Suicidal ideation and suicide attempts in anxious or depressed family caregivers of patients with cancer: a nationwide survey in Korea

Suicidal Thoughts and Behaviors in Parents Caring for Children with Disabilities and Long-Term Illnesses

OBJECTIVE

There is a growing body of evidence on suicide risk in family carers, but minimal research on parents caring for children with disabilities and long-term illnesses. The aim of this study was to conduct the first dedicated research on suicide risk in parent carers and identify: (1) the number of parent carers experiencing suicidal thoughts and behaviors, and (2) the risk and protective factors for suicidality in this population.

METHOD

A cross-sectional survey of parent carers in England (n = 750), co-produced with parent carers. Suicidal thoughts and behaviors were measured with questions from the Adult Psychiatric Morbidity Survey. Frequencies summarized the proportion of carers experiencing suicidal thoughts and behaviors. Logistic regressions identified risk and protective factors.

RESULTS

42% of parents had experienced suicidal thoughts and behaviors while caring for a disabled or chronically ill child. Only half had sought help for these experiences. Depression, entrapment, dysfunctional coping, and having a mental health diagnosis prior to caring, were significant risk factors.

CONCLUSION

Parent carers contemplate suicide at levels that exceed those of other family carers and the general public. There is an urgent need, in policy and practice, to recognize parent carers as a priority group for prevention and intervention.

Suicidal Ideation in Canadian Family Caregivers for a Person with Dementia: A Portrait of the Situation

This study aimed to explore the prevalence of suicidal thoughts and potential associations (i.e., strength and direction) with caregiver characteristics or factors. A targeted survey was distributed to dementia caregivers aged 55+ years. Questions concerning psychological distress, suicidal thoughts while caregiving and antecedents of suicidal behaviours were administered. A sample of 71 French-speaking Canadian caregivers completed the survey between May and October 2019. Among them, 52.1 per cent (n = 37) reported suicidal ideation while providing care to a relative or a friend living with dementia. Caregivers who presented suicidal ideation reported more abusive behaviour toward the care recipient. Caregivers who reported suicidal thoughts were significantly more distressed than caregivers without them on measures of burden, depression, and anxiety. Suicidal thoughts in caregivers are important evaluation targets, primarily for the prevention of suicide, but also because caregivers who report suicidal thoughts also present a heightened risk for abusing the care recipient.

The Morbidity and Associated Factors of Depression in Caregivers of Patients with Depressive Disorder

Objective

Depressive disorder significantly impacts patients' daily living activities and quality of life. Caregivers of patients with depression may also suffer from psychological distress related to the chronic burden of caring for the patient's mood changes. The purpose of this study was to evaluate the morbidity and associated factors of depression in caregivers of patients with depressive disorder.

Methods

In this study, we used a cross-sectional design with consecutive sampling. Study subjects were recruited from the psychiatric outpatient clinic of a medical center from August 2021 to June 2022. Caregivers of depressive disorder patients were enrolled and assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale (HADS), Suicide Assessment Scale (SAS), Stigma Scale of the Explanatory Model Interview Catalogue (EMIC), and Family APGAR Index.

Results

Of the 120 caregivers that completed the study, 59.2% (n=71) were females. The most common psychiatric diagnosis was depressive disorders (25.8%), followed by anxiety disorders (17.5%) and insomnia disorder (15.8%); 54.2% of the caregivers had a psychiatric diagnosis. Using logistic regression analysis, we found that anxiolytics/hypnotics use (OR=5.58; 95% CI, 1.84-16.96; p<0.01), higher suicide risk (SAS) (OR=1.10; 95% CI, 1.05-1.16; p<0.001), and lower family support (APGAR scores) (OR=0.82; 95% CI, 0.71-0.94; p<0.01) were three significant associated factors.

Conclusion

Depression was the most prevalent psychiatric diagnosis in caregivers of patients with depressive disorder. Early psychiatric diagnosis for caregivers of patients with depression is crucial to offering suitable support and treatment and may improve caregivers' quality of life.

Association between changes in having of cancer patients in the family and depression: A longitudinal panel study

BACKGROUND

Cancer diagnosis can cause considerable stress among patients and their families. Both may experience clinical depression and severe anxiety. Therefore, this study investigated the association between the occurrence of cancer patients in the family and the depression among family members.

METHODS

Data from the Korean Longitudinal Study of Aging (2006-2020) were used. A total of 6251 participants who completed the short-form Center for Epidemiologic Studies Depression Scale (CESD-10-D) questionnaire were included. General estimating equations were used to assess the temporal effects of changes on depression in the presence of cancer patients in the family.

RESULTS

Having cancer patients in the family was associated with a high risk of depression among both men and women (men, Odd Ratios (OR):1.78, 95 % Confidence Intervals (CI) 1.13-2.79; women, OR:1.53, 95 % CI 1.06-2.22). Depressive symptoms were particularly high in women, especially when cancer symptoms were more severe than previous surveys (OR: 2.48, 95 % CI 1.18-5.20).

LIMITATIONS

First, non-responders were excluded but this could be affected by underestimation bias. Second, depression was defined as the CESD-10-D score, and the biological risk factors of depression could not be identified because of survey-based database. Third, due to the retrospective design study, confirming the causal relationship clearly is difficult. Finally, residual scheming effects of unmeasured variables could not be eliminated.

