression analysis with interaction terms was conducted to examine the associations between masculine self-esteem, depression, resilience, and demoralization. Results Depression scores increased linearly with demoralization severity, but demoralization scores were higher than depression scores (21.3% vs. 15.2%). Lower scores on masculine self-esteem and higher scores on depressive symptoms were associated with greater demoralization. Resilience significantly moderated the association between masculine self-esteem and demoralization, but not between depression and demoralization. Conclusion Assessment of depression, masculine self-esteem, resilience, and demoralization in the clinical setting is critical for improving the mental health status of PCa patients.
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Affiliation(s)
- Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Francesco Mangiapia
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Roberto La Rocca
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesco Di Bello
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Natascia De Lucia
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Benedetta Muzii
- Department of Humanistic Studies, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy
| | - Micaela Cantone
- Departmental Program of Clinical Psychopatology, Public Hospital of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Rita Zampi
- Departmental Program of Clinical Psychopatology, Public Hospital of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Gianluigi Califano
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nicola Longo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Effects of Psychotherapy on Hope/Hopelessness in Adults with Cancer: a Systematic Review and Meta-analysis. Int J Behav Med 2022; 29:691-704. [PMID: 35137362 DOI: 10.1007/s12529-021-10051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although psychotherapy is a common treatment for hopelessness and hope, the effectiveness remains controversial. The purpose of this study was to quantitatively synthesize available evidence related to the effect of a broad range of psychotherapy interventions on hope/hopelessness in cancer patients. METHOD Eight electronic databases were searched for studies with adult cancer patients (mean age ≥ 18 years) receiving psychotherapy interventions with hope/hopelessness measured as outcomes and written in English. We used the random-effects model to compute effect size using Hedges' g and conducted moderator analyses. RESULTS We found 27 primary studies which included 1,998 participants who were 57.6 ± 8.0 years old across studies. The psychotherapy effect size ranged from - 0.86 to 2.92. Researchers who conducted psychotherapy at hospital/health centers showed higher effects, that is, improved hope scores (g = 0.63), than those who conducted psychotherapy in the community (g = 0.05). When researchers enrolled participants alone, psychotherapy resulted in higher effects (g = 0.62) than when partners/caregivers were involved (g = - 0.04). Researchers who included group discussion showed lower effects (g = 0.36) than without group discussion (g = 1.10). Researchers who examined fidelity found lower effects (g = 0.16) than researchers who did not examine fidelity (g = 0.66). Interestingly, researchers who studied people with breast cancer showed higher effects (g = 0.96) than those who studied people with other types of cancer (g = 0.26). Researchers who included higher percentages of women showed greater effects (slope = 0.008, Qmodel = 3.99, p = 0.046). Finally, the greater the time span between psychotherapy and the measurement of hope, the lower the psychotherapy effects (slope = - 0.002, Qmodel = 4.25, p = 0.039). CONCLUSION Psychotherapy had a solid moderate effect on reducing hopelessness and improving hope in cancer patients compared to controls.
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Zhang J, Zhang X, Yang G, Feng Z. Impulsiveness indirectly affects suicidal ideation through depression and simultaneously moderates the indirect effect: A moderated mediation path model. Front Psychiatry 2022; 13:913680. [PMID: 35966489 PMCID: PMC9363579 DOI: 10.3389/fpsyt.2022.913680] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aims to investigate the indirect effect of impulsiveness on suicidal ideation through depression and the moderating effect of impulsiveness on the indirect effect in an integrated path model. METHODS Self-rating depression scale (SDS), Barratt impulsiveness scale-11th version (BIS-11), and self-rating idea of suicide scale (SIOSS) were applied. A moderated mediation path model was established including impulsiveness, depression, and suicidal ideation as observed variables. RESULTS The main results revealed that the moderated mediation path model fit well in describing the relationships among impulsiveness, depression, and suicidal ideation. The indirect effect of impulsiveness mediated by depression and the moderating effect of impulsiveness on suicidal ideation was significant. Multiple comparisons showed that the indirect effects under different conditions of impulsiveness had statistical differences. The higher the impulsiveness was, the stronger the predictive effect of depression on suicidal ideation was. CONCLUSIONS The present study confirms that people who have impulsive traits are riskier to generate suicidal thoughts because they are more likely to suffer from depression and that people who are depressive have even higher risk to develop suicidal thoughts when they simultaneously have impulsive traits. In clinical and health care work, when considering depression to prevent suicidal ideation, impulsiveness needs to be monitored throughout the process of premorbid and onset stages of depression.
