Suicidal Ideation and Psychological Strain Among Patients Diagnosed With Stomach Cancer: The Mediation of Psychopathological Factors

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

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

Suicidal ideation in Chinese patients with advanced breast cancer: a multi-center mediation model study

PURPOSE

The pathways underpinning suicide ideation (SI) and certain physical and psychological factors in patients with advanced breast cancer remain unclear. This study develops and validates a mediation model that delineates the associations between several multidimensional variables and SI in Chinese patients with advanced breast cancer.

METHODS

Patients with advanced breast cancer (n = 509) were recruited as study participants from 10 regional cancer centers across China from August 2019 to December 2020. Participants were required to complete five questionnaires using an electronic patient-reported outcomes (ePRO) system: 9 item- Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), 5-level EQ-5D (EQ-5D-5L), and MD Anderson Symptom Inventory (MDASI). Risk factors for SI were identified using multivariable logistic regression, and inputted into serial multiple mediation models to elucidate the pathways linking the risk factors to SI.

RESULTS

SI prevalence was 22.8% (116/509). After adjusting for covariates, depression (odds ratio [OR] = 1.384), emotional distress (OR = 1.107), upset (OR = 0.842), and forgetfulness (OR = 1.236) were identified as significant independent risk factors (all p < 0.05). The ORs indicate that depression and distress have the strongest associations with SI. Health status has a significant indirect effect (OR=-0.044, p = 0.005) and a strong total effect (OR=-0.485, p < 0.001) on SI, mediated by insomnia severity and emotional distress.

CONCLUSIONS

There is a high SI prevalence among Chinese patients with advanced breast cancer. Our analysis revealed predictive pathways from poor health to heightened SI, mediated by emotional distress and insomnia. Regular management of distress and insomnia can decrease suicide risk in this vulnerable population.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Distress Thermometer Score Is Useful For Predicting Suicidal Ideation in Patients With Cancer

PURPOSE

Suicidal ideation (SI) and depressive symptoms are common in patients with cancer. A Distress Thermometer (DT) is an effective tool to screen depression and anxiety in such cohorts. We investigated the value of the DT for predicting SI and the prevalence and associated risk factors of SI in the study population.

METHODS

This cross-sectional study enrolled a total of 162 heterogeneous patients with cancer. Information regarding sociodemographic and clinical characteristics, the Hospital Anxiety and Depression Scale, DT score, and the past month SI were collected. Receiver operating characteristic (ROC) analysis was performed to find accuracy and the optimal cutoff score for predicting risk of SI. The significance of difference between DT scores was obtained using the median independence test. Likelihood of risk was analyzed through odds ratio.

RESULTS

DT possesses good overall accuracy (area under the ROC curve = 0.797) for predicting SI in patients with cancer. The DT had a sensitivity of 0.929 and a specificity of 0.522 with a cutoff score of ≥4. The patients with SI had significantly higher DT scores than the patients without SI (7 [5,8] v 3 [1,6]; P < .001). The 1-month prevalence of SI was 17.3%. Depression, anxiety, and psychological distress were the predictive factors of SI.

CONCLUSION

SI is a global issue in patients with cancer. The DT scores may be a rapid predicting tool for identifying SI in patients with cancer. Higher DT scores and patients with psychosocial problems need to be routinely screened for SI, which may help to prevent suicidal risk.

Self-reported sleep quality and mental health mediate the relationship between chronic diseases and suicidal ideation among Chinese medical students

High prevalence and strong associations of chronic disease, poor sleep quality, poor mental health, and suicidal ideation (SI) have been reported worldwide. However, the underlying mechanism remains unexamined. The participants were 2646 Chinese medical college students with an average age of 20.13 years. Pittsburgh Sleep Quality Index, the Kessler Psychological Distress Scale, and SI was evaluated. The lifetime SI, past 12-month SI, and chronic disease prevalence rates were 10.0%, 8.4%, and 4.6%, respectively. The results of logistic regression analysis in this study found that chronic disease, self-reported poor sleep quality, poor mental health, gender and scholarship were associated with lifetime SI. Similar results were also found for 12-month SI with an exception of region. This result indicated that the effects of chronic diseases on the SI were mediated by self-reported sleep quality and mental health. Physical diseases, sleep-related concerns, and mental health issues need to be addressed through a multidisciplinary team approach and various delivery systems to prevent SI among medical college students.