CONCLUSION

Our findings support efforts to diagnose and manage depression in the families of cancer patients. Accordingly, healthcare services and supportive interventions to reduce the psychological factors of cancer patients' families are needed.

Factors associated with anxiety and depression among caregivers of patients receiving medical home visits

In recent years, Japan has promoted home visits to support older adults, with caregivers playing an important role. However, caregivers generally experience a high frequency of anxiety and depression, and the factors associated with these conditions among home visit caregivers remain unknown. To identify the associated factors, we conducted a questionnaire-based cross-sectional study of home visit caregivers in Tokushima Prefecture, Japan. The survey included caregivers' Hospital Anxiety and Depression Scale;sociodemographic items of patients and caregivers;and caregivers' perceptions of the home care environment, patients, and themselves. The questionnaires were sent to 379 caregivers;203 responded (53.6% response rate), of which 173 were valid (85.2% valid response rate). The prevalence of anxiety and depression was 43.9% and 69.4%, respectively. Multiple logistic regression analysis of factors associated with anxiety and depression showed that stable family finances (OR:0.69, 95% CI:0.48-1.00, p=0.049) and stable caregiver health (OR:0.45, 95% CI:0.30-0.68, p<0.001) were associated with anxiety. Further, stable family finances (OR:0.60, 95% CI:0.38-0.93, p=0.022), stable caregiver health (OR:0.49, 95% CI:0.30-0.81, p=0.005), and stable patient condition (OR:0.51, 95% CI:0.29-0.92, p=0.025) were associated with depression. These findings demonstrate that caregiver wellbeing is essential in home care settings. J. Med. Invest. 70 : 443-449, August, 2023.

Depression among caregivers of cancer patients: Updated systematic review and meta-analysis

BACKGROUND

It is imperative to provide care for patients with terminal illnesses such as cancer, though it demands time, financial resources and other unmet needs. Subsequently, caregivers might be exposed to psychological stress and other mental health problems. Previous meta-analysis finding shows caregivers of cancer patient suffer from depression. During the past 4 years, there has been a considerable increase in the number of newly studies, and we therefore intended to update this finding and provide current global prevalence of depression among caregivers of Cancer patients.

METHODS

We searched PubMed, SCOPUS, CINAHIL, Embase, and PsychINFO to identify peer-reviewed studies which reported the prevalence of depression among caregivers of cancer patients using pre-defined eligibility criteria. Studies were pooled to estimate the global prevalence of depression using a random-effect meta-analysis model. Heterogeneity was assessed using Cochran's Q and I² statistics. Funnel plot asymmetry and Egger's regression tests were used to check for publication bias.

RESULT

Our search identified 4375 studies, of which 35 studies with 11,396 participants were included in the meta-analysis. In the current review, the pooled prevalence of depression among caregivers of Cancer patients was 42.08% (95% CI: 34.71-49.45). The pooled prevalence of depression was higher in the studies that used cross-sectional data (42%, 95% CI: 31-52) than longitudinal data (34%, 95% CI: 18-50). We also observed a higher rate of depression among female caregivers when compared to their male counterparts (57.6%) (95% CI: 29.5-81.5).

CONCLUSION

Globally, around two in five cancer patient caregivers screened positive for depression, which needs due attention. Routine screening of depressive symptoms and providing psychosocial support for caregivers is crucial.

Suicidal ideation in mothers of asthmatic children and adolescents in a subspecialty outpatient practice

We aimed to investigate prevalence and factors associated with Suicide ideation (SI) in mothers of asthmatic children. This cross-sectional study included 362 dyads of mothers and children with asthma aged 2 to 14 years who attended two pediatric outpatient clinics in Brazil. We assessed the presence of SI (Self-Report Questionnaire-20), the occurrence of stressful events and maternal social support. The prevalence of SI was 8.6%. Low maternal education, exposure to serious illness, and low perception of social support in its affective–social interaction dimension remained significantly associated with SI in the final model. Thus, life stressors, social support and low maternal education accounted for most of the variation in prevalence of maternal SI. There were no effects of child asthma severity on maternal SI in this study.

Associations of financial hardship with suicidal ideation among bereaved cancer caregivers

PURPOSE

To examine associations between financial hardship and suicidal ideation among bereaved informal caregivers of cancer patients.

DESIGN

Longitudinal cohort study.

SAMPLE

173 informal caregivers of advanced cancer patients.

METHODS

Caregivers were interviewed a median 3.1 months before and 6.5 months after the death of the patient they cared for. Logistic regression models estimated associations between caregiver-perceived pre-loss and post-loss financial hardship due to the patient's illness and post-loss suicidal ideation.

FINDINGS

Suicidal ideation was identified in 12% (n = 21) of the sample pre-loss, rising to 20% (n = 34) post-loss (p=.049). Pre-loss financial hardship (OR = 3.4, 95% CI = 1.5-7.4, p=.002) and post-loss financial hardship (OR = 3.7, 95% CI = 1.7-8.2, p=.001) were each bivariately associated with post-loss suicidal ideation. In multivariable models adjusting for pre-loss suicidal ideation, psychiatric diagnosis, and spousal relationship to the patient, post-loss financial hardship remained significantly associated with post-loss suicidal ideation (AOR = 3.6, 95% CI = 1.4-8.8, p=.006).

CONCLUSION

Among a cohort of cancer caregivers followed from active caregiving into bereavement, post-loss financial hardship was associated with suicidal ideation in bereavement.