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Affiliation(s)
- Jingxuan Zhang
- Department of Medical Psychology, Army Medical University, Chongqing, China
| | - Xiaolin Zhang
- Teaching Examination Centre, Army Medical University, Chongqing, China
| | - Guoyu Yang
- Department of Medical Psychology, Army Medical University, Chongqing, China
| | - Zhengzhi Feng
- Department of Medical Psychology, Army Medical University, Chongqing, China
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27
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Sun G, Liu Z, Ma Z, Lew B, Jia C. The Relationship Between Negative Focused Disposition and Suicidal Ideation Among College Students: The Mediating Effects of Somatic Anxiety, General Distress, and Depression. Front Psychiatry 2022; 13:928666. [PMID: 35836665 PMCID: PMC9275592 DOI: 10.3389/fpsyt.2022.928666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Suicide among college students is a major public health problem. Research has confirmed that negative focused disposition had a significant effect on suicidal ideation. This study aims to evaluate somatic anxiety, general distress and depression as mediators of the relationship between negative focused disposition and suicidal ideation. METHODS A total of 1798 college students (942 males) were recruited to complete measures of negative focused disposition, somatic anxiety, general distress, positive affect and suicidal ideation. The mediation models were conducted to assess the mediating effects of somatic anxiety, general distress and depression. RESULTS There was a significant and positive correlation between negative focused disposition and suicidal ideation in Chinese college students. On mediation analysis, somatic anxiety, general distress and depression mediated the relationship between negative focused disposition and suicidal ideation. CONCLUSIONS Negative focused disposition appears to directedly associate with suicidal ideation and can indirectly relate to suicidal ideation through the relation with somatic anxiety, general distress and depression. College students with few positive expectations of the future may benefit from interventions focusing on somatic anxiety, general distress and depression.
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Affiliation(s)
- Guoxiao Sun
- School of Physical Education, Shandong University, Jinan, China
| | - Zongyu Liu
- School of Physical Education, Shandong University, Jinan, China
| | - Zhiyao Ma
- School of Physical Education, Shandong University, Jinan, China
| | - Bob Lew
- Griffith University, School of Applied Psychology, Australian Inst Suicide Res & Prevent, Brisbane, QLD, Australia
| | - Cunxian Jia
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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Bobevski I, Kissane DW, Vehling S, Mehnert‐Theuerkauf A, Belvederi Murri M, Grassi L. Demoralisation and its link with depression, psychological adjustment and suicidality among cancer patients: A network psychometrics approach. Cancer Med 2021; 11:815-825. [PMID: 35122411 PMCID: PMC8817077 DOI: 10.1002/cam4.4406] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/05/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background Demoralisation is a clinically significant problem among cancer patients with a prevalence of 13%–18%. It is defined by difficulty in adjusting to a stressor, wherein the person feels trapped in their predicament and experiences helplessness, hopelessness, loss of confidence and loss of meaning in life. Demoralisation has a strong link with the desire for hastened death and suicidal ideation among the medically ill. This study explored whether a group of symptoms could be identified, distinct from depression, but consistent with adjustment difficulties with demoralisation and linked to ideation of death and suicide. Methods Exploratory Graph Analysis, a network psychometrics technique, was conducted on a large German study of 1529 cancer patients. Demoralisation was measured with the Demoralisation Scale II and depressive symptoms with the PHQ‐9. Results A network of symptoms, with four stable communities, was identified: 1. Loss of hope and meaning; 2. Non‐specific emotionality; 3. Entrapment; 4. Depressive symptoms. The first three communities were clearly distinct from the PHQ‐9 depressive symptoms, except for suicidality and fear of failure. Community 1, Loss of hope and meaning, had the strongest association with thoughts of death and suicide. Hopelessness, loss of role in life, tiredness, pointlessness and feeling trapped were the most central symptoms in the network. Conclusions Communities 1 to 3 are consistent with poor coping without anhedonia and other classic depression symptoms, but linked to suicidal ideation. For people facing the existential threat of cancer, this may indicate poor psychological adjustment to the stressors of their illness.