Psychological strain and suicidal ideation in young university students during Covid-19 outbreak: the mediating roles of rumination and depression

The link between psychological strain and suicidal ideation is well embedded in literature, however, the underlying mechanism is rarely explored. Therefore, this study aimed to examine the relationship between psychological strain, suicidal ideation, rumination, and depression among Pakistani young adults during the Covid-19 outbreak. In addition, it will also try to determine the mediating role of ruminative subtypes and depression in the relationship between psychological strain and suicidal ideation. The sample consists of 400 university students (83 males and 289 females) with the age range from 18 to 30 years (M = 22.25, SD = 2.40). Psychological strain scale, Suicidal Ideation Scale, Beck Depression Inventory, and Ruminative Response Scale were administered to the participants. Results indicated a significant and positive association between the study variables. Psychological strain positively influenced suicidal ideation both directly, and indirectly via brooding and depression. Both variables were found to be serially mediated by the brooding subtype of rumination and depression and not with the reflective subtype. Strain theory of suicide and response style theory also postulated important insights regarding the association of these variables in young adults, among which, strain is serially related to first brooding and then depression, which is eventually related to suicidal ideation. The present study makes a significant contribution to the literature by providing a unique conceptual and theoretical framework to identify suicide at the ideation level before it proceeds to behavior during this unprecedented time of the pandemic outbreak.

Psychiatric Distress and Suicidal Tendencies in Adult Cancer Survivors: Verifying the Validity of the Brief Symptom Inventory-18 for Identifying Suicidal Ideation in the Hospitalized Population of Mainland China

The Brief Symptom Inventory-18 (BSI-18) is widely used to assess psychiatric distress but has not been verified in the Chinese population. From March to April 2019, 293 hospitalized cancer patients, aged 20-87, completed the cross-sectional survey with demographics questionnaire, BSI-18, and PHQ-9. We analyzed the single suicide-related item of PHQ-9 with the full score clinical outpoint for BSI-18 and PHQ-9 using SPSS 22.0 and R 2.15, including Pearson's χ² test and ROC curve analyses. A Pearson's χ² test was carried out to compare the three different methods with the gold screening criteria. The p-value was correspondingly to .006, .066, .838. When the PHQ-9 ≥ 10 criteria for the BSI-18, receiver operating characteristic analysis revealed that AUC values were 0.839, optimal cut-off points for both BSI-18 ≥ 50, the sensitivity of 85.8%, and 62.5%, respectively. The BSI-18 is suitable for a screening tool for psychological distress and could also be used in clinical settings for preliminary screening of hospitalized cancer patients.

Psychological Strain and Suicidal Behaviors Among Medical Students in Northwest, China: The Mediating Effect of Psychological Distress and Hopelessness

ABSTRACT

Although most studies have shown the psychological strains associated with increased risk of suicidal behaviors, how psychological strains are linked to suicidal behaviors is still unclear. The current study examines the possible mediation effect of psychological distress and hopelessness on the relationship between psychological strains and suicidal behaviors among Chinese medical college students. A cross-sectional survey was conducted from November 2017 to March 2018 involving 5703 medical college students, and the 12-month prevalence of suicidal behaviors was 12.89%. Psychological strains significantly associated with suicidal behaviors, and psychological distress and hopelessness partially explained this relationship. A positive psychological intervention program is needed to buffer the psychological strains, which is a crucial predictor for suicidal behaviors among Chinese medical college students.

Risk factors for suicide in individuals with cancer: an integrative literature review

OBJECTIVE

to develop an integrative literature review on risk factors for suicide in individuals with cancer.

METHOD

searching for articles was conducted in the Scientific Electronic Library Online, Medicinal Literature Analysis and Retrieval System Online, Latin American & Caribbean Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and SciVerse Scopus databases, using the descriptors "suicide" and "cancer".

RESULTS

eighteen articles were selected. Lung, bladder and colorectal cancers are the types of highest risk for suicide. Male, white and over 60 years of age are demographic factors with higher risk for suicide in individuals with cancer.