IMPLICATIONS

Economic policies that financially benefit caregivers may represent promising strategies for preventing suicidal thoughts and behaviors.

Suicidal ideation after acute traumatic brain injury: A longitudinal actor-partner interdependence model of patients and caregivers in Latin America

PURPOSE/OBJECTIVE

Traumatic brain injury (TBI) is associated with depression, anxiety, and even suicidality in individuals with TBI and in caregivers. Moreover, emotional functioning in individuals with TBI is linked with caregiver functioning. However, no known studies to date have examined linkages in suicidal ideation in individuals with TBI and family caregivers. This is especially important in Latin America, where TBI rates are high, and where cultural norms influence family caregiving. This study examined associations among self-reported suicidal ideation in individuals with TBI and their primary caregivers over time in Mexico and Colombia. Research Method/Design: A total of 109 individuals and their primary caregivers completed measures during hospitalization for TBI and at 2- and 4-months posthospitalization. The primary outcome was Item 9 from the Spanish version of the Patient Health Questionnaire-9, assessing for thoughts of death or suicide in the previous 2 weeks.

RESULTS

Patients and caregivers reported high levels of suicidal ideation (18.3%-22.4% and 12.4%-15.7%, respectively) at each time point, and suicidal ideation at one time point strongly predicted ideation at the next. When patients endorsed suicidal ideation in the hospital, their caregivers tended to endorse suicidal ideation 2 months later. Although unaccounted for variables could be driving these relationships, they may also provide possible evidence of causal preponderance between patient and caregiver suicidal ideation post-TBI.

CONCLUSIONS/IMPLICATIONS

Clinicians and rehabilitation specialists can use these findings to inform suicide risk assessment by expanding these practices to caregivers of patients who endorsed suicidal ideation. Interventions after TBI should incorporate caregivers given this study showed significant interdependence of suicidality between patients and caregivers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Suicide probability in psychiatric patients' primary caregivers: The role of care burden, alexithymia and some risk factors

BACKGROUND

Although suicidal ideation seems to be related with both burden of care and alexithymia, there is no study investigating the correlation between these factors and suicide probability in informal caregivers of psychiatric patients in the literature.

AIM

In this study, it was aimed to determine the suicide probability in psychiatric patients' primary caregivers, and to evaluate the effects of care burden, alexithymia and some risk factors on suicide probability.

METHODS

This study was conducted with 262 caregivers between February 2019 and December 2019. Data were collected with the Personal Information Form, Suicide Probability Scale, Zarit Burden Interview, Toronto Alexithymia Scale.

RESULTS

The mean score the caregivers obtained from the Suicide Probability Scale was 79.75 ± 59.29, and 17.9% of them were at risk for suicide. Also, caregivers' suicide probability was related to variables such as caregivers' sex, economic status, presence of any disease, duration of care, and patients' education level, psychiatric diagnosis, duration of illness, presence of physical illness, compliance with treatment. In addition, caregivers' burden and alexithymia levels were significantly associated with the participating caregivers' suicide probability.

CONCLUSIONS

This study demonstrates that approximately one out of every five caregivers was at risk for suicide. Therefore, hospital and community-based intervention strategies to support caregivers should be developed.

Suicidality in family caregivers of people with long-term illnesses and disabilities: A scoping review

An emerging body of international research suggests family caregivers may be a high-risk group for suicide, but the evidence has not been synthesised. Forty-eight peer-reviewed journal articles were included in this review, spanning low-, middle-, and high-income countries and a variety of illnesses and disabilities. The proportion of caregivers experiencing suicidal ideation ranged from 2.7% to 71%, with evidence of suicide attempts, deaths by suicide, and deaths by homicide-suicide also reported. Risk and protective factors varied across studies and there was little consideration of differences by caregiving relationship, type of illness/disability, or country. There is sufficient evidence to warrant concern for caregivers around the world and prompt action in policy and practice, but more rigorous research is required to draw clear, nuanced conclusions about risk and inform evidence-based prevention and intervention.

Coping Strategies for Stress and Self-Efficacy in Patients With Cancer and Their Spouses: A Cross-Sectional Study

BACKGROUND

Cancer is one of the most important diseases of the present century worldwide. Patients and their spouses can find more difficulty accepting the diagnosis of cancer than its phases of treatment. Both the physical health and mental health of the patient and spouse are important in the process of recovery from cancer and its treatment.

OBJECTIVE

The aim of this study was to determine the relationship between coping strategies for stress and self-efficacy in patients with cancer and that of their spouses.

METHODS

In this descriptive-analytical cross-sectional study, 91 patients and their 91 spouses completed the Endler and Parker Coping Inventory, the Sherer General Self-Efficacy Scale, and a demographic information questionnaire.

RESULTS

The problem-oriented coping style was used more than the other strategies by patients with cancer and their spouses. The least used coping style by patients and their spouses was the avoidance style. The self-efficacy of patients and their spouses was above average. Self-efficacy was directly and moderately correlated with problem-oriented coping style (P < .001) and inversely and moderately correlated with emotion-oriented coping style (P < .001).

CONCLUSIONS

Adoption of strategies like training and consulting may enhance the problem-focused coping style and reduce emotion-focused coping style and therefore lead to increased self-efficacy in patients and their spouses.

