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

Suicide among lymphoma patients

BACKGROUND

Higher suicide rates were observed in patients diagnosed with lymphoma. In this study, we accurately identified patients with high-risk lymphoma for suicide by constructing a nomogram with a view to effective interventions and reducing the risk of suicide.

METHODS

235,806 patients diagnosed with lymphoma between 2000 and 2020 were picked from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training (N = 165,064) and validation set (N = 70,742). A combination of the Least absolute shrinkage and selection operator (LASSO) and Cox proportional hazards regression identified the predictors that constructed the nomogram. To assess the discrimination, calibration, clinical applicability, and generalization of this nomogram, we implemented receiver operating characteristic curves (ROC), calibration curves, decision curve analysis (DCA), and internal validation. The robustness of the results was assessed by the competing risks regression model.

RESULTS

Age at diagnosis, gender, ethnicity, marital status, stage, surgery, radiotherapy, and annual household income were key predictors of suicide in lymphoma patients. A nomogram was created to visualize the risk of suicide after a lymphoma diagnosis. The c-index for the training set was 0.773, and the validation set was 0.777. The calibration curve for the nomogram fitted well with the diagonal and the clinical decision curve indicated its clinical benefit.

LIMITATION

The effects of unmeasured and unnoticed biases and confounders were difficult to eliminate due to retrospective studies.

CONCLUSION

A convenient and reliable model has been constructed that will help to individualize and accurately quantify the risk of suicide in patients diagnosed with lymphoma.

The Relationship Between Social Support and Suicide Resilience in Chinese Cancer Patients: A Serial Multiple Mediation Model Through Self-care Self-efficacy and Meaning in Life

BACKGROUND

A growing body of literature has shown a higher risk of suicide in cancer patients compared with the general population. Early detection of factors related to suicide resilience in cancer patients could prevent loss of life.

OBJECTIVE

The study aimed to investigate the serial-multiple mediation of self-care self-efficacy and meaning in life in the relationship between social support and suicide resilience among Chinese cancer patients.

METHODS

A cross-sectional investigation of 287 cancer patients using a battery of self-reported questionnaires was performed. For preliminary analyses, descriptive, univariate, and Pearson correlation analyses were performed. Mediation analyses were tested using a serial-multiple mediation model (PROCESS model 6).

RESULTS

Mediation analysis indicated the indirect effects of social support on suicide resilience mediated solely by either self-care self-efficacy (point estimate = 0.20; 95% confidence interval [CI], 0.12-0.30), or by meaning in life (point estimate = 0.06; 95% CI, 0.01-0.12), or by the multiple mediation of self-care self-efficacy to meaning in life (point estimate = 0.03; 95% CI, 0.01-0.06).

CONCLUSIONS

The findings demonstrated the crucial direct or indirect effects of social support, self-care self-efficacy, and meaning in life on facilitating cancer patients' suicide resilience.

IMPLICATIONS FOR PRACTICE

Oncology nurses, as 24-hour care providers for cancer patients, may interact with and be important sources for the psychosocial care of cancer patients at risk of suicide. Prevention and intervention efforts must be directed at assisting cancer patients, improving self-care self-efficacy, and finding meaning in life after a cancer diagnosis.

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.

Prevalence and correlates of suicide risk among non-psychiatric inpatients in a general hospital in China

OBJECTIVE

This study aims to investigate the suicide risk and mental health status of non-psychiatric inpatients in general hospital and explore the risk factors of suicide.

METHODS

A prospective study was conducted at a tertiary general hospital in Guangzhou, Guangdong Province, China. On-line assessment of mental health status and suicide was completed at admission and discharge. We assessed depression, anxiety, insomnia and suicide of inpatients and binary logistics regression was used to examine the risk factors of suicide.

RESULTS

From April 1, 2021 and January 31, 2022, 3685 inpatients were included. The detection rates of depression, anxiety and insomnia were 14.6 %, 9.0 % and 17.8 %, respectively. There were 2.7 % of inpatients at suicide risk. Binary logistics regression demonstrated that the inpatients with anxiety were at higher risk of suicide.

LIMITATIONS

(1) Single-center study limits the generalization of conclusion, (2) low response rate at discharge.

CONCLUSIONS

The comorbidity of physical illnesses and mental health problems, including depression, anxiety, insomnia, and suicide among non-psychiatric patients in general hospital was common. An assessment of anxiety may help identify individuals at high suicide risk. Medical staff in general hospitals should be trained to improve their ability to identify mental disorders and high-risk individuals for suicide, provide timely interventions and effectively reduce the suicide risk of patients.

Identifying the Risk Factors of Suicidal Ideation in Patients With Hematologic Malignancies Using a Multidimensional Approach

BACKGROUND

Patients with hematologic malignancies have a 3.5-fold higher rate of suicide completion than the noncancer population, and the Hodgkin lymphoma has the highest suicide rate among all cancers. Although the risk factors for suicidal ideation among the cancer population are well-known, the specific risk factors contributing to the high suicide rate among patients with hematologic malignancies are elusive.

OBJECTIVE

This study aimed to identify the risk factors for suicidal ideation among patients with hematologic malignancies using a multidimensional approach.

METHODS

This was a cross-sectional, observational study. A total of 163 patients were recruited from the oncology department of a university hospital. We collected data on psychological and physical symptoms, social support, and suicidal ideation using the Memorial Symptom Assessment Scale-Short Form, the Multidimensional Scale of Perceived Social Support, and the Suicidal Ideation Scale. Multiple regression analysis was performed using SPSS (version 26.0) to analyze the clinical data.

RESULTS

Among the 163 participants, 96 (58.9%) were male, 57 (35%) were diagnosed with acute leukemia, and 97 (59.5%) received chemotherapy. The mean age was 55.26 ± 15.75. Physical symptoms, psychological symptoms, and willingness to use mental health services accounted for 39.5% of suicidal ideation cases.

CONCLUSIONS

Assessment of psychological conditions at the beginning of diagnosis, provision of appropriate interventions throughout treatment, and follow-up care to relieve psychological symptoms should be initiated in patients with hematologic malignancies to prevent suicide.

