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Du J, Zhang F, Zheng W, Lu X, Yu H, Zeng J, Chen S. Quantifying Suicide Risk in Prostate Cancer: A SEER-Based Predictive Model. J Epidemiol Glob Health 2025; 15:46. [PMID: 40111711 PMCID: PMC11925820 DOI: 10.1007/s44197-025-00384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 02/26/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Prostate cancer patients have a significantly higher risk of suicide compared to the general population. This study aimed to develop a nomogram for identifying high-risk patients and providing empirical evidence to guide effective intervention strategies. METHODS We analyzed data from 176,730 prostate cancer patients diagnosed between 2004 and 2021, sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly allocated to training (n = 123,711) and validation (n = 53,019) cohorts in a 7:3 ratio. Feature selection was conducted using the Least Absolute Shrinkage and Selection Operator (LASSO), followed by model construction with Cox proportional hazards regression. The results were visualized using nomogram. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, concordance index (C-index), and internal validation. RESULTS Multivariate analysis identified seven independent predictors of suicide. The nomogram demonstrated favorable discriminative capability in both cohorts, with C-index of 0.746 and 0.703 for the training and bootstrapped validation cohorts. Time-dependent ROC analysis indicated strong accuracy in predicting suicide risk. Calibration plots displayed high concordance between predicted probabilities and actual outcomes, Kaplan-Meier analysis confirmed the model's significant discriminative ability among risk groups. LIMITATIONS This retrospective study, based on SEER data, lacks detailed clinical and mental health information. Additionally, potential coding errors and reporting biases may affect the accuracy of the results. CONCLUSION We developed a applicable nomogram for the individualized quantification of suicide risk in prostate cancer patients. This model provides clinicians with a robust tool for identifying high-risk patients and implementing timely interventions.
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Affiliation(s)
- Jiaxing Du
- Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Fen Zhang
- Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Weinan Zheng
- Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Xue Lu
- Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Huiyi Yu
- Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Jian Zeng
- Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Sujun Chen
- Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China.
- Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China.
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Tang WZ, Cheng SL, Mangantig E, Yulita Hanum PI, Jia K, Yusuf A. Factors correlated with demoralization among cancer patients: A systematic review and meta-analysis. Palliat Support Care 2025; 23:e16. [PMID: 39831587 DOI: 10.1017/s1478951524001597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
OBJECTIVES Demoralization isa common psychological problem in cancer patients. The purpose of this study is to systematically evaluate the correlated factors of demoralization among cancer patients. We also summarized the available evidence, effect estimates, and the strength of statistical associations between demoralization and its associated factors. METHODS We systematically searched PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, PsycINFO, and 2 electronic databases to identify studies published up to October 2023 with data on the correlates of demoralization. Two researchers independently reviewed references, extracted data, and assessed data quality. Meta-analysis was performed using R4.1.1 software. RESULTS Thirty-eight studies were included in this meta-analysis. For the most studied sociodemographic correlates, demoralization was negatively correlated with income (z = -0.29, 95% CI: -0.51, -0.02), education (z = - 0.11, 95% CI: - 0.16, -0.05), and age (z = -0.45, 95%CI: -0.75, -0.01). For the most studied clinical correlates, demoralization was positively correlated with symptom burden (z = 0.37, 95% CI: 0.22, 0.50) and negatively correlated with quality of life (z = -0.40, 95% CI: -0.54, -0.24). For the most studied psychosocial correlates, demoralization was negatively correlated with social support (z = -0.39, 95% CI: -0.51, -0.26) and positively correlated with anxiety (z = 0.65, 95% CI: 0.56, 0.73), depression (z = 0.61, 95% CI: 0.54, 0.67), and suicidal ideation (z = 0.48, 95% CI: 0.34, 0.60). SIGNIFICANCE OF RESULTS Demoralization showed either positive or negative associations with sociodemographic, clinical, and psychological variables. More research is needed to explore the underlying mechanisms to develop effective interventions. This review provides information on the factors associated with demoralization in cancer patients, which can be used to inform strategies for clinical care providers.