IMPLICATIONS FOR PRACTICE

Healthcare providers', especially nurses', knowledge and sensitivity about the coping strategies of patients with cancer and their spouses may help providers select more effective interventions for improving patients' and their spouses' effective coping styles and self-efficacy.

Hope level and associated factors among parents of retinoblastoma patients during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The 2019 coronavirus disease (COVID-19) is a global public health emergency. So far, only a limited number of studies have investigated the impact of the COVID-19 pneumonia pandemic on the mental health of parents having children with cancer. This study investigated the hope, and relevant influencing factors (depression, anxiety, demographic data) among parents whose children had retinoblastoma (RB) during the COVID-19 pandemic.

METHODS

A cross-sectional survey and a convenient sampling survey were conducted on 317 parents of RB children admitted to the Ninth People's Hospital affiliated with Shanghai Jiao Tong University, School of Medicine, and Qilu Children's Hospital of Shandong University. The survey tools included Demographic Questionnaire, Herth Hope Index (HHI), The Generalized Anxiety Disorder (GAD-7), and the Patient Health Questionnaires (PHQ)-2.

RESULTS

The hope level score of the parents of RB patients was (35.36 ± 4.42), which was at the medium level. The highest dimension of hope score was inner positive readiness and expectancy (12.07 ± 1.57), and the lowest dimension was interconnectedness with self and others (11.50 ± 1.64). The incidence rate of depression and anxiety was 29.97% (95/317) and 41.32% (131/317), respectively. Monoculus or binoculus disease, sleep status, health status, and depression /anxiety had statistically significant effects on the parental hope level (p < 0.05). Multiple linear regression analysis revealed that time since diagnosis, education level, treatment type and depression were independent influencing factors (p < 0.05), accounting for 22.60% of the variation in hope level.

CONCLUSION

During the COVID-19 pandemic, medical staff should formulate targeted intervention measures according to different characteristics of ocular disease, time since diagnosis, treatment type, parental educational level and emotional state in order to improve the level of parental hope.

Phenotypes of caregiver distress in military and veteran caregivers: Suicidal ideation associations

The United States (US) has been at war for almost two decades, resulting in a high prevalence of injuries and illnesses in service members and veterans. Family members and friends are frequently becoming the caregivers of service members and veterans who require long-term assistance for their medical conditions. There is a significant body of research regarding the physical, emotional, and social toll of caregiving and the associated adverse health-related outcomes. Despite strong evidence of the emotional toll and associated mental health conditions in family caregivers, the literature regarding suicidal ideation among family caregivers is scarce and even less is known about suicidal ideation in military caregivers. This study sought to identify clusters of characteristics and health factors (phenotypes) associated with suicidal ideation in a sample of military caregivers using a cross-sectional, web-based survey. Measures included the context of caregiving, physical, emotional, social health, and health history of caregivers. Military caregivers in this sample (n = 458) were mostly young adults (M = 39.8, SD = 9.9), caring for complex medical conditions for five or more years. They reported high symptomology on measures of pain, depression, and stress. Many (39%) experienced interruptions in their education and 23.6% reported suicidal ideation since becoming a caregiver. General latent variable analyses revealed three distinct classes or phenotypes (low, medium, high) associated with suicidality. Individuals in the high suicidality phenotype were significantly more likely to have interrupted their education due to caregiving and live closer (within 25 miles) to a VA medical center. This study indicates that interruption of life events, loss of self, and caring for a veteran with mental health conditions/suicidality are significant predictors of suicidality in military caregivers. Future research should examine caregiver life experiences in more detail to determine the feasibility of developing effective interventions to mitigate suicide-related risk for military caregivers.

The Effects of Counseling about Death and Dying on Perceptions, Preparedness, and Anxiety Regarding Death among Family Caregivers Caring for Hospice Patients: A Pilot Study

Purpose

This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients.

Methods

Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test.

Results

Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit.

Conclusion

The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

Investigation to identify individual socioeconomic and health determinants of suicidal ideation using responses to a cross-sectional, community-based public health survey

OBJECTIVES

To address a gap in knowledge by simultaneously assessing a broad spectrum of individual socioeconomic and potential health determinants of suicidal ideation (SI) using validated measures in a large UK representative community sample.

DESIGN

In this cross-sectional design, participants were recruited via random area probability sampling to participate in a comprehensive public health survey. The questionnaire examined demographic, health and socioeconomic factors. Logistic regression analysis was employed to identify predictors of SI.

SETTING

Community setting from high (n=20) and low (n=8) deprivation neighbourhoods across the North West of England, UK.

PARTICIPANTS

4319 people were recruited between August 2015 and January 2016. There were 809 participants from low-deprivation neighbourhoods and 3510 from high-deprivation neighbourhoods. The sample comprised 1854 (43%) men and 2465 (57%) women.

PRIMARY OUTCOME MEASURES

SI was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire-9 instrument.

RESULTS

454 (11%) participants reported having SI within the last 2 weeks. Model 1 (excluding mental health variables) identified younger age, black and minority ethnic (BME) background, lower housing quality and current smoker status as key predictors of SI. Higher self-esteem, empathy and neighbourhood belonging, alcohol abstinence and having arthritis were protective against SI. Model 2 (including mental health variables) found depression and having cancer as key health predictors for SI, while identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) and BME were significant demographic predictors. Alcohol abstinence, having arthritis and higher empathy levels were protective against SI.

