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

Abstract

PurposeThis study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention.MethodsPurposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3.ResultsTobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t = 2.84, p < 0.01). When PHQ-9 ≥ 10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77–0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively.ConclusionsDemoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.

Suicidal ideation, depression, and health-related quality of life in patients with benign and malignant brain tumors: a prospective observational study in 83 patients

“…Similar rates were observed by others in cancer patients (e.g., prostate, breast, lung) [13,22,35]. The percentage / assessment reported here is comparable.…”

Suicide and accidental deaths among patients with non‐metastatic prostate cancer

“…While substantial research has shown a relatively higher risk of suicidal death in patients with prostate cancer compared with the 'cancer-free' population [5,12,22], to our knowledge we present the first report directly comparing the risk of suicidal death in men with prostate cancer to those with other solid cancers. Higher burden of psychiatric illnesses has been documented in patients diagnosed with cancer (regardless of the anatomical site involved) compared with the cancer-free population [4]. By using patients with other cancers as a comparison group, we attempted to mitigate the confounding impact of psychiatric disorders (and other pre-existing comorbidities) amongst patients with cancer in determining suicide risk, potentially allowing more direct association of prostate cancer with suicidal mortality.…”

“…In this regard, we observed parallel trends in suicidal and accidental death in men with prostate cancer, a novel finding of the study. Possible hypotheses to explain the link between suicide and death due to accidental injuries include mental distress [4,29], increased likelihood of physical illnesses such as cardiovascular events [5,22], and worsening of social and physical function secondary to cancer diagnosis, all of which may drive the risk of accidental death in patients with cancer. Additionally, some suicides may be misclassified as deaths of undetermined intent [17,43] or unintentional poisoning mortality [18] in registry or claims-based data, potentially inflating the incidence of accidental death.…”

“…Important contributory factors include anxiety associated with a recent diagnosis of cancer [7], presence of comorbidities [8] or pre-existing psychosocial conditions [4,9], and inferior quality of life from adverse effects of treatment [7,10]. Studies have also shown a higher incidence of mental health illnesses (including depression and anxiety) [11] and suicidal deaths in men diagnosed with prostate cancer [12], even amongst those harbouring low-risk disease [13].…”

“…Suicide rates are consistently higher in the population afflicted with cancer, for both solid [1][2][3][4][5] and haematological malignancies [6]. Important contributory factors include anxiety associated with a recent diagnosis of cancer [7], presence of comorbidities [8] or pre-existing psychosocial conditions [4,9], and inferior quality of life from adverse effects of treatment [7,10].…”