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Affiliation(s)
- Wen-Zhen Tang
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, KTN, Malaysia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Naning, GX, People's Republic of China
| | - Shi-Li Cheng
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, KTN, Malaysia
| | - Ernest Mangantig
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Malaysia
| | | | - Kui Jia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Naning, GX, People's Republic of China
| | - Azlina Yusuf
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, KTN, Malaysia
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Chukwuemeka NA, Yinka Akintunde T, Uzoigwe FE, Okeke M, Tassang A, Oloji Isangha S. Indirect effects of health-related quality of life on suicidal ideation through psychological distress among cancer patients. J Health Psychol 2024; 29:1061-1073. [PMID: 38279547 PMCID: PMC11344958 DOI: 10.1177/13591053231225306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
The interrelationships of suicidal ideation, psychological distress, and impaired health-related quality of life (HRQoL) in cancer patients are complex and multifaceted. Limited empirical evidence exists on the indirect effects of impaired HRQoL on suicidal ideation through psychological distress among cancer patients. To fill this research gap, 250 cancer patients were recruited through a cross-sectional hospital-based research design. Structural equation model (SEM) results indicated that impaired HRQoL is a predictor of psychological distress (β = 0.153; p < 0.05), and psychological distress positively predicts suicidal ideation (β = 0.647; p < 0.000). The study found no direct effects of impaired HRQoL on suicidal ideation (β = -0.05; p = 0.223). Indirect effects of HRQoL on suicidal ideation was confirmed, showing a full-mediation effect β = 0.099 (SE = 0.048, CI = [0.030, 0.189], p < 0.05) (i.e. the pathway impaired HRQoL predict suicidal ideation is through psychological distress). Cognitive-behavioral therapy and other emotional support programs should be considered for cancer patients to mitigate psychological vulnerabilities linking impaired HRQoL to suicidal ideation.
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Affiliation(s)
| | | | | | | | - Andrew Tassang
- University of Buea, Cameroon
- Buea Regional Hospital, Annex, Cameroon
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Gu ZW, Zhang CP, Chen LP, Huang X. Clinical effects of nonconvulsive electrotherapy combined with mindfulness-based stress reduction and changes of serum inflammatory factors in depression. World J Psychiatry 2024; 14:653-660. [PMID: 38808093 PMCID: PMC11129146 DOI: 10.5498/wjp.v14.i5.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/13/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Depression is a common and serious psychological condition, which seriously affects individual well-being and functional ability. Traditional treatment methods include drug therapy and psychological counseling; however, these methods have different degrees of side effects and limitations. In recent years, nonconvulsive electrotherapy (NET) has attracted increasing attention as a noninvasive treatment method. However, the clinical efficacy and potential mechanism of NET on depression are still unclear. We hypothesized that NET has a positive clinical effect in the treatment of depression, and may have a regulatory effect on serum inflammatory factors during treatment. AIM To assess the effects of NET on depression and analyze changes in serum inflammatory factors. METHODS This retrospective study enrolled 140 patients undergoing treatment for depression between May 2017 and June 2022, the observation group that received a combination of mindfulness-based stress reduction (MBSR) and NET treatment (n = 70) and the control group that only received MBSR therapy (n = 70). The clinical effectiveness of the treatment was evaluated by assessing various factors, including the Hamilton Depression Scale (HAMD)-17, self-rating idea of suicide scale (SSIOS), Pittsburgh Sleep Quality Index (PSQI), and levels of serum inflammatory factors before and after 8 wk of treatment. The quality of life scores between the two groups were compared. Comparisons were made using t and χ2 tests. RESULTS After 8 wk of treatment, the observation group exhibited a 91.43% overall effectiveness rate which was higher than that of the control group which was 74.29% (64 vs 52, χ2 = 7.241; P < 0.05). The HAMD, SSIOS, and PSQI scores showed a significant decrease in both groups. Moreover, the observation group had lower scores than the control group (10.37 ± 2.04 vs 14.02 ± 2.16, t = 10.280; 1.67 ±0.28 vs 0.87 ± 0.12, t = 21.970; 5.29 ± 1.33 vs 7.94 ± 1.35, t = 11.700; P both < 0.001). Additionally, there was a notable decrease in the IL-2, IL-1β, and IL-6 in both groups after treatment. Furthermore, the observation group exhibited superior serum inflammatory factors compared to the control group (70.12 ± 10.32 vs 102.24 ± 20.21, t = 11.840; 19.35 ± 2.46 vs 22.27 ± 2.13, t = 7.508; 32.25 ± 4.6 vs 39.42 ± 4.23, t = 9.565; P both < 0.001). Moreover, the observation group exhibited significantly improved quality of life scores compared to the control group (Social function: 19.25 ± 2.76 vs 16.23 ± 2.34; Emotions: 18.54 ± 2.83 vs 12.28 ± 2.16; Environment: 18.49 ± 2.48 vs 16.56 ± 3.44; Physical health: 19.53 ± 2.39 vs 16.62 ± 3.46; P both < 0.001) after treatment. CONCLUSION MBSR combined with NET effectively alleviates depression, lowers inflammation (IL-2, IL-1β, and IL-6), reduces suicidal thoughts, enhances sleep, and improves the quality of life of individuals with depression.