CONCLUSIONS

This study suggests that it could be useful to increase community support and sense of belonging using a public health approach for vulnerable groups (e.g. those with cancer) and peer support for people who identify as LGBTQ and/or BME. Also, interventions aimed at increasing empathic functioning may prove effective for reducing SI.

Relationships Between Anxiety Symptoms, Hopelessness and Suicidal Ideation Among Parental Caregivers of Mandarin-Speaking Children With Speech Impairment: The Mediating Effect of Depressive Symptoms

Background: Determining the mental health status of parents who chronically care for a child with speech impairment is important for developing appropriate interventions to improve both parents' and children's health and achieve a win-win situation. Unfortunately, no study in China has explored this issue. This study investigated the differences in four aspects of mental health between maternal and paternal caregivers for the Mandarin-speaking children with speech impairment and determine whether depressive symptoms mediate the relationships between anxiety symptoms and suicidal ideation, hopelessness and suicidal ideation. Methods: This cross-sectional questionnaire survey was conducted in February 2020 by sending a link to the predesigned electronic questionnaire in WeChat. Standardized assessment tools were employed. Hierarchical multiple logistic regression was conducted to examine the associations between various factors and suicidal ideation, and two separate structural equation models were performed to evaluate the mediating effects of depressive symptoms in the relationship between anxiety symptoms and suicidal ideation as well as between hopelessness and suicidal ideation. Results: This study included 446 parental caregivers of Mandarin-speaking children with speech impairment. Paternal caregivers had greater score than maternal caregivers on loss of motivation (one of the subdomains of hopelessness). Somatic complications of the child (OR = 2.73, 95% CI: 1.09-6.67) and depressive symptoms (OR = 3.38, 95% CI: 1.83-6.30) were positively associated with caregivers' suicidal ideation. Having speech therapy of child (OR = 0.54, 95% CI: 0.29-0.98) was negatively correlated with caregivers' suicidal ideation. There was direct effect of depressive symptoms on suicidal ideation. Depressive symptoms play mediating roles on the relationships between anxiety symptoms (β = 0.171, p < 0.001) as well as between hopelessness and suicidal ideation (β = 0.187, p < 0.001). Conclusions: Paternal and maternal caregivers of Mandarin-speaking children with speech impairment suffered from mental health problems. Preventive strategies and interventions to ameliorate parental psychological well-being, and health care policies to increase the accessibility to speech therapy care of children with speech impairment are imperative.

Risk factors for suicidal thoughts in informal caregivers: results from the population-based Netherlands mental health survey and incidence Study-2 (NEMESIS-2)

BACKGROUND

Previous research suggests that family caregivers contemplate suicide at a higher rate than the general population. Much of this research has been disease specific and in relatively small samples. This study aimed to compare suicidal thoughts between non-caregivers and informal caregivers of people with a variety of conditions, in a large representative sample, and to identify significant risk factors.

METHODS

The general population study NEMESIS-2 (N at baseline = 6646) included 1582 adult caregivers at the second wave (2010-2012) who also participated at the third wave (2013-2015). Suicidal thoughts were assessed over 4 years, with the Suicidality Module of the Composite International Diagnostic Interview 3.0. The presence of suicidal thoughts was estimated and risk factors for suicidal thoughts were assessed with logistic regression analyses adjusted for age and gender.

RESULTS

Thirty-six informal caregivers (2.9%) reported suicidal thoughts during the 4 year study period. The difference between caregivers and non-caregivers (3.0%) was not significant. Among caregivers, significant risk factors for suicidal thoughts included being unemployed, living without a partner, having lower levels of social support, having a chronic physical disorder, a mood disorder or an anxiety disorder, and having impaired social, physical and emotional functioning. These risk factors were also found in non-caregivers. No caregiving-related characteristics were associated with suicidal thoughts.

CONCLUSION

There was no elevated rate of suicidal thoughts in caregivers and risk factors for suicidal thoughts in caregivers were consistent with risk factors in non-caregivers. No association between caregiving characteristics and suicidal thoughts was found. Caregivers with limited resources and in poorer health might still benefit from prevention and intervention efforts.

Prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders

AIMS AND OBJECTIVES

This study aimed to analyse the prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders.

BACKGROUND

Studies conducted with family caregivers of people with dementia and cancer point out a high prevalence of suicidal ideation among these subjects; however, this aspect has not yet been investigated among family caregivers of people with mental disorders.

DESIGN

This is a cross-sectional study, conducted with 537 family caregivers of patients from 16 Psychosocial Care Centers (CAPS) of the 21st Health Region of the state of Rio Grande do Sul, Brazil.

METHODS

Question 17 of the Self-Reporting Questionnaire (SRQ-20) was used for suicidal ideation screening. The prevalence of suicidal ideation was calculated according to sociodemographic and care variables, with confidence interval estimate (95% CI). Crude and adjusted odds ratios were calculated by logistic regression. The Guidelines to Reporting of Observational Studies in Epidemiology (STROBE Statement) was adhered in this study (See File S1).

RESULTS

The prevalence of suicidal ideation found in this study for the 30 days preceding the interview was 12.5% (95% CI: 10-15). The factors associated with the outcome were lower age, lower schooling, feeling of burden, self-report of stress problem and dissatisfaction with family relationships.

CONCLUSION

The prevalence of suicidal ideation among the studied family caregivers was high and strongly associated with issues regarding care, showing the need for interventions that provide support.