CONCLUSION

this review made it possible to verify that cancer may be a risk factor for suicide. This evidence can be useful for planning preventive actions in order to reduce the risk of suicide.

Thoughts of death and suicidality among patients with cancer: Examining subtypes and their association with mental disorders

OBJECTIVE

Cancer is associated with an increased risk for completed suicide. We explored subtypes of thoughts of death, death wishes, suicidal ideation and behavior and their association with mental disorders and demographic and disease-related characteristics.

METHODS

We studied 2,141 cancer patients with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O). Assessment included 4-weeks-prevalences of thoughts of death, wish to die, suicidal ideation, suicide plans, and lifetime suicide attempts. We further assessed 4-weeks-prevalences of mood, anxiety, adjustment, somatoform, substance use, and disorders due to general medical condition. We conducted latent class analyses (LCA).

RESULTS

The LCA identified three classes with distinct patterns of suicidality. Class 1 (89.0% of the sample) showed no suicidality. Class 2 (6.9%) was characterized by thoughts of death without suicidal ideation. Class 3 (4.1%) was characterized by thoughts of death, suicidal ideation, and suicide plans. Death wishes occurred in both classes 2 and 3. Classes 2 and 3 were associated with a significantly higher risk for any mental disorder (OR from 4.22, adjustment disorder, to 10.20, mood disorders, p < 0.001) compared to class 1. Patients with mental disorders were equally likely in classes 2 and 3. Patients with incurable cancer were significantly more likely in class 2, and less likely in class 3.

CONCLUSIONS

Cancer patients with suicidal ideation are not distinctly characterized by mental disorders. Further study of concepts that consider problematic adjustment to the cancer stressor such as death anxiety and demoralization may contribute to understand psychological distress underlying subtypes of thoughts of death and suicidality in cancer.

Using Contemporary Psychometric Methods to Construct and Validate Scores on a Short-Form Version of the Psychological Strain Scales

BACKGROUND

The 40-item Psychological Strain Scales (PSS) was developed to measure four dimensions of psychological strains based on the Strain Theory of Suicide. Although the PSS has been increasingly used in recent years, the dimensionality and scoring of the PSS remained to be thoroughly examined using the Item Response Theory (IRT) approach.

METHODS

Data came from a large sample of 11,412 Chinese undergraduate students. A bifactor-IRT model, specifying one general strain factor and four specific strains factors, was examined for fit to the sample data. A detailed item analysis, with analysis of the differential item functioning (DIF) of the items across gender, was undertaken to evaluate the dimensionality of the PSS. The associations among the PSS scale scores with scores on the concurrent measures, assessing psychache and suicidal behaviors, were examined.

RESULTS

IRT-derived specific bifactor indices showed that the PSS was unidimensional, and thus the PSS total scores should be reported. Unidimensional subset of 5 items identified (Item 9, Item 12, Item 14, Item 16, and Item 20), using bifactor-IRT modeling and incremental validation, were selected to construct a potential short form of the PSS (PSS-SF). The PSS-SF scale scores demonstrated strong psychometric properties and associations with scores on the concurrent measures assessing relevant constructs.

LIMITATIONS

This study used cross-sectional data from a non-clinical sample of Chinese undergraduate students.

CONCLUSIONS

The PSS-SF should be considered as a unidimensional instrument with potential in enhancing our understanding and measurement of psychological strains with reduced response burden.

A cross-sectional study on associations of physical symptoms, health self-efficacy, and suicidal ideation among Chinese hospitalized cancer patients

BACKGROUND

Epidemiological studies have shown increased risk of suicide in cancer patients compared with the general population. The present study aimed to examine the association between physical symptoms and suicidal ideation in Chinese hospitalized cancer patients and test the modifying effect of health self-efficacy on the association.

METHODS

A cross-sectional study was conducted with 544 hospitalized cancer patients in two general hospitals in northeast China via face-to-face interviews. Suicidal ideation was measured by using the first four items on the Yale Evaluation of Suicidality scale and then dichotomized into a positive and negative score. Multivariate logistic regression analyses were conducted to examine the impacts of physical symptoms, health self-efficacy, and their interactions on suicidal ideation.