Ethical dilemmas and legal ambiguity in China: a chain mediation model linking suicide rumination, legitimization, and acceptance among acutely-ill adults

Background

This study explores the complex intersection of euthanasia, legal ambiguities, cultural attitudes, and the psychology of suicide among seriously ill patients in China. It addresses the lack of clear legislation on euthanasia and doctor-assisted killing, the impact of cultural and philosophical beliefs, and the evolution of legal and ethical perspectives on suicide. Additionally, it examines the psychological aspects of suicide ideation in acutely-ill patients, focusing on factors like familial burden and loss of dignity.

Method

A survey was conducted with 356 Chinese adults, aged 23 to 64 years, using popular social media platforms in China. The study aimed to reflect a broad spectrum of the adult population in terms of age, education, and professional sectors. The research model involves suicide rumination as an independent variable, acutely-ill patients' suicide acceptance as a dependent variable, and three mediators: cognitive depression, ethical suicide acceptance, and suicide legitimization.

Results

The findings reveal a significant total effect of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance, underlining a robust direct relationship that supports Hypothesis 1. The analysis indicates that Suicide Rumination is a significant predictor of Cognitive depression, explaining approximately 8.05% of its variance, thereby fully supporting Hypothesis 2a. However, the effect of Suicide Rumination on Ethical Suicide Acceptance did not emerge as significant, failing to support Hypothesis 2b, while its impact on Suicide Legitimization was also non-significant, not supporting Hypothesis 2c. Cognitive depression was found to have a substantial effect in the models for both Ethical Suicide Acceptance and Suicide Legitimization, supporting Hypotheses 3a and 3b. In the comprehensive model assessing Acutely-ill Patients' Suicide Acceptance, incorporating all mediators, a significant variance (R-squared = 0.6625) was explained. Notably, Suicide Rumination, Ethical Suicide Acceptance, and Suicide Legitimization all emerged as significant predictors of this acceptance, with varying effects, thus supporting Hypotheses 4a and 4b. The role of Cognitive depression in this model was marginally significant, offering limited support for Hypothesis 4c. Crucially, the indirect effects of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance through different mediational paths varied in significance and impact. The indirect effect via Cognitive depression alone, and through the sequential combination of Cognitive depression and Ethical Suicide Acceptance, were significant, highlighting the nuanced role of these mediators. These findings underscore the importance of considering multiple pathways in understanding the dynamics of Suicide Rumination and its influence on the acceptance of suicide among acutely-ill patients.

Conclusion

This paper presents a comprehensive analysis of the legal, cultural, ethical, and psychological dimensions of euthanasia, doctor-assisted killing, and suicide in China. The findings highlight the significant direct and mediated effects of suicide rumination on the acceptance of suicide among acutely-ill patients. The study contributes valuable insights into the evolving bioethics and the interplay of various factors in the context of end-of-life decision-making in modern Chinese society.

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.

Suicidal ideation, attempt and associated factors among people with cancer attending cancer center, eastern Ethiopia

Background

Suicide is one of the most common public health problems and the second leading cause of death among individuals 15-29 years of age. Suicidal ideation and attempt are one of the common psychiatric emergence in patients with cancer that needs early detection and management before patients end their lives. Therefore, the aim of the study was to assess the magnitude of suicidal ideation, attempts, and associated factors among people with cancer in Eastern Ethiopia.

Methods

An institutional-based cross-sectional study design was conducted among 362 participants. A composite international diagnostic interview was used to evaluate suicidal ideation and attempt. Epi-Data version 4.6.2 was used for data entry, and SPSS version 20 was used for analysis. Logistic regression analysis was done to identify associated factors for both suicidal ideation and attempt. p-values less than 0.05 are considered statistically significant, and the strength of the association will be represented by an adjusted odds ratio with a 95% confidence interval.

Results

The magnitude of suicidal ideation and attempt among people with in this study was 22.9% [95% CI, 18.7-27.4] and 9.8% [95%CI, 6.7-12.8] respectively. Being living alone [AOR = 4.90, 95% CI, 2.08-11.90], and having depressive symptoms [AOR = 3.28, 95% CI, 1.37-7.73], female ([AOR = 1.53, 95% CI, 1.30-3.23], anxiety symptoms [AOR = 3.06, 95% CI, 1.35-6.73)] and having poor social support [AOR = 3.08, 95% CI, 1.72-5.05], were significantly associated suicidal ideation whereas, Being living alone [AOR = 2.89, 95% CI, 1.09-7.65], having a depressive symptoms [AOR = 4.88, 95% CI, 1.45-13.28], being divorced/widowed [AOR = 3.46, 95% CI, 1.09-10.09] and stage four cancer [AOR = 5.53, 95% CI 2.97-7.47] were significantly associated with suicidal attempt.

Conclusion

Nearly one-quarter and one-tenth of people with cancer have suicide ideation and attempt, respectively. Suicidal behavior among cancer patients was found in this study to be a common problem. Living alone, having depressive and anxiety symptoms, being a female, having poor social support, and being in forth stage of cancer were risk factors for suicide. Therefore, early screening, diagnosing, and treating suicide and its factors will be mandatory and expected from health care providers and non-governmental organizations.

Moderating effects of suicide resilience and meaning in life on the association between entrapment and suicidal ideation in Chinese patients with ovarian cancer: a cross-sectional study

BACKGROUND

Numerous studies have confirmed that patients with ovarian cancer have a relatively high risk of suicidality. Early identification of psychological factors related to suicidal ideation in patients with ovarian cancer may provide effective information for suicide prevention strategies. This study aimed to investigate whether and how suicide resilience and meaning in life moderate the relationship between entrapment and suicidal ideation in patients with ovarian cancer.

METHODS

This was a cross-sectional investigation was conducted in 505 Chinese patients with ovarian cancer. Patients completed a battery of self-reported questionnaires that included the General Information Questionnaire, and Chinese versions of the Entrapment Scale, Scale for Suicidal Ideation, Suicide Resilience Inventory-25, and Meaning in Life Scale. Descriptive statistics, Pearson' s chi-square, Pearson' s correlation, and hierarchical multiple linear regression analysis were performed.

RESULTS

In this study, the prevalence of suicidal ideation reported by patients with ovarian cancer was 32.07%. Patients' suicidal ideation could be explained by the following three predictors: entrapment × suicide resilience × meaning in life (β = -0.169, p < 0.001), entrapment × suicide resilience (β = -0.148, p < 0.001), and entrapment × meaning in life (β = -0.107, p = 0.005).