RELEVANCE FOR CLINICAL PRACTICE

Nurses are a large part of the workforce of the community mental health services. The careful characterisation of the subjects who show suicidal ideation, as performed in this study, may reveal specificities capable of refining the diagnostic potential for establishment of action plans in a timely manner, avoiding possible attempts or even the consummation of suicide.

A Visual-Analogue Screening Tool for Assessing Mood and Quality of Daily Life Complications in Family Members of People Living With Cancer: Portuguese Version of the Emotion Thermometers: Burden Version

Cancer is a disease that impacts not only the patient but also affects the entire family. Family members experience high levels of distress. Therefore, screening for cancer-specific distress among family members of people with cancer is important but relatively unexplored. This cross-sectional study aims to analyze the psychometric properties of a screening tool for family members of people with cancer. We examined the usefulness of the emotional thermometers burden version (ET-BV) in detecting caregiver emotional distress. The ET-BV is a simple multidomain visual analogue scale distributed in two major domains: "emotional upset" and "impact." A total of 364 cancer patients' family members completed the ET-BV and Brief Symptom Inventory. Analyses were aimed to examine the diagnostic accuracy (receiver operating characteristic) of the ET-BV. A fair to good diagnostic accuracy was achieved for ET-BV. For emotional upset thermometers, a cutoff of ≥5 was determined and for impact thermometers, a cutoff of ≥4 was established. ET-BV seems to be a useful, quick, and simple tool for distress screening in family members of people with cancer. A revision of a specific thermometer is discussed in order to increase ET screening performance and clinical utility.

Research Commentary: A Carer's Roadmap for Research, Practice, and Policy on Suicide, Homicide, and Self-Harm

Academic researchers are increasingly asked to engage with the wider world, both in terms of creating impact from their work, and in telling the world what goes on in university research departments. An aspect of this engagement involves working with patients, carers or members of the public as partners in research. This means working with them to identify important research questions and designing studies to address those questions. This commentary was jointly written by two researchers and people with relevant caring experience for this special issue. It brings to the forefront the concerns of carers who are also involved in research as partners. The aim is to highlight their perspectives to inform future research, policy, and practice.

Family Members of Cancer Patients in Korea Are at an Increased Risk of Medically Diagnosed Depression

Objectives

Family members are often cancer patients’ primary source of social and emotional support and make a major contribution to how well patients manage their illness. We compared the prevalence of depression in the family members of cancer patients and the general population.

Methods

This study used the data from the fourth, fifth, and sixth rounds of the Korea National Health and Nutrition Examination Survey. The variable of interest was the presence of a cohabitating cancer patient in the family and the dependent variable was the presence of diagnosed depression.

Results

The odds of having medically diagnosed depression in those with a cohabitating cancer patient in the family were significantly higher than among those who did not have cancer patients in their families (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.12 to 2.17; p=0.009). The OR for females was 1.59, and this increase was statistically significant (95% CI, 1.09 to 2.31; p=0.02).

Conclusions

We need to invest more effort into diagnosing and managing depression in the family members of cancer patients. This will have an impact both on their quality of life and on the well-being of patients, as supporters and caregivers play an instrumental role in helping patients manage their illness.

Prevalence and determinants of depression in caregivers of cancer patients: A systematic review and meta-analysis

BACKGROUND

Aim of this study was to estimate the prevalence rate of depression in cancer patient caregivers and to identify factors affecting depression and quality of life of cancer caregivers.

METHODS

Relevant research articles were retrieved after literature search in several electronic databases. Random effects meta-analyses were performed to obtain pooled estimates of the prevalence rates of depression and anxiety; their respective scores, and quality of life scores. Significant relationships between depression and factors related to depression and quality of life reported in individual studies were identified.

RESULTS

Thirty studies were included. Overall, 21,149 caregivers were appraised in these studies (age 52.65 years [95% CI: 49.65, 55.65]; 31.14% [28.40, 33.89] men). The prevalence of depression and anxiety were 42.30% [33.31, 51.29] % and 46.55% [35.59, 57.52], respectively. Quality of life score, as measured with Caregiver Quality of Life-Cancer scale was 64.55 [47.44, 81.66]. Patient's condition, caregiving burden, duration of caregiving, spouse caregiver, caregiver being unemployed, caregiver with chronic disease, caregiver's sleep quality, caregiver's avoidance, financial problems, and female sex were positively associated with depression whereas overall quality of life of caregiver, pre-loss grief, caregiver's education level, caregiver's age, caregiver's sense of coherence, and caregiver's bondage with patient were negatively associated with depression in caregivers.

CONCLUSION

A considerably high prevalence of depression is found in cancer patient caregivers. Several factors may affect depression and their quality of life of cancer patient caregivers.

Suicidal Risk, Psychopathology, and Quality of Life in a Clinical Population of Adolescents

BACKGROUND

According to literature data, psychopathology is associated with both quality of life (QoL) and suicidal risk in adolescents, but the literature does not fully support a direct association between psychopathology and suicidal thoughts and behaviors. The aim of this study was to investigate the possible mediational role of QoL in the relationship between psychopathology and level of suicidal risk in a clinical sample of adolescents.