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Affiliation(s)
- Irene Bobevski
- Department of Psychiatry School of Clinical Sciences at Monash Health Faculty of Medicine, Nursing and Health Sciences Monash University Clayton VIC Australia
- Palliative Medicine University of Notre Dame Darlinghurst NSW Australia
| | - David W. Kissane
- Department of Psychiatry School of Clinical Sciences at Monash Health Faculty of Medicine, Nursing and Health Sciences Monash University Clayton VIC Australia
- Palliative Medicine University of Notre Dame Darlinghurst NSW Australia
| | - Sigrun Vehling
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Anja Mehnert‐Theuerkauf
- Department of Medical Psychology and Medical Sociology University Medical Center Leipzig Leipzig Germany
| | - Martino Belvederi Murri
- Institute of Psychiatry Department of Biomedical and Specialty Surgical Sciences University of Ferrara Ferrara Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior S. Anna University Hospital and Health Authorities Ferrara Italy
| | - Luigi Grassi
- Institute of Psychiatry Department of Biomedical and Specialty Surgical Sciences University of Ferrara Ferrara Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior S. Anna University Hospital and Health Authorities Ferrara Italy
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Costanza A, Radomska M, Zenga F, Amerio A, Aguglia A, Serafini G, Amore M, Berardelli I, Ojio Y, Nguyen KD. Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030876. [PMID: 33498520 PMCID: PMC7908343 DOI: 10.3390/ijerph18030876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) results from repetitive brain injuries and is a common neurotraumatic sequela in contact sports. CTE is often accompanied by neuropsychiatric symptoms, which could escalate to suicidal ideation (SI) and suicidal behaviour (SB). Nevertheless, fairly limited emphasis about the association between suicidality and CTE exists in medical literature. Here, we report two cases of retired professional athletes in high contact sports (boxing and ice hockey) who have developed similar clinical trajectories characterized by progressive neuropsychiatric symptoms compatible with a CTE diagnosis and subsequent SB in its severe forms (medical serious suicide attempt (SA) and completed suicide). In addition to the description of outlining clinical, neuropsychological, neuroimaging, and differential diagnosis elements related to these cases, we also hypothesized some mechanisms that might augment the suicide risk in CTE. They include those related to neurobiological (neuroanatomic/neuroinflammatory) dysfunctions as well as those pertaining to psychiatry and psychosocial maladaptation to neurotraumas and retirement from professional competitive activity. Findings described here can provide clinical pictures to improve the identification of patients with CTE and also potential mechanistic insights to refine the knowledge of eventual severe SB development, which might enable its earlier prevention.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
- Correspondence:
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), 1206 Geneva, Switzerland;
| | - Francesco Zenga
- Department of Neurosurgery, City of Health and Science Hospital, 10126 Torino, Italy;
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, MA 02111, USA
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Isabella Berardelli
- Suicide Prevention Center, Department of Neurosciences, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Yasutaka Ojio
- National Center of Neurology and Psychiatry, Department of Community Mental Health Law, National Institute of Mental Health, Tokyo 187-8553, Japan;
| | - Khoa D. Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA 94304, USA;
- Tranquis Therapeutics, Palo Alto, CA 94304, USA
- Hong Kong University of Science and Technology, Hong Kong, China
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30
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Costanza A, Zenga F, Rudà R, Amerio A, Aguglia A, Serafini G, Amore M, Bondolfi G, Berardelli I, Nguyen KD. Suicidality in Patients with Brain Tumors: A Brief Literature Review with Clinical Exemplar. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:725. [PMID: 33371470 PMCID: PMC7767493 DOI: 10.3390/medicina56120725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Abstract
Background: Suicidality and brain tumors are two life-threatening conditions and, somewhat unexpectedly, the associations between them have scarcely been reported. Objective: In this study, we aimed to provide a brief literature review of epidemiological studies on suicidal ideation (SI) and suicidal behavior (SB) in patients with brain tumors. To illustrate various aspects of brain tumors that potentially underlie the emergence of suicidality, the review is supplemented with a clinical exemplar of a long-term survivor of brain tumor (glioblastoma) who experienced persistent SI. Furthermore, we discuss putative both neurobiological (including anatomical and immunological) and psychosocial mechanisms that might be accountable for the development of SI and SB in patients with brain tumors. Conclusions: While the etiology of this phenomenon appears to be multifactorial and still remains a subject of much debate, it is of critical importance to identify patients for which a psychiatric evaluation could recognize, in a timely manner, a possible suicide risk and alleviate the deep related suffering, by appropriate psychopharmacological and supportive and psychotherapeutic interventions.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland;
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Francesco Zenga
- Department of Neurosurgery, University and City of Health and Science Hospital, 10126 Torino, Italy;
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, 10126 Torino, Italy;
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16133 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16133 Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, MA 02111, USA
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16133 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16133 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16133 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16133 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16133 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16133 Genoa, Italy
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland;
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Isabella Berardelli
- Department of Neuroscience, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy;
| | - Khoa Dinh Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA 94305, USA;
- Tranquis Therapeutics, Palo Alto, CA 94305, USA
- Hong Kong University of Science and Technology, Hong Kong, China
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