CONCLUSION

These findings suggest that ovarian cancer patients are prone to suicidal ideation when they feel a sense of entrapment. Enhancing patients' suicide resilience and meaning in life may be two targeted interventions to reduce suicidal ideation in ovarian cancer patients. In particular, considering both the protective effects of suicide resilience and meaning in life may yield better suicide prevention outcomes than considering only one of these factors.

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.

Factors Affecting Inpatients' Mortality through Intentional Self-Harm at In-Hospitals in South Korea

This study aimed to identify the patient characteristics, comorbidities, risk factors, and means of the self-harm of patients who attempt self-harm in and outside of a hospital, and to determine the characteristics of death by suicide among survival and death patient groups in South Korea. This study used data from the Korean National Hospital Discharge In-depth Injury Survey conducted from 2007 to 2019. In total, 7192 outpatient participants and 43 inpatient participants performed self-harm. Frequency analysis, chi-square tests, Fisher's exact test, and logistic regression analysis were performed using STATA, version 15.0 (StataCorp), and statistical significance was set at 5%. Thirty-one inpatients who performed self-harm survived, and 12 died. Among male inpatients, the older they were, the higher the rates of self-harm and mortality rates due to falls and poisoning if they had comorbidities and financial problems. In addition, the rate of self-harm attempts within a short period after hospitalization was high. Our evidence of the characteristics of patients who performed self-harm in the hospital and the influencing factors of self-harm can be used as primary data for predicting patients at a high risk of self-harm and for creating preventative policies to reduce the risk of self-harm among inpatients in South Korea.

Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis

Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.

Suicide and women living with and beyond a breast cancer diagnosis

Early diagnosis and intervention, and the use of targeted cancer treatments, have significantly reduced mortality from breast cancer. Emotional distress following a diagnosis of cancer is a normal and anticipated, but it may manifest in some individuals at some point as a level of anxiety or depression that significantly affects quality of life and coping. In extreme cases, these feelings can move from physical symptoms of low energy and an inability to complete basic tasks to despair and hopelessness. Confronting a cancer diagnosis is a life-changing experience, bringing a sense of vulnerability. This may create or precipitate a crisis that threatens to overwhelm a person, resulting in a negative impact on established coping mechanisms. There appears to be a paucity of literature on suicide or suicide attempts by people living with and beyond a cancer diagnosis. A literature search identified 19 papers on suicide and or suicide ideation in patients who had had a cancer diagnosis, which were included in the review. Two clear themes emerged from the literature: that a cancer diagnosis with or without pre-existing mental health comorbidities is a risk factor for suicide; and that there is a significant incidence and prevalence of anxiety and depression in cancer patient populations. The literature identifies multiple variables that impact on prevalence of mental health disorders after a breast cancer diagnosis. Despite this, there appears to be a lack of guidance at national level for screening for mental health comorbidities in patients with a cancer diagnosis.

Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis

BACKGROUND

Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors.

METHODS

Patients aged 10 or above who received their first cancer-related hospital admission (2002-2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender.

RESULTS

In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender.

CONCLUSIONS

Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.

Suicidal ideation and attempted suicide among cancer patients during the COVID-19 pandemic

This study aimed to understand the suicidal ideation and suicidal attempts among cancer patients during the COVID-19 pandemic. The data were collected from patients diagnosed with cancer while attending the largest cancer center in the south of China. A structured questionnaire was used to investigate patients' demographic data, suicidal behavior, and factors related to COVID-19. Mental health conditions were measured by the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Brief Symptom Inventory. Comorbidities and medical conditions of cancer patients were extracted from the electronic healthcare records. Among the 5670 cancer patients, 755 (13.3%) reported suicidal ideation, and 266 (4.7%) reported suicidal attempts during the COVID-19 pandemic. The age group with the highest risk of suicidal ideation was 20-24 years (23.9%). Lifetime history of suffering from mental disorders, longer time since cancer diagnosis, regional and distant tumor stage, depression, anxiety, hostility, having a higher frequency of worrying about cancer management due to COVID-19, higher frequency feeling of overwhelming psychological pressure due to COVID-19, having a higher level of barriers to manage cancer due to COVID-19, and higher barriers to continue treatment of cancer due to inconveniences caused by COVID-19, were all significantly associated with increased risk of suicidal ideation. We also identified the risk factors of suicide attempts. This is the first study investigating the prevalence and risk factors associated with suicidal ideation and suicidal attempts in Chinese cancer patients during the COVID-19 pandemic. Our findings suggest that it is essential to monitor the mental health conditions of this vulnerable population, especially for cancer patients who have comorbidity with a history of mental disorders. Also, government policymakers should take action to protect cancer patients to avoid any interruption of their continued treatment. Further efforts are urgently required to develop specific psychological interventions to reduce the risk factors among cancer patients during the COVID-19 pandemic.

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

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

Suicidal ideation, attempt and associated factors among people living with cancer in Ethiopia: a cross-sectional study

BACKGROUND

Suicide and cancer are serious public health problems worldwide, and people living with cancer are at high risk of having suicidal behaviors, such as ideation, plan and attempt. Patients with cancer had high possibilities of having suicidal ideation and attempt which lead to poor adherence of medication, worsening of their medical illness, and end the life. Even though people are affected by cancer in Ethiopia, there are limited studies regarding suicidal problem among patients with cancer. Therefore, this study was aimed to assess the magnitude and associated factors of suicidal ideation and attempt among people living with cancer in Ethiopia.

METHODS

Institutional-based cross-sectional study was conducted among total of 416 participants. Outcome variables were assessed using suicidality module of World health organization (WHO) composite international diagnostic interview (CIDI). Data were analyzed using SPSS-20 and bivariate and multivariate logistic regressions were conducted and variables with P value less than 0.05 were considered as statistically significant with corresponding 95% CI.

