Suicidal ideation in advanced cancer patients without major depressive disorder

Abstract

Introduction Major depressive disorder (MDD) is associated with an increased risk of suicide and suicide attempt among cancer patients. However, we do not know how many cancer patients without MDD have suicidal ideation (SI). Objectives This study aimed to investigate the prevalence, characteristics and correlated factors of SI among advanced cancer patients without MDD. Methods This is a multi‐center, cross‐sectional study based on an electronic patient‐reported outcome systems in patients who were diagnosed with advanced lung, liver, gastric, esophageal, colorectal or breast cancer, the top six prevalent cancers in China. A total of 2930 advanced cancer patients were recruited from 10 regional representative cancer centers across China from August 2019 to December 2020. Patients completed the Patient Health Questionnaire‐9 regarding if they had thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Patients also completed the symptom inventory and quality of life assessment. Generalized estimating equation model was performed to explore the correlated factors associated with SI among the patients without MDD. Results The overall prevalence of SI among advanced cancer patients without MDD was 13.1%. The prevalence was higher in older patients. After adjusted for existing conditions, patients with vomiting symptom (p < 0.001), poorer life quality (p < 0.001), and middle education level (p = 0.031) were correlated factors of SI. Conclusions The suicidal ideation is common in advanced cancer patients without MDD. Patients with vomiting, poor quality of life, and middle education level should be screened and monitored for suicidal ideation even without MDD. Clinical Trial Information ChiCTR1900024957.

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

“…And in community, it is imperative to engage in frequent visitations and communication, or organize community activities aimed at enhancing their social functioning, maintaining social roles, and fostering a sense of worthiness. Patients with higher levels of education or living in urban were more involved in treatment decisions, had more access to disease information, and had adequate communication with their physicians ( Tang et al, 2022 ). On the contrary, in low educated patients or patients living in rural, treatment decisions were mostly made by family members, and even some of these patients did not have a complete understanding of their condition.…”

“…The treatment cycle is long, the cost is high, and the side effects are obvious, such as vomiting, changes in appearance and sleep disorders ( Choi et al, 2014 ). Vomiting may cause the patient to feel a loss of appetite, resulting in insufficient daily energy intake to cope with daily life and treatment, which may fall into a vicious cycle, loss of confidence in life and even suicidal ideation ( Tang et al, 2022 ). Cancer patients who experience no or mild pain tend to have reduced psychological distress and an enhanced quality of life.…”

“…According to the cumulative evidence, several studies have reported a range of risk factors for suicidal ideation in cancer patients. For example, general demographic risk factors include age ( Akechi et al, 2000 ; Walker et al, 2008 ; Ernst et al, 2022 ), gender ( Hagezom et al, 2021 ; Ma et al, 2022 ; Tang et al, 2022 ), religion ( Spencer et al, 2012 ; Trevino et al, 2014b ), education level ( Zhou et al, 2020 ; Tang et al, 2022 ) and so on. The disease-related factors included pain ( Akechi et al, 2002 ; Walker et al, 2008 ; Tang et al, 2016 ), cancer stage ( Hagezom et al, 2021 ; Yu et al, 2023 ) and time since diagnosis ( Zhou et al, 2020 ; Yu et al, 2023 ).…”

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

“…However, only a few studies have focused specifically on the incidence of suicide among breast cancer patients in China, as the general consensus has been that addressing depression fully mitigates suicidal tendencies in cancer patients. In a multicentre cross-sectional study, a noteworthy degree of suicidal ideation was recognised in advanced cancer patients without MDD [ 19 ]. This finding indicates that we should not limit the attention placed on suicidal ideation to individuals with major depressive disorder.…”

Comprehensive analysis of Major depression Related gene Signature for predicting prognosis in lung adenocarcinoma

“…In addition, due to the need for continuous care and monitoring, cancer patients must make and maintain important changes in their lifestyle and life plans, which may be related to stress and continuous negative emotions [15] . Finally, due to the extremely poor prognosis and extremely low survival rate, LUAD patients are usually accompanied by persistent fear of cancer, which may lead to pathological anxiety, depression attacks, and signi cant uctuations in the survivors' motivation to continue to manage their own health [16,17] . With the increasing research of mental stress and depression on the occurrence and progress of cancer, MDD is considered an independent predictor of increased mortality in many cancers [18] .…”