RESULTS

The suicidal ideation rate was 26.3% in the enrolled cancer patients. Logistic regression showed that insomnia (aOR = 1.84, 95% CI 1.13 to 3.00, p = 0.015) and lack of appetite (aOR = 2.14, 95% CI 1.26 to 3.64, p = 0.005) were significantly associated with suicidal ideation. Low health self-efficacy had a marginally significant exaggerating effect on the association between pain and suicidal ideation (aOR = 2.77, 95% CI 0.99 to 7.74, p = 0.053), after adjusting for significant socio-demographics, clinical characteristics, and depression.

CONCLUSIONS

These findings demonstrate significant associations between physical symptoms (insomnia and/or lack of appetite) and suicidal ideation and highlight the potential modifying role of health self-efficacy in the identification and prevention of suicide among cancer patients.

Psychological Strain and Suicidal Ideation in Athletes: The Multiple Mediating Effects of Hopelessness and Depression

The present study aims to examine the relationship between psychological strain, suicidal ideation, hopelessness, and depression among Chinese athletes. Participants were 774 Chinese athletes (454 men and 320 women), with a range of ages from 12 to 35 (M = 18.47, SD = 3.39). The structural equation modeling method was used to examine the multiple mediating effects of hopelessness and depression between psychological strain and suicidal ideation. As expected, a positive correlation between psychological strain, suicidal ideation, hopelessness, and depression was found. Additionally, results seem to indicate that psychological strain directly and positively influenced suicidal ideation, and that hopelessness and depression played a serial mediating role in the relationship between psychological strain and suicidal ideation. To conclude, the psychological strain theory is applicable for explaining suicidal ideation in athletes. In athletes, psychological strain is sequentially associated first with a sense of hopelessness and then depression, which is in turn related to suicidal ideation. The present study makes a significant contribution to the literature because we provide a new theoretical basis and new methods for preventing mental disorder and suicidality in athletes.

Depression, Anxiety, and Stress as a Function of Psychological Strains: Towards an Etiological Theory of Mood Disorders and Psychopathologies

BACKGROUND

The etiological factors of mood disorders and psychopathologies are understudied. In this paper, we explored whether social psychological strains are related to depression, anxiety, and stress in non-clinical populations.

METHODS

6,305 college students (39.3% men; 60.7% women) from six Chinese provincial-level jurisdictions completed a paper-and-pencil survey with Psychological Strain Scales (PSS-40) and Depression, Anxiety, and Stress Scales-21 (DASS-21), both validated in Chinese populations.

RESULTS

Both PSS-40 and DASS-21 have high internal consistency reliabilities, and are highly correlated with each other. Hence, Chinese college students with greater psychological strains (value, aspiration, deprivation, or coping) have greater depression, anxiety, and stress. These results still held after controlling for relevant socio-demographic variables in the multiple regression models.

LIMITATIONS

This was a cross-sectional study, and the sample only included several provinces in mainland China, not a representative sample of all of them.

CONCLUSIONS

Mood disorders and psychopathologies are linked to suicidal thoughts and behaviors. The results of this study extend the Strain Theory of Suicide from explaining the risk factors of suicidality to mood disorders and psychopathologies. Hence, these findings can inform prevention measures among college students, and possibly the general population.

Psychometric properties of the psychological strain scales (PSS) in suicide attempters and community controls of rural China

BACKGROUND

Psychological Strain Scales (PSS) were developed to measure four types of strain comprising value strain, deprivation strain, aspiration strain, and coping strain. This study aimed to evaluate the psychometric properties of the Chinese version of 40-item PSS in suicide attempters and community controls of rural China.

METHODS

Data of this study came from the investigation of 132 suicide attempters and their paired community controls matched with the same sex, age (±3 years) and residence in five counties in rural Shandong, China. The Chinese version of PSS, the Center for Epidemiologic Studies Depression Scale (CES-D), the Trait Anxiety Inventory (TAI) and the Self-esteem Scale (SES) were administered and reliability test and validity test of the PSS were conducted.