RESULTS

The overall magnitude of suicidal ideation and attempt were 16.6% and 5.5%, respectively. Being divorced [(AOR = 2.97, (95% CI 1.22, 7.22)], having depression [(AOR = 2.67, (95%CI 1.34, 5.32)], the first 18 months, since diagnosed cancer [(AOR = 2.57, (95%CI 1.15, 5.75)], severe pain [(AOR = 3.27, (95%CI 1.18, 9.04)] and stage IV cancer [(AOR = 3.35, (95%CI 1.26, 9.04)] were significantly associated with suicidal Ideation. Whereas, female sex [(AOR = 5.32, (95%CI 1.39, 20.25)], having depression [(AOR = 4.8, (95%CI 1.23, 18)] and advanced stage of cancer [(AOR = 6.76, (95%CL 1.2, 37)] were significantly associated with suicidal attempt.

CONCLUSIONS

The magnitude of Suicidal ideation and attempt in this study were high. Health care providers working in cancer treatment unit should give more attention to patients with high suicidal risk factors. Consultation services should be strengthened with psychiatric professionals in oncology treatment clinic.

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.

Suicidal ideation, distress, and related factors in a population of cancer patients treated in a general acute hospital

Purpose

Suicidality and suicidal ideation (SI) in oncology has long been an underestimated danger. Although there are cancer-specific distress screening tools available, none of these specifically incorporates items for SI. We examined the prevalence of SI in cancer patients, investigated the relation between SI and distress, and tried to identify additional associated factors.

Methods

A cross-sectional study with patients treated for cancer in a primary care hospital was conducted. Psychosocial distress and SI in 226 patients was assessed. An expert rating scale (PO-Bado-SF) and a self-assessment instrument (QSC-R23) were used to measure distress. SI was assessed with item 9 of the PHQ-9. Data was descriptively analyzed, and correlations and group comparisons between clinically distressed and non-distressed patients were calculated.

Results

SI was reported by 15% of patients. Classified as clinically distressed were 24.8% (QSC-R23) to 36.7% (PO-Bado-SF). SI was correlated with externally (r_τ = 0.19, p < 0.001) and self-rated distress (r_τ = 0.31, p < 0.001). Symptoms sufficiently severe for at least a medium major depressive episode were recorded in 23.5% of patients (PHQ-9). Factors associated with SI were feeling bad about oneself, feeling down, depressed, and hopeless, deficits in activities of daily life, psycho-somatic afflictions, social restrictions, and restrictions in daily life. Being in a steady relationship seemed to have a protective effect.

Conclusions

SI is common in cancer patients. Distress and associated factors are increased in patients with SI. A distress screening with the ability to assess SI could be an important step in prevention, but more research is necessary.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06429-w.

Magnitude and Associated Factors of Suicidal Ideation Among Cancer Patients at Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia, 2019: Cross-sectional Study

Background

Suicide is a worldwide public health issue and considered as a psychiatric emergency. The majority of all completed suicides occur in low- and middle-income countries. A diagnosis of cancer has been associated with an increased risk of suicidal ideation and suicide is one of the leading causes of non-cancer-related mortality among cancer patients in recent years. Suicidal ideation is four times higher in cancer patients than in the general population. There is limited evidence on suicidal ideation on patients diagnosed with cancer in Ethiopia as well as in African countries.

Objective

To assess the magnitude and associated factors of suicide ideation among cancer patients at Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia, 2019.

Methods

An institution-based cross-sectional study was conducted from May 1 to 30, 2019. Systematic random sampling technique was used and a total of 410 of cancer patients participated in the study. Data were collected using the Suicide Manual of Composite International Diagnostic Interview (CIDI) questionnaire. Data were coded, entered into EpiData manager version 4.4 and analyzed using SPSS version 20. Descriptive, analytical statistical procedures, bivariable, multivariable logistic regression with odds ratio, 95% confidence interval were employed. The statistical significance was declared at P-value <0.05.

Results

The finding of the present study on magnitude of suicidal ideation among cancer patients were 28.5% with 95%CI: 24.1–33.2, respectively. In multivariable logistic regression analysis being female advanced stage, perceived stigma and anxiety was significantly associated with suicidal ideation.

Conclusion and Recommendation

The magnitude of suicidal ideation among cancer patients was higher than in the general population. It also reported that, advanced stage, perceived stigma, anxiety and being female were factors significantly associated with suicidal ideation. This study gives us clues that cancer patients are prone to suicide ideation. Therefore, cancer patients need special attention to reduce these problems.

Characteristics of cancer patients who died by suicide: A quantitative study of 15-year coronial records

OBJECTIVE

Cancer patients have elevated suicide risk compared to the general population. However, little is known about the characteristics of cancer patients who have died by suicide. The objectives of the study were to compare the characteristics of suicide cases with, and without cancer, and determine whether age was associated with differences in characteristics.

METHODS

A total of 14,446 suicide cases between 2003 and 2017 in Hong Kong were identified using Coroner's Court reports. Cases were grouped by cancer status, based on medical history in the reports. Information extracted from the reports included sociodemographic variables and detailed descriptions of the suicide event. Univariate analyses and overall and subgroup multiple logistic regressions were performed to compare characteristics between the two groups.

RESULTS

Of the 14,446 suicide cases, 1,461 (10.11%) had a cancer history. Compared to noncancer cases, cancer patients were generally older and less likely to live alone; more likely to use violent methods; less likely to have histories of physical and psychiatric problems; and more likely to communicate about their suicidal intent before death. Age was significantly associated with differences between cancer and noncancer cases.

CONCLUSIONS

Cancer suicide cases have different characteristics from noncancer cases. Mental health screening may not be sufficient for suicide prevention among cancer patients. Healthcare professionals and caregivers should be aware of cancer patients' suicide risk, even when there are no signs of psychiatric disturbance.

Ketamine as augmentation for the treatment of major depression and suicidal risk in advanced cancer: Case report

OBJECTIVE

Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk.

METHOD

We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.

RESULT

A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.

SIGNIFICANCE OF RESULTS

This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.

Association between social support and suicidal ideation in patients with cancer: A systematic review and meta-analysis

OBJECTIVE

To quantitatively examine the relationship between social support and suicidal ideation (SI) among patients with cancer and identify the moderators that influence the magnitude of this association.

METHODS

Publications were searched in PubMed, PsycINFO, EMBASE, Cochrane Library and Chinese National Knowledge Infrastructure from database inception to May, 2020. Correlation coefficients (r) were chosen as the effect size with a random model to evaluate the overall effect size between social support and SI in patients with cancer. To assess statistical heterogeneity, we examined potential moderator variables on the social support and SI.

