Stepwise psychological intervention: Mitigated psychological distress and suicide risk in patients with liver cancer chemoembolization

Table 1 Comparison of baseline characteristics between the two groups, n (%)/mean ± SD

Variable	Control group (n = 49)	Observation group (n = 49)	χ²/t value	P value
Age (years)	56.72 ± 8.21	55.95 ± 7.82	0.475	0.636
Sex			0.234	0.628
Male	37 (75.51)	39 (79.59)
Female	12 (24.49)	10 (20.41)
Disease duration (months)	6.23 ± 2.11	5.91 ± 2.36	0.708	0.481
Child–Pugh classification			0.192	0.661
Grade A	34 (69.39)	36 (73.41)
Grade B	15 (30.61)	13 (26.53)
CNLC stage			0.057	0.972
Stage IIb	14 (28.57)	15 (30.61)
Stage IIIa	23 (46.94)	22 (44.90)
Stage IIIb	12 (24.49)	12 (24.49)
ECOG score			0.049	0.825
0-1 point	33 (67.35)	34 (69.39)
2 points	16 (32.65)	15 (30.61)
Number of tumors			0.172	0.678
Single lesion	20 (40.82)	18 (36.73)
Multiple lesions	29 (59.18)	31 (63.27)
Maximum tumor diameter			0.172	0.678
< 5 cm	18 (36.73)	20 (40.82)
≥ 5 cm	31 (63.27)	29 (59.18)
Portal vein tumor thrombus			0.186	0.667
Present	15 (30.61)	17 (34.69)
Absent	34 (69.39)	32 (65.31)
Distant metastasis			0.272	0.602
Present	8 (16.33)	10 (20.41)
Absent	41 (83.67)	39 (79.59)
Type of targeted therapy			0.169	0.681
Sorafenib	21 (42.86)	19 (38.78)
Lenvatinib	28 (57.14)	30 (61.22)
Previous history of TACE			0.046	0.831
Yes	17 (34.69)	16 (32.65)
No	32 (65.31)	33 (67.35)

TACE: Transarterial chemoembolization; ECOG: Eastern Cooperative Oncology Group; CNLC: China liver cancer.

Table 2 Comparison of Distress Thermometer and Nurses’ Global Assessment of Suicide Risk scores before and after intervention between the two groups, mean ± SD

Group	Case	DT		NGASR
		Before	After	Before	After
Control	49	6.82 ± 1.35	4.91 ± 1.18	5.76 ± 1.42	4.23 ± 1.09
Observation	49	6.79 ± 1.31	3.25 ± 0.92	5.71 ± 1.38	2.16 ± 0.81
t value		0.112	7.766	0.177	10.670
P value		0.911	< 0.001	0.860	< 0.001

DT: Distress Thermometer; NGASR: Nurses’ Global Assessment of Suicide Risk.

Table 3 Comparison of Self-Rating Anxiety Scale and Self-Rating Depression Scale scores before and after intervention between the two groups, mean ± SD

Group	Case	SAS		SDS
		Before	After	Before	After
Control	49	58.64 ± 7.21	50.12 ± 6.35	57.38 ± 6.95	49.26 ± 6.12
Observation	49	58.27 ± 7.16	42.35 ± 5.48	57.01 ± 6.88	41.53 ± 5.36
t value		0.255	6.485	0.265	6.651
P value		0.799	< 0.001	0.792	< 0.001

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 4 Comparison of treatment adherence and nursing satisfaction between the two groups, n (%)

Variable	Control group (n = 49)	Observation group (n = 49)	χ² value	P value
Treatment adherence
Complete adherence	21 (42.86)	32 (65.31)
Partial adherence	17 (34.69)	15 (30.61)
Non-adherence	11 (22.45)	2 (4.08)
Treatment adherence rate	38 (77.55)	47 (95.92)	7.184	0.007
Nursing satisfaction
Very satisfied	23 (46.94)	34 (69.39)
Satisfied	14 (28.57)	13 (26.53)
Dissatisfied	12 (24.49)	2 (4.08)
Overall satisfaction rate	37 (75.51)	47 (95.92)	8.333	0.004

Table 5 Comparison of safety incident incidence rates between the two wards, n (%)

Group	Cases (n)	Suicide attempt	Self-harm behavior	Extreme refusal of treatment	Total cases (incidence rate)
Control group	49	2 (4.08)	3 (6.12)	4 (8.16)	9 (18.37)
Observation group	49	0 (0.00)	1 (2.04)	1 (2.04)	2 (4.08)
χ² value					5.018
P value					0.025

Table 6 Multivariate logistic regression analysis of factors influencing psychological distress and suicide risk

Outcome/predictor	B	SE	OR	95%CI	P value
Model 1: Significant psychological distress at follow-up (DT ≥ 4)
Stepped psychological intervention vs control	-1.171	0.478	0.31	0.12-0.78	0.014
Baseline DT score, per 1-point increase	0.392	0.143	1.48	1.12-1.96	0.006
Advanced tumor stage, yes vs no	0.975	0.474	2.65	1.05-6.72	0.040
Good family support, yes vs no	-0.868	0.432	0.42	0.18-0.98	0.045
Model 2: High suicide risk at follow-up (NGASR ≥ 5)
Stepped psychological intervention vs control	-1.309	0.554	0.27	0.09-0.79	0.018
Baseline NGASR score, per 1-point increase	0.476	0.156	1.61	1.19-2.19	0.002
Advanced tumor stage, yes vs no	1.125	0.540	3.08	1.07-8.89	0.037
Good family support, yes vs no	-1.022	0.486	0.36	0.14-0.94	0.036

DT: Distress Thermometer; NGASR: Nurses’ Global Assessment of Suicide Risk; OR: Odds ratio.