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Affiliation(s)
- Zhi-Wen Gu
- Department of Psychiatry, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510180, Guangdong Province, China
| | - Chun-Ping Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou HuiAi Hospital), Guangzhou 510370, Guangdong Province, China
| | - Li-Ping Chen
- Department of Psychiatry, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510180, Guangdong Province, China
| | - Xiong Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou HuiAi Hospital), Guangzhou 510370, Guangdong Province, China
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Ernst M, Schwinn T, Hirschmiller J, Cleare S, Robb KA, Brähler E, Zwerenz R, Wiltink J, O'Connor RC, Beutel ME. 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. Clin Psychol Rev 2024; 109:102413. [PMID: 38518584 DOI: 10.1016/j.cpr.2024.102413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/29/2023] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
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.
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Affiliation(s)
- Mareike Ernst
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria; Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Tamara Schwinn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Judith Hirschmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kathryn A Robb
- Cancer Behaviour Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Elmasian TF, Nikoloudi M, Tsilika E, Kostopoulou S, Zygogianni A, Katsaragakis S, Mystakidou K. Psychometric Properties of the Greek Version of Demoralization Scale-II (DS-II) in Patients with Cancer. J Caring Sci 2023; 12:103-109. [PMID: 37469748 PMCID: PMC10352633 DOI: 10.34172/jcs.2023.31856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/17/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction The concept of demoralization is used to describe situations of existential distress and self-perceived inability to effectively deal with stressors. The Demoralization Scale-II (DS-II) is a short and modified version of the original DS that measures the level of demoralization in patients. The purpose of this study is to evaluate the psychometric properties of the Greek version of the Greek Demoralisation Scale-II (DS-II GR) in the population of patients with cancer. Methods The main tool used in this cross-sectional study is the DS-II GR translated and evaluated for its psychometric properties in a sample of 150 Greek patients with cancer. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, known groups' validity, cut-off points, internal consistency reliability and test-retest reliability were done. Results According to the CFA, a two-factor model emerged with a different conceptual content and grouping than the original. The correlation coefficients between DS-II GR and Hospital Anxiety and Depression Scale-Greek (HADS-GR) The internal consistency of DS-II GR for factor 1, factor 2, and total score were measured with Cronbach's alpha and calculated to be 0.906, 0.810, and 0.913. Conclusion The Greek version of the demoralization scale is reliable and valid for assessing demoralization in Greek patients with cancer.
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Affiliation(s)
- Tania-Flora Elmasian
- Social Policy and Social Anthropology, Ministry of Migration and Asylum, Asylum Service Case Officer, Greece
| | - Maria Nikoloudi
- Pain Relief and Palliative Care Unit, Aretaieion Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eleni Tsilika
- Health Psychologist, Pain Relief and Palliative Care Unit, Aretaieion Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotiria Kostopoulou
- Pain Relief and Palliative Care Unit, Aretaieion Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Anna Zygogianni
- Department of Radiology, Aretaieion Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Aretaieion Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Suicide risk in cancer patients: cancer prognosis and mental health. Support Care Cancer 2023; 31:163. [PMID: 36781560 DOI: 10.1007/s00520-023-07636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
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