RESULTS

A total of 881 studies were identified in initial search, and twelve studies were eligible. A negative, small but significant correlation (r = -0.22, 95% CIs: -0.30,-0.14, p < 0.001) was observed between social support and SI in patients with cancer, with a significant heterogeneity (I²  = 95.24%, Q = 231.27, p < 0.001). Moderator analyses indicated that race/ethnicity (Q(1) = 8.4, p < 0.05) and measurements of social support (Q(3) = 9.78, p < 0.05) and SI (Q(3) = 9.69, p < 0.05) significantly moderate the effect size between social support and SI.

CONCLUSION

Taken together, we found a negative yet significant association between social support and SI in patients with cancer, which supported the importance of social support for the prevention of SI in patients with cancer.

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.

Incidence of suicide death in patients with cancer: A systematic review and meta-analysis

BACKGROUND

Growing evidence indicated the higher risk of suicide in cancer survivors compared with general population. Our aim is to systematically quantify the extent of suicide death and identify risk factors associated with the incidence of suicide in cancer patients.

METHODS

We conducted a meta-analysis of relevant studies published in English or Chinese before May 20, 2020. Suicide rate and the number of suicide death were extracted. Our main outcome was suicide rate per 100,000 person-years with 95% CIs using random-effects model.

RESULTS

The pooled incidence of suicide death was 39.72 per 100,000 person-years (95%CI, 33.91-46.52, I ²= 99.6%, P <0 .001). The suicide rate for cancer patients was higher in men (57.78, 95%CI, 47.31-70.56) than in women (14.47, 95%CI, 11.27-18.57). For both sexes combined, esophagus cancer had the highest rate of suicide (87.71, 95%CI, 27.42-280.54). By sex, suicide rates ranked first in males and females were pancreas cancer (195.70, 95%CI, 129.55-295.61) and esophagus cancer (18.34, 95%CI, 5.92-56.84), respectively. The highest suicide rate was 61.02(95%CI, 53.66-69.40) in Asia, and Oceania (24.07, 95%CI, 20.78-27.88) had lowest suicide rate. Suicide rate had a downward trend by years after diagnosis, with the first six months after cancer diagnosis clearly standing out (89.33, 95%CI, 50.64-157.58).

LIMITATIONS

Included studies came from high-income countries and our results might not represent the suicide rate among cancer patients in low- and middle-income countries.

CONCLUSIONS

The incidence of suicide among cancer patients was high despite the declined trend recent years, which emphasized psychological health aspects of interventions and perfecting suicide prevention programs.

Serial multiple mediation of demoralization and depression in the relationship between hopelessness and suicidal ideation

OBJECTIVE

Suicidal ideation is common in cancer patients and may be associated with hopelessness, demoralization, and depression. This study aims to investigate the serial multiple mediation of demoralization and depression in the relationship between hopelessness and suicidal ideation in cancer patients.

METHODS

A total of 244 cancer patients were investigated by using the following standardized self-reported questionnaires: self-rating idea of suicide scale, Beck hopelessness scale, demoralization scale-Mandarin version, and patient health questionnaire depression scale-9. The mediation hypothesis was tested with a serial multiple mediation model (PROCESS model 6). An exploratory graph analysis was performed to detect the correlations among the dimensions of the mental conditions measured by these instruments.

RESULTS

Bootstrap analyzes indicate that there were direct and indirect effects of hopelessness on suicidal ideation mediated solely by demoralization (B = 2.3074, SE = 0.1724, P < .001) or by demoralization together with depression (B = 0.1605, SE = 0.0303, 95% confidence interval [CI] = 0.1102 to 0.2303). The mediation of depression alone in the relationship between hopelessness and suicidal ideation was insignificant (B = 0.1541, SE = 0.0519, 95% CI = -0.0565 to 0.0715). The exploratory graph analysis suggests that the strongest edge of dimensions between demoralization and suicidal ideation was desperation-disheartenment (0.62).

CONCLUSIONS

The results of the study support the hypothesis that demoralization and depression mediate between hopelessness and suicidal ideation. The early identification of and interventions for hopelessness, demoralization, and depression may prevent cancer patients from developing suicidal ideation.

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.

Suicidal Ideation among Veterans Living with Cancer Referred to Mental Health

Objectives: Eliminating Veteran suicide is a top priority for the Department of Veterans' Affairs (VA). This study identified factors associated with suicidal ideation (SI) among a rarely studied subgroup of Veterans: those with cancer.Methods: Veterans (age M = 61.83) with cancer (N= 175) referred for psychological evaluation completed measures of pain, sleep, depressive, anxiety, and PTSD symptoms. SI was defined by endorsing on paper-and-pencil questionnaire thoughts of killing oneself in the past 2 weeks or during clinical interview.Results: 25.1% reported SI. Compared to those without SI, Veterans with SI had higher ratings on measures of depression, anxiety, and PTSD symptoms. History of suicide attempt(s) was included in the model due to clinical significance. Logistic regression was performed with these variables as predictors of SI. The omnibus model was significant (p< .001). However, only anhedonia and depressed mood had a statistically significant contribution to the model (β = 0.540, p= .001).Conclusions: Anhedonia and depressed mood predicted SI among Veterans with cancer above and beyond other risk factors.Clinical Implications: This study's findings highlight the importance of incorporating suicide risk screenings in oncology clinics across VA medical centers.

Suicidal Ideation in Newly-Diagnosed Chinese Cancer Patients

OBJECTIVE

Suicide is one of the main reasons cited behind the death rate of cancer, and suicidal ideation (SI) is the first step toward it. This study aimed to investigate the prevalence and associates of suicidal ideation in newly-diagnosed Chinese cancer patients.

METHODS

This multicenter study was conducted from January 2018 to September 2019. Eligible participants were asked to complete a Case Record Form (CRF), the Patient Health Questionnaire (PHQ-9), General Anxiety Disorder Questionnaire (GAD-7), Fear of Cancer Recurrence Questionnaire (FCRQ-7), and McGill Pain Questionnaire-Visual Analogue Scale (MPQ-VAS). Univariate analyses and multivariate logistic regression analyses were conducted for assessment.