METHOD

The authors examined a clinical population of 134 adolescents, aged 13-18 years. Suicidal risk-having any current suicidal ideations and/or previous suicide attempt-was assessed by the Mini International Neuropsychiatric Interview. QoL was evaluated by the adolescent self-rated versions of "Das Intervertar zur Erfassung der Lebensqualität Kindern und Jugendlichen" (ILK: Measure of Quality of Life for Children and Adolescents) and psychopathology was measured by adolescent self-rated versions of the Strengths and Difficulties Questionnaire (SDQ). A mediational model, in which QoL mediated the relationship between psychopathology and suicidal risk controlling for gender and age, was tested by means of regression analyses.

RESULTS

Gender and age were both associated with suicidal risk. Self-reported QoL significantly mediated the relationships between emotional problems (=1.846; 95% BCa CI: 0.731-2.577), as well as peer problems (=0.883; 95% BCa CI: 0.055-1.561) and suicidal risk: more emotional and peer problems were associated with lower QoL, which in turn was related to higher level of suicidal risk.

CONCLUSION

Based on this study, which aims to make further steps in suicidal prevention, our findings suggest that clinicians should routinely screen the QoL of their patients, especially in adolescents with emotional and peer problems. Furthermore, it is important to focus intervention and treatment efforts on improving the QoL of adolescents with emotional and peer problems.

Stress and Depressive Symptoms in Cancer Survivors and Their Family Members: Korea Community Health Survey, 2012

This study examined the prevalence of perceived stress and depressive symptoms in cancer survivors and their family members compared with subjects without cancer and without family members with cancer. The subjects of this cross-sectional study were adults ≥19 years old who participated in the 2012 Korea Community Health Survey. Stress and depressive symptoms in cancer survivors and their family members were assessed and compared to symptoms in control groups by chi-square tests and multiple logistic regression analyses. Of the 6783 cancer survivors, 26.9% and 8.7% reported having stress and depressive symptoms, respectively, and 27.7% and 5.9% of family members of cancer survivors reported having stress and depressive symptoms, respectively. Cancer survivors showed higher adjusted odds ratio (aOR) for stress (aOR = 1.26, 95% confidence interval (CI) = 1.16-1.37) and depressive symptoms (aOR = 1.82, 95% CI = 1.57-2.11) than subjects without cancer history. Family members of cancer survivors showed a higher OR for stress and depressive symptoms than subjects without a family member who survived cancer. Cancer survivors and family members of cancer survivors had more stress and depressive symptoms than controls. Careful management for cancer patients and their family members should include screening for stress and depression to improve mental health associated with cancer survivorship.

The Mediating Role of Parental Support in the Relationship between Life Stress and Suicidal Ideation among Middle School Students

Background

Youth suicide is increasingly being recognized as a major social problem in South Korea. In this study, we aimed to explore the effects of parental support on the relationship between life stress and suicidal ideation among middle-school students.

Methods

This study analyzed data from a cross-sectional study on mental health conducted by the South Korea National Youth Policy Institute between May and July of 2013. Questionnaire responses from 3,007 middle-school students regarding stress factors, thoughts of suicide during the past year, and parental support were analyzed in terms of 3 subscale elements: emotional, academic, and financial support.

Results

Among the participants, 234 male students (7.8%) and 476 female students (15.8%) reported experiencing suicidal ideation in the past year. Life stress significantly influenced suicidal ideation (P<0.001), and parental support and all of the subscale elements had a significant influence on decreasing suicidal ideation. As shown in model 1, life stress increased suicidal ideation (adjusted odds ratio [aOR], 1.318; P<0.001), and, in model 2, the effect of life stress on suicidal ideation decreased with parental support (aOR, 1.238; P<0.001).

Conclusion

Parental support was independently related to a decrease in suicidal ideation, and life stress was independently related to an increase in suicidal ideation. Parental support buffered the relationship between life stress and suicidal ideation.

Psychometric Properties and Correlates of the Beck Hopelessness Scale in Family Caregivers of Nigerian Patients with Psychiatric Disorders in Southwestern Nigeria

Objectives:

To examine the construct and correlates of hopelessness among family caregivers of Nigerian psychiatric patients.

Materials and Methods:

This is a cross-sectional, descriptive study involving 264 family caregiver-patients’ dyads recruited from two university teaching hospitals psychiatric clinics in Southwestern Nigeria.

Results:

Exploratory factor analysis revealed a two-factor 9-item model of the Beck Hopelessness Scale (BHS) among the family caregivers. Confirmatory factor analysis of the model revealed satisfactory indices of fitness (goodness of fit index = 0.97, comparative fit index = 0.96, Chi-square/degree of freedom (CMIN/DF) = 1.60, root mean square error of approximation = 0.048, expected cross-validation index = 0.307, and standardized root mean residual = 0.005). Reliability of the scale was modestly satisfactory (Cronbach's alpha 0.72). Construct validity of scale was supported by significant correlations with the family caregivers’ scores on the Zarit Burden Interview, mini international neuropsychiatric interview suicidality module, General Health Questionnaire-12 (GHQ-12), and Patient Health Questionnaire-9. The greatest variance in the family caregivers’ scores on the BHS was contributed by their scores on the psychological distress scale (GHQ-12).

Conclusions:

The BHS has adequate psychometric properties among Nigerian psychiatric patients’ family caregivers. There is the need to pay attention to the psychological well-being of the family caregivers of Nigerian psychiatric patients.