RESULTS

Cronbach's α and Guttman Spilt-Half coefficient of PSS was 0.942 and 0.842 for suicide attempters, and 0.950 and 0.874 for community controls. For both suicide attempters and community controls, the Exploratory Factor Analysis indicated a one-factor structure of each strain scale, which accorded with the original factor structure proposed by the authors. The scores of the total PSS and four subscales were positively correlated with the scores of CES-D and TAI; and negatively correlated with the score of SES, which indicated a good performance in convergent validity.

LIMITATIONS

This study was limited to its generalizability to the Chinese urban population.

CONCLUSIONS

The Chinese version of the 40-item PSS has satisfactory psychometric properties in terms of reliability and validity in Chinese rural suicide attempters and community controls.

Suicidal ideation in patients with cancer: A systematic review of prevalence, risk factors, intervention and assessment

OBJECTIVES

Suicidal ideation (SI) underlies risk of death by suicide. It is well established that patients with cancer are at increased risk of death by suicide. Therefore, understanding SI in patients with cancer is critically important. The goal of this systematic review was to investigate the prevalence, risk factors, intervention, and assessment of SI in patients with cancer.

METHODS

This systematic review was registered with the PROSPERO database (CRD42018115405) and was guided by the PRISMA statement. We searched Medline, PsycInfo, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and Cochrane Central. Two reviewers independently screened abstracts and assessed for quality assurance using a revised Newcastle-Ottawa Scale.

RESULTS

We identified 439 studies to screen for eligibility. Eligible studies included adults with cancer diagnoses and listed SI as an outcome. Ultimately, 44 studies were included in the analyses. Prevalence of SI ranged greatly from 0.7% to 46.3%. Single items drawn from validated measures were the most frequent method of assessing SI (n = 20, 45.5%); additional methods included validated measures and psychological interviews. Commonly identified risk factors for SI included age, sex, and disease/treatment-related characteristics, as well as psychological constructs including depression, anxiety, hopelessness, existential distress, and social support.

SIGNIFICANCE OF RESULTS

Assessment of SI in patients with cancer is the concern of researchers worldwide. Prevalence of SI varied with study population and was likely influenced by the method of assessment. Psychological distress consistently predicted SI. Increasing awareness of demographic, clinical, and psychological associations is critical for risk assessment and intervention development.

The Role of Depressive Symptoms in Suicide Attempt in Rural China

Depression is a well-established predictor of suicidal behaviors, yet its effects among Chinese rural suicide attempters are understudied. In this study, we examined the role of depressive symptoms with other common risk factors, such as impulsivity, among medically serious suicide attempters. A case-controlled study was conducted in 13 rural counties in China. Medically serious suicide attempters (n = 791) and 791 nonsuicidal controls matched for sex and age range (±3 years) in the same location were recruited and interviewed to obtain information with regard to demographics, depressive symptom severity, and psychological strain measures. Both depressive symptoms, assessed with the Center for Epidemiological Studies Depression Scale, and psychological strains predicted suicide attempt risk, and psychological strains significantly predicted depressive symptoms. Depressive symptoms fully mediated the relations between value strain, deprivation strain, and suicide attempt risk, and partially mediated the associations among aspiration strain, coping strain, and suicide attempt risk. The reduction of psychological strains may help decrease both depression and suicidal behaviors.

Relationship of Suicidal Ideation With Demoralization, Depression, and Anxiety: A Study of Cancer Patients in Mainland China

Demoralization is a form of psychological distress that may cause suicidal ideation. Demoralization syndrome is common among cancer patients, but there has been little empirical study on the association of suicidal ideation with demoralization, depression, and anxiety in this population. This study aims to investigate the prevalence of high demoralization among cancer patients in mainland China and the contribution of high demoralization to suicidal ideation beyond the impact of self-report depression and anxiety. In this cross-sectional study, 303 patients with cancer were invited to complete questionnaires. In total, 14.5% participants reported suicidal ideation and 49.50% high demoralization. Logistic regression analysis identified high demoralization as an independent risk factor for suicidal ideation. Only depression (odds ratio [OR], 6.68) had a stronger influence on suicidal ideation than demoralization (OR, 5.85), and patients with both depression and high demoralization were most likely to experience suicidal ideation. These findings suggest that measures of demoralization can help identify cancer patients at high suicide risk and that such patients require further attention and measures targeting demoralization for suicide prevention.