RESULTS

Out of 603 patients, 91 (15.1%, 95%CI: 12.23%-17.96%) reported suicidal ideation in the last 2 weeks. Physical comorbidities (OR=1.808, P=0.039), childhood adversity experience (OR=5.999, P=0.001), cancer pain (OR=1.828, P=0.047), depression (OR=2.811, P=0.013), and anxiety (OR=6.532, P<0.001) were significantly associated with suicidal ideation. It was also found that patients who regularly exercised were less likely to report suicidal thoughts (OR=0.172, P=0.007).

CONCLUSION

Physical comorbidities, body ache, and mood disturbances are possible risk factors for suicidal ideation that warrant further attention in clinical practice. Preventive measures, such as systematic screening and arrangement for regular check-ups, could be beneficial to lower the risk of suicide.

Interventions for Reducing Suicide Risk in Cancer Patients: A Literature Review

The suicide risk of people diagnosed with cancer is two times higher than the general population. The number of cases of diagnosed cancer is estimated to rise by 70% over the next two decades. Evidence-based prevention strategies are necessary to protect this vulnerable group of individuals. The purpose of this review was to find out the risk factors of suicide and which types of interventions can serve as prevention strategies. Psychosocial interventions, pharmacotherapy and physical activity can play a preventive role in reducing psychosocial and physical risk factors, such as mental disorders, poor social support, poor performance status and pain. Further research is needed to develop effective suicide prevention strategies for cancer patients.

The desire to hasten death in advanced cancer patients at a Mexican palliative care service

Introduction. The desire to hasten death (DHD) might be present in patients with advanced cancer. Multiple distressing physical and psychosocial symptoms may be related to it. There is limited literature about the characteristics of these patients in México. Objective. To describe the prevalence and factors associated with DHD in advanced cancer patients evaluated by a palliative care psychiatrist. Method. We conducted a cross-sectional study, including all patients referred to psychiatric assessment at the Servicio de Cuidados Paliativos of the Instituto Nacional de Cancerología in Mexico City, from January to December 2016. DHD was defined as the presence of death ideas, suicidal ideation, and/or request for euthanasia or medically assisted suicide. Patients with delirium, dementia, psychosis, or uncontrolled physical symptoms were excluded. Results. Sixty-four patients were included in the study. Most of them were women (59%); the mean age was 49 years old (SD = 16). Of them, 64% met criteria for a major depressive disorder, 64% for generalized anxiety disorder and/or panic disorder, and 11% for substance use disorders. 44% expressed DHD. In a multivariate regression analysis predicting DHD, only one factor emerged: clinical depression (OR = 13.5, p = .002, 95% CI [02.562, 71.726]). Discussion and conclusion. The desire to hasten death is a frequent issue for the patients evaluated at the psychiatric palliative care clinic. Depression and other distressing psychiatric pathologies were associated with DHD. Interdisciplinary interventions are needed to treat DHD. More research is warranted in order to understand the factors associated with the expression of DHD.

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.

Psychometric Properties of the Short Form of the Fear of Cancer Recurrence Inventory (FCRI) in Chinese Breast Cancer Survivors

Objective: Currently, fear of cancer recurrence (FCR) is emerging as an important issue for long-term breast cancer survivors and is associated with lower quality of life and functional impairment. Given that there is a dearth of research regarding the FCR of Chinese breast cancer survivors, this study investigated whether the short form of the Fear of Cancer Recurrence Inventory (FCRI) could detect high FCR and explored the level and characteristics of FCR in breast cancer survivors. Methods: Two hundred forty patients who had undergone successful breast cancer surgery in China submitted their survey through a website. The participants' demographic and medical data, level of FCR, anxiety, depression, and quality of life were assessed. Results: Two hundred seven patients with ages ranging from 19 to 60 years completed the questionnaires. The mean FCR score of the total sample was 18.39. A cutoff score of 12 or higher on the short form of the FCRI was optimal for the detection of high FCR with a sensitivity of 98.6% and a specificity of 35%, and the PPV (positive predictive values) and NPV (negative predictive values) were 44% and 98%, respectively. The area under the curve of the receiver operating characteristics (ROC) analysis was 83%. A total of 159 breast cancer survivors (76.81%) experienced high FCR levels (FCR score > 12), characterized by lower functional and overall health than survivors with a low FCR (P < 0.01). Conclusions: The short form of the FCRI is capable of detecting high FCR and is therefore able to assist Chinese breast cancer survivors in receiving appropriate care for reducing FCR.

Sexual life satisfaction of methadone-maintained Chinese patients: individuals with pain are dissatisfied with their sex lives

Purpose

Pain is potentially associated with sexual dysfunction. Both sexual dysfunction and pain are common in methadone-maintained patients, but the association of pain with sexual dysfunction in methadone-maintained patients is rarely studied. This study examined the association between pain and sexual life satisfaction (SLS) in Chinese patients receiving methadone maintenance treatment (MMT).

Patients and methods

A total of 477 methadone-maintained patients who recently had sex with their sex partners were recruited from three MMT clinics in Wuhan, China. SLS was assessed with a single question, and the sociodemographic, psychological, and clinical data were collected with standardized questionnaires. Pain intensity was assessed with the 5-point verbal rating scale. Multiple ordinary logistic regression was used to control for potential confounders that may bias the pain–SLS relationship.

Results

The prevalence of self-reported dissatisfaction with one’s sexual life was significantly higher in patients with clinically significant pain (CSP) than those without CSP (41.5% vs 19.4%, χ² =23.567, P<0.001). After controlling for potential sociodemographic, psychological, and clinical confounders, CSP was still significantly and independently associated with an increase in sexual life dissatisfaction (OR =1.89, P=0.011).

Conclusion

Pain is significantly associated with low SLS in methadone-maintained patients. Appropriate pain management might improve SLS of patients receiving MMT.

Cancer and suicidal ideation and behaviours: protocol for a systematic review and meta-analysis

INTRODUCTION

Prevalence of suicidal ideation (SI) and behaviours are higher among patients with cancer than general population. No systematic review/meta-analysis investigated this topic; therefore, our aim will be to assess the relationship between cancer and SI and behaviours.