Negative Public Attitudes Towards Cancer Survivors Returning to Work: A Nationwide Survey in Korea

Purpose

Early diagnosis and an improved survival rate have emerged as important issues for cancer survivors returning to work during the prime of their working life. This study investigated the attitudes of the general public towards cancer survivors returning to work in Korea and attempted to identify the factors influencing this negative attitude.

Materials and Methods

A general public perception survey regarding cancer survivors returning to work, targeting 2,000 individuals between 40-70 years of age, was conducted as face-to-face home visit.

Results

The public expressed a negative attitude towards cancer survivors returning to work, in terms of both perception and acceptance. Negative perception was higher among those in metropolitan areas compared with urban/rural areas (odds ratio [OR], 1.71), with monthly incomes < $2,000 compared with > $4,000 (OR, 1.54), and with patient care experience compared with those without (OR, 1.41). Negative acceptance was higher among those with monthly incomes < $2,000 compared with > $4,000 (OR, 1.71) and those with patient care experience compared with those without (OR, 1.54). The common factors between acceptance and perception that influenced negative attitude included area of residence, patient care experience, and monthly income.

Conclusion

This study identified negative attitudes towards cancer survivors returning to work in South Korea and the factors influencing the reintegration of cancer survivors into society. It is necessary to promote community awareness and intervention activities to enable access to community, social, and individual units for the social reintegration of cancer survivors.

Depression and socio-economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross-sectional survey study using a 5-point Likert-type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho-social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.

Coping styles and social support among depressed Chinese family caregivers of patients with esophageal cancer

OBJECTIVES

To determine the coping styles of family caregivers of patients with esophageal cancer and examine the relationships between depression, coping styles and social support.

METHODS

A descriptive and correlational survey was conducted in three university-affiliated oncology and thoraco-cardiac surgery departments in Shiyan, China. A convenience sample of 301 Chinese family caregivers of hospitalized patients with esophageal cancer were asked to respond to a set of four questionnaires including: Socio-demographic questionnaire, Center for Epidemiological Studies Depression, Brief COPE Inventory, and Multidimensional Scale of Perceived Social Support.

RESULTS

For the positive coping style, male caregivers used more problem-coping than female caregivers. However, for negative coping, both male and female caregivers used maladaptive coping styles. There were significant correlations between emotion-focused coping styles with adaptive coping, maladaptive coping, depression and social support.

CONCLUSIONS

Family caregivers play a major role in caring for cancer patients and suffer from various psycho-social problems. What is lacking in the literature was to address the cultural differences in cancer caregiving burden, roles, and appropriate interventions to help them face the multiple demands of caregiving. Therefore, a need to develop and evaluate interventions using randomized clinical trials and sensitive instruments to measure the effectiveness of the intervention on patients' and caregivers' outcomes.

Determinants of a hopeful attitude among family caregivers in a palliative care setting

OBJECTIVE

This study investigated the determinants of a hopeful attitude among family caregivers involved with palliative care.

METHOD

We investigated a broad range of factors for the patient-family dyad in a palliative care setting using a cross-sectional design. The patients' sociodemographic, clinical and psychological factors were evaluated, as well as caregiver-related sociodemographic and psychological factors, including depressive symptoms, burden, coping style and religiosity. Caregivers were divided into two groups based on a hopeful or nonhopeful attitude and assessed using the abbreviated version of the seven-item Beck Hopelessness Scale (BHS-7).

RESULTS

Of 304 analyzed dyads, 210 (69.1%) caregivers showed a hopeful attitude, with a BHS-7 score of 0. The adjusted logistic regression analyses showed that caregivers' hopeful attitude was determined by only their psychological status: less depressive symptoms [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.83-0.90], active coping strategy (OR, 1.12; 95% CI, 1.07-1.18) and lower burden (OR, 0.93; 95% CI, 0.88-0.99). In a subpopulation analysis (n=200), higher religiosity was a significantly associated factor.

CONCLUSION

Healthcare providers need to pay attention to the psychological vulnerability of caregivers to encourage a hopeful attitude. Additional studies of longitudinal design for hopeful attitude throughout the trajectory of palliative care are necessary.

The werther effect of two celebrity suicides: an entertainer and a politician

Purpose

Suicide is a major health problem in Korea. Extensive media exposure of celebrity suicide may induce imitative suicide, a phenomenon called the Werther effect. We examined the increased suicide risk following the suicides of an entertainer and a politician, and identified the relative suicide risks.

Methods

News articles about the celebrity suicides were obtained from three major newspapers and analysed for quantitative and qualitative features. Imitative suicide risk was investigated by applying a Poisson time series autoregression model with suicide mortality data from the National Statistics Office for 1.5 years before and 1.5 years after each celebrity’s suicide. The period with a significantly increased number of suicides immediately after the celebrity’s suicide determined the Werther effect band. The relative risk during this period was examined for different ages, genders, and suicide methods.

Results

News reports were more numerous and they contained more positive definitions about the entertainer’s suicide. The risk of suicide deaths rose markedly after both celebrity suicides. However, the Werther effect band was longer for the entertainer (6 weeks) than for the politician (4 weeks). The relative suicide risk was significant for almost all ages and both genders during that of both individuals. Use of the same suicide method was a prominent risk factor after both celebrity suicides.

Conclusions

Our results confirm the existence of imitative suicide behaviours, suggesting a facilitation effect of media reports. Guidelines for responsible media reporting need to be implemented to enhance public mental health in Korea.