Psychological strains, depressive symptoms, and suicidal ideation among medical and non-medical staff in urban china

BACKGROUND

The Strain Theory of Suicide has been tested and well supported regarding rural people who show risk of suicide. Studies on the impact of psychological strains on psychopathologies and suicidality in urban environments in China have been lacking.

AIMS

This study was designed to further examine the associations between psychological strains, depressive symptoms, and suicidal ideation in two separate urban samples of adults in China.

METHODS

One sample consisted of randomly selected medical employees of a large hospital (n = 1012), and a second sample included heterogeneous office employees (n = 1052). A self-administered questionnaire was used to collect demographics, psychological strains, social support, depressive symptoms, and suicidal ideation.

RESULTS

Depressive symptoms were associated with longer work hours, less social support, value strain, aspiration strain and coping strain among medical staff, and were linked to longer work hours, less social support, aspiration strain and coping strain among non-medical staff. Suicide ideation was associated with longer work hours, coping strain, and depression among medical staff, and was linked to longer work hours, gender, religion, value strain and depression among non-medical staff.

CONCLUSIONS

Both depressive symptoms and suicidal ideation were associated with psychological strains among Chinese urban professionals. Reduction of psychological strain is necessary to help maintain proper mental health and to ensure optimal performance at work.

Comparison of Coping, Psychological Distress, and Level of Functioning in Patients With Gastric and Colorectal Cancer Before Adjuvant Chemotherapy

CONTEXT

Patients with gastrointestinal cancers are at high risk for functional problems that are generally accompanied by a decline in their overall status and intense psychological distress.

OBJECTIVES

This study compares the level of functioning in individuals with gastric cancer (GC) and colorectal cancer (CRC) and analyzes whether improved functioning can be explained by patients' psychological status and coping strategies.

METHODS

This is a prospective, transversal, multicenter study in patients with nonmetastatic GC and CRC before initiating adjuvant chemotherapy. Participants answered questionnaires evaluating quality of life, including functioning (European Organization for Research and Treatment of Cancer Quality of Life questionnaire), coping strategies (Mini-Mental Adjustment to Cancer), and psychological distress (Brief Symptom Inventory-18).

RESULTS

Between December 2015 and July 2017, 266 patients with CRC and 69 patients with GC were consecutively recruited. A pathological level of functioning was more prevalent in people with GC than in those with CRC (20% vs. 5%). Individuals with GC presented worse functioning and more psychological distress and displayed more hopelessness, anxious preoccupation, and cognitive avoidance as coping strategies than those with CRC. Psychological distress and fighting spirit accounted for 40% of the functional status in GC patients, whereas psychological distress and hopelessness represented 58% of CRC patients' functional status.

CONCLUSION

Our findings suggest that level of functioning affects many subjects with GC and reveals the importance of developing interventions targeted at enhancing adaptive coping strategies before initiating adjuvant cancer treatment.

Freeing Chinese Abused Women From Stereotype: A Pretest-Posttest Comparison Study on Group Intervention in Refuge Centers

OBJECTIVE

The efficacy of heal-change group (HCG) intervention-brief trauma-recovery group intervention applying a gender-specific cognitive behavioral approach-for Chinese-abused women in refuge centers was examined in a pretest-posttest comparison study.

METHODS

A total of 100 women at three refuge centers in Hong Kong participated. Among them, 50 women from two centers joined the HCG and 50 women from the remaining center participated in a comparison mutual support group. Participants and interviewers were blinded to the group assignment. Both groups were six sessions long. Linear regression analyses were performed using the intention-to-treat framework.

RESULTS

Significant improvements in PTSD symptoms (overall mean change of -1.6, p < .001; subdomain scores; p < .001 to < .01) and depressive symptoms (BDI-II mean change; p < .01) were recorded in the intervention group.

CONCLUSION

The results suggest HCG is beneficial to Chinese-abused women. Further research is needed to determine the intervention's effectiveness in improving longer-term outcomes in these women.