METHODS

We will search PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, PsycINFO and Cochrane Library databases from their inception until 30 June 2018. Case-control and cohort studies focused on the association between cancer (any type) and suicidal outcomes (suicide, suicide attempt and SI) will be included. Two team members will independently: (A) perform the selection of the included studies and data extraction, with the supervision of a third member in case of discrepancies and (B) assess each study with: (1) Newcastle-Ottawa Scale (NOS); (2) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement; (3) Grading of Recommendations Assessment, Development and Evaluation (GRADE). We will conduct a random-effects meta-analysis. Individual and pooled ORs and associated 95% CIs will be calculated as well as between-study heterogeneity. We will examine the potential for publication bias. If possible, we will explore reasons for potential between-study heterogeneity.

ETHICS AND DISSEMINATION

This study does not require ethical approval. The study will be submitted to a peer-reviewed journal, will be publicly disseminated and will be the topic of research presentations.

PROSPERO REGISTRATION NUMBER

CRD42017072482.

Steviol, a natural product inhibits proliferation of the gastrointestinal cancer cells intensively

New anticancer agents with lower toxicity have been always urged because of drug resistance associated with overused chemotherapy agents. In this study, steviol, a colonic metabolite of natural sweetener and also a component in leaves of stevia rebaudiana bertoni, was found to possess intensive anticancer activity on the human gastrointestinal cancer cells. Steviol inhibited six human gastrointestinal cancer cells intensively as 5-fluorouracil did at 100 μg/mL. The inhibition mechanism follows mitochondrial apoptotic pathway that was evidenced by increase of Bax/Bcl-2 ratio, activation of p21 and p53; and caspase 3-independent mechanism was also involved. These results are consistent with the miRNA expression analysis. The most regulated miRNAs in the steviol treated gastrointestinal cancer cells were miR-203a-3p (log2 =1.32) and miR-6088 (log2 =-2.54) in HCT-116, miR-1268b (log2 =19.85) and miR-23c (log2 =-2.05) in MKN-45. In view of the metabolic characteristics of steviol and its cytotoxicity on the cancer cells, steviol could be a chemotherapy agent potentially for cancer treatment.

Health-related quality of life in Chinese inpatients with lung cancer treatedin large general hospitals: across-sectional study

OBJECTIVE

In China, psychosocial problems of patients with cancer are under-recognised and undertreated in medical oncology practice. This study examined the health-related quality of life (QOL) in inpatients with lung cancer treated in large general hospitals and explored the demographic, clinical and psychosocial factors associated with QOL.

DESIGN

Cross-sectional study.

PARTICIPANTS AND SETTING

Altogether, 148 inpatients with lung cancer were consecutively recruited from two large general hospitals in Tianjin, China.

MAIN OUTCOME MEASURED

QOL, pain intensity, depressive and anxiety symptoms, and social support were assessed with WHO QOL Scale Brief Version, four-point Verbal Rating Scale, Hospital Anxiety and Depression Scale and Social Support Rating Scale, respectively.

RESULTS

Compared with the normative data for the Chinese general population, patients had significantly lower scores in physical (t=-25.860, p<0.001) and psychological (t=-18.225, p<0.001) QOL. Being unmarried (β=-2.471, 95% CI -4.908 to -0.034), poor economic status (β=-1.764, 95% CI -2.964 to -0.564), cancer metastasis (β=-1.328, 95% CI -2.632 to -0.024), poor performance status (β=-0.959, 95% CI -1.542 to -0.376), depression (β=-0.465, 95% CI -0.631 to -0.299), anxiety (β=-0.208, 95% CI -0.354 to -0.062) and low utilisation of social support (β=-0.344, 95% CI -0.577 to -0.111) were independently associated with poor physical QOL, while female gender (β=-1.494, 95% CI -0.649 to -2.339), less education years (β=-0.209, 95% CI -0.294 to -0.123), currently receiving chemotherapy (β=-1.536, 95% CI -3.051 to -0.021), small-cell cancer (β=-1.157, 95% CI -2.223 to -0.091), more intense pain (β=-0.535, 95% CI -0.919 to -0.151), poor performance status (β=-0.930, 95% CI -1.383 to -0.477), anxiety (β=-0.178, 95% CI -0.248 to -0.108) and inadequate subjective social support (β=-0.137, 95% CI -0.153 to -0.121) were independently associated with poor psychological QOL.

CONCLUSIONS

Inpatients with lung cancer treated in Chinese large general hospitals have poorer QOL than the general population. Effective prevention and management of psychosocial problems are potentially effective to improve their QOL.

Depression and its impact on health-related quality of life among Chinese inpatients with lung cancer

Depression is of great concern for patients with cancer. A detailed epidemiological profile of depression in Chinese patients with lung cancer and whether depression impacts patients’ health-related quality of life (HRQOL) remain unknown. This study examined the prevalence and socio-demographic and clinical correlates of depression and its effect on HRQOL in Chinese inpatients with lung cancer of two large general hospitals. A total of 148 inpatients were consecutively recruited, and administered with a standardized questionnaire to collect socio-demographic and clinical data. Depression and HRQOL were assessed with the Hospital Anxiety and Depression Scale and World Health Organization QOL Scale Brief Version, respectively. As high as 43.2% Chinese inpatients with lung cancer had clinically significant depressive symptoms. Multiple logistic regression found that depression was significantly associated with moderate-to-severe pain (OR: 4.43), metastatic cancer (OR: 3.63), a short duration after cancer diagnosis (OR: 1.04), poor performance status (OR: 3.41), and small-cell cancer (OR: 4.52). Depressed patients had significantly poorer HRQOL than not depressed patients in terms of all four domains of HRQOL. After controlling for the potential confounding effects of socio-demographic and clinical factors with analysis of covariance, these group-differences in physical (F = 29.074, P < 0.001), psychological (F = 76.869, P < 0.001), social (F = 21.465, P < 0.001), and environmental (F = 27.685, P < 0.001) HRQOL remained statistically significant. Depression is prevalent in inpatients with lung cancer and independently associated with poor HRQOL. To address this serious issue, effective pain management, psycho-oncology services and, when necessary, psychiatric assessment and treatment, should be routinely provided in oncology departments of Chinese general hospitals.

