Study On The Influencing Factors And Prediction Model About Suicidal Ideation Of Inpatients With Cancer

In 2015,cancer was the second leading cause of death worldwide^[1],and suicide was the 17th cause of death and the second among 15-29 years old^[2].Cancer might also lead to suicide:prior studies have shown that suicide incidence among patients with cancer is almost double compared with the general population^[3-5].Moreover,patients with cancer were found to be particularly prone to suicidal ideation（SI）^[4,5],especially in the case of advanced cancer patients,and suicide attempts（SAs）^[5-7].In recent years,the incidence of cancer worldwide has been increasing year by year,becoming a global public health concern.However,studies on the prevalence and characteristics of suicidal ideation,the influencing factors and structural equation models of suicidal ideation among cancer inpatients in general hospitals is limit.Study 1:Reliability and Validity of the Chinese Version of the Yale Evaluation of Suicidality Scale in Cancer InpatientsObjective:To evaluate the reliability and validity of the Chinese version of Yale Evaluation of Suicidal Scale（YESS）in cancer inpatients from general hospitals.Methods:544 cancer inpatients were selected as participants in two general hospital in Dalian.The reliability of the revised suicide assessment scale was assessed by the revised Chinese version of YES scale.The reliability of the revised suicide assessment scale was tested by internal consistency and retest reliability.Exploratory factor analysis and confirmatory factor analysis were used.The content and construct validity of Chinese version YES scale were tested.Results:1.The internal consistency of the Chinese version of YES is 0.899,and the test-retest reliability is 0.667.2.Exploratory factor analysis KMO=0.892,extracted 2 factors in total,the cumulative contribution rate was 77.02%.3.CFI、GFI、AGFI、RMSEA、NFIand TLI were 0.840,0.924,0.901,0.082,0.957 and0.915,respectively.Conclusion:The Chinese version of YES scale has good reliability and validity,can be used as a screening tool for suicide risk assessment and research in clinical cancer patients.Study 2:Prevalence and Influencing Factors of Suicidal Ideation among Cancer InpatientsObjective:To investigate the epidemiological status of suicidal ideation of cancer patients in general hospitals,understand the current status and characteristics of suicidal ideation of cancer patients,and reveal the influencing factors of suicidal ideation.Methods:572 cancer inpatients were selected as participants in Zhongshan Hospital Affiliated to Dalian University and the Second Affiliated Hospital of Dalian Medical University from January 2015 to December 2015.The questionnaires contains self-made general information questionnaire,physical health questionnaire,Yale Evaluation of Suicidality Scale（YESS）,Mc Gill Quality of Life Scale（MQOL）,Stategies Used by People to Promote Health（SUPPH）,Brief Coping Orientation to Problems Experienced scale（BCOPE）,Family Adaptablility and Cohesion Evaluation Scale（FACES）and Multidimensional Scale of Perceived Social Support（MSPSS）.In total 544 participants completed the questionnaires.The data were analyzed by SPSSl7.0 statistical software package,including descriptive analysis,Chi-square test,t-test,Logistic regression model analysis and so on.Results:1.The incidence of suicidal ideation among hospitalized cancer patients was 26.3%（143 cases）.The incidence of suicidal ideation in women was higher than that in men,and the difference was not significant.The people whose marriage status was divorced or widowed,and the occupational status was retired more prone to have suicidal ideation,the difference was statistically significant.The rate of suicidal ideation in patients with metastatic cancer was significantly higher than that in patients without metastasis.The incidence of suicidal ideation in patients with metastatic cancer was higher than that in patients with metastatic cancer within 1 month and 2-12 months after diagnosis.2.Compared with the group without suicidal ideation,the scores of quality of life and four latitudes in the group with suicidal ideation were lower than those in the group without suicidal ideation（p<0.05）;the scores of self-efficacy and three latitudes（decompression,decision-making,positive attitude）were lower than those in the group without suicidal ideation（p<0.05）;the scores of social support and three dimensions（family branch）The scores of holding,friend support and other support were lower in the group with suicidal ideation than in the group without suicidal ideation（p<0.05）.In denial and substance use coping style scores were higher than those without suicidal ideation（p<0.05）.3.Multivariate logistic regression analysis showed that demographic variables（model1）:marital status was divorced or widowed（OR=1.71）,working status was retired（OR=2.21）,disease and treatment related variables（model 2）:time after diagnosis（OR=2.72）;Social psychology factors（model 3）:Coping style of material use（OR=1.26）was a significant risk factor for suicidal ideation;better physical function（OR=0.98）,positive attitude of self-efficacy（OR=0.95）and friend support（OR=0.93）in social support were protective factors for suicidal ideation.Conclusion:We revealed a higher prevalence of suicidal ideation among cancer inpatients in general hospitals and identified several risk factors,suggesting the potential risk of suicide cannot be ignored.Routine suicide assessment and effective intervention is needed for this high-risk population.Study 3:Prediction Model of Suicidal Ideation in Cancer InpatientsObjective:This study explores the impact of physical health status on suicidal ideation by investigating the mediating effect of self-efficacy and social support.Methods:Direct and indirect（via self-efficacy and social support）effects of physical health status on suicidal ideation were tested among 544 caner inpatients from two general hospitals.For this purpose,structural equation model（SEM）and bootstrap method were used.Results:1.The direct effect of physical health on suicidal ideation was 0.214.2.Self-efficacy and social support partially mediated the relationship between physical health status and suicidal ideation.The overall mediating effect was 0.228,accounting for 51.6%of the total effect.The individual mediating effect of self-efficacy was 0.178,accounting for 78.07%of the total mediating effect,while the individual mediating effect of social support was 0.022,accounting for 9.65%of the total mediating effect.Conclusion:Results from this study support the mediate role of self-efficacy and social support in the relationship between physical health status and suicidal ideation.Future suicide prevention programs should include strategies to enhance self-efficacy and social support for physical health status to be most effective for this population.