Suicidal ideation among Chinese methadone-maintained patients: prevalence and correlates

Heroin users are at high risk for suicide. However, the epidemiological profile of suicidal behaviors in Chinese methadone-maintained patients remains largely unknown. This study determined the prevalence and correlates of suicidal ideation among Chinese methadone-maintained patients. A total of 603 methadone-maintained patients were consecutively recruited from three methadone maintenance treatment (MMT) clinics in Wuhan, China, and administered with standardized questionnaires to collect sociodemographic, clinical, and psychological data. Suicidal ideation was measured with a single self-report question “Have you ever thought about committing suicide?”. Depression and anxiety were assessed with Zung’s Self-rating Depression Scale and Zung’s Self-rating Anxiety Scale, respectively. The one-month and lifetime prevalence rates of suicidal ideation were 17.9% and 58.9%, respectively. In multiple logistic regression, lifetime suicidal ideation was significantly associated with female (OR: 1.69), an educational attainment of primary school and below (OR: 1.47), fair and poor interpersonal relationship (OR: 2.20), a history of injecting heroin (OR: 1.60), depression (OR: 1.38), and anxiety (OR: 4.00). Methadone-maintained patients of MMT clinics have a high prevalence of suicidal ideation and therefore at high risk for suicide. Suicide prevention efforts at MMT clinics should include periodic evaluation of suicidality, psychosocial supports, and, when necessary, psychiatric treatment and crisis intervention.

The synergistic effect of dual use of amphetamine-type stimulants and ketamine on drug-induced psychotic symptoms in Chinese synthetic drug users

The use of amphetamine-type stimulants (ATS) and ketamine is of particular clinical concern because of its associated psychotic symptoms. In Chinese clinical practice, ATS and ketamine are commonly used simultaneously, but very few studies have reported the symptom profile of users who use both drugs. This study determined whether the combined use of ATS and ketamine is associated with more psychotic symptoms than either ATS or ketamine alone. According to drug use characteristics, 375 Chinese synthetic drug users were categorized into 2 pairs of comparison groups: ATS-only (n=125) vs. ATS-mainly (ATS most of the time and ketamine sometimes, n=150) and ketamine-only (n=38) vs. ketamine-mainly (ketamine most of the time and ATS sometimes, n=62). We used the Chinese Brief Psychiatric Rating Scale (BPRS) to assess these patients’ psychotic symptoms. ATS-mainly group had more anxiety/depression and anergia symptoms than ATS-only group (p<0.001), and ketamine-mainly group had more thinking-disorder, activity and hostility-suspicion symptoms than ketamine-only group (p≤0.001). These findings indicate that ATS may exacerbate the thinking-disorders, activity and hostility-suspicion symptoms of ketamine users, and ketamine may exacerbate anxiety/depression and anergia symptoms of ATS users.

Prevalence of pain and its socio-demographic and clinical correlates among heroin-dependent patients receiving methadone maintenance treatment

To date there have been no studies investigating the characteristics of pain in Chinese heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT). This study examined the frequency and socio-demographic and clinical correlates of pain in HDPs under MMT. A consecutive sample of 603 HDPs was recruited from three MMT clinics in Wuhan, China. These patients completed a standardized questionnaire concerning socio-demographic and clinical data. Pain intensity was assessed with the 5-point Verbal Rating Scale (“Overall, how intense is your pain now?”) with responses of: 1 = none, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe. A pain score of three or higher was used to denote clinical significant pain (CSP). The prevalence of CSP in HDPs receiving MMT was 53.6%. Factors significantly associated CSP in multiple logistics regression analysis were old age, marital status of “non-married”, unemployment, having religious beliefs, a history of injecting heroin, a high dose of methadone, and more depressive symptoms. Over a half of Chinese HDPs receiving MMT have CSP. Services for HDPs in MMT settings should include periodic screening for pain, psychosocial supports, and professional treatment for pain.

Significantly more intense pain in methadone-maintained patients who are addicted to nicotine

Pain and cigarette smoking are very common in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT) and both have substantial negative effects on HDPs' physical and mental health. Nevertheless, very few studies have assessed the relationship between the two in HDPs. This study examined the association between pain intensity and smoking in Chinese methadone-maintained HDPs. A total of 603 HDPs were consecutively recruited from three MMT clinics in Wuhan, China, and administered with a socio-demographic and drug use questionnaire, a smoking questionnaire concerning average number of cigarettes smoked daily and Heaviness of Smoking Index, and Zung's Self-rating Depression Scale. We used a five-point Verbal Rating Scale to rate the intensity of pain. To determine whether pain's associations with smoking and nicotine dependence were independent, an analysis of covariance was adopted to control for the potential confounding effects of socio-demographic variables, drug use characteristics, and depressive symptoms. Net of potential confounders, in methadone-maintained HDPs, pain intensity was significantly higher in smoker than non-smokers (F = 11.836, P = 0.002) but the pain intensity did not differ significantly across patients with various levels of cigarette consumption (F = 1.992, P = 0.137), while the pain intensity significantly differed across patients with different levels of nicotine dependence (F = 3.252, P = 0.013). Pain is significantly associated with smoking in HDPs receiving MMT, this phenomenon may be explained by the association between nicotine dependence and pain.

Sexual life satisfaction and its associated socio-demographic and workplace factors among Chinese female nurses of tertiary general hospitals

Adverse workplace factors such as job stress are reported to be associated with poor physical and mental health of nurses. However, associations between occupational factors and sexual life satisfaction (SLS) of nurses remain understudied. This study investigated SLS of Chinese female nurses of tertiary general hospitals and socio-demographic and occupational factors associated with reduced SLS of nurses. In this cross-sectional survey, 393 Chinese female nurses of four tertiary general hospitals completed a standardized socio-demographic and occupational characteristics questionnaire, Zung's Self-rating Scale for Depression, Job Content Questionnaire, and a self-report SLS question. Multiple ordinal logistic regression was used to identify factors related to reduced SLS. Fourteen point five percent female nurses were dissatisfied with their current sex lives. In multiple regression, related factors for decreased SLS included being unmarried (OR = 1.49), shift work (OR = 1.92), contract employment (OR = 1.63), high job demands (OR = 2.21), low job control (OR = 1.88), inadequate social support (OR = 2.32), and depression (OR = 3.14). Chinese female nurses of tertiary general hospitals have poor SLS. Reducing job stress and providing psycho-social support may help improve SLS of nurses.