| Research One The relationship between of suicidal ideation and psychological strain in patients with stomach cancerAim1.To investigate the proportion of suicidal ideation in stomach cancer patients.2.To verify the application of Strain Theory of suicide in stomach cancer patients.To be specific,to determine whether hopelessness and psychological distress act as mediators,and medical and social support factors act as moderators in the relationship between psychological strain and suicidal ideation.MethodA cross-sectional design was used to collect samples.Participants for the study were stomach cancer patients in four of the top three hospitals in Shandong Province.The questionnaires were administered to eligible patients to collect demographic and medical information,and to measure suicidal ideation,psychological strain,psychological distress,hopelessness and family function.Totally 354 questionnaires were sent out and 332 valid ones were retrieved.The effective rate was 93.7%.SPSS 20.0 were applied to analyze all the data.Suicidal ideation was defined as binary dependent variable,psychological strain as independent variable,sex,age and educational levels were as covariate variables,psychological distress and hopelessness were defined as mediators,family function,work status,marriage status,and disease-related factors as moderators in testing Strain Theory of Suicide.Descriptive statistics,one-sample t test,Chi-square test,correlation analysis and Logistic analysis were used to analyze the data.Results1.There were 18.37%of 332 stomach cancer patients reporting suicidal ideation.2.The mean score of psychological strain is 92.06(SD=22.94,range:40?157),the mean score of value strain is 21.59(SD=7.60,range:10?46),the mean score of aspiration strain is 24.88(SD=7.56,range:10?47),the mean score of deprivation stain is 22.23(SD=7.14,range:10?45)and the mean score of coping stain is 23.36(SD=6.21,range:10-42).The mean score from high to low was aspiration strain,coping strain,deprivation strain and value strain in our sample.79.21%of participant had good family function.The proportion of anxiety,depression and hopelessness were 32.83%.23.80%and 46.39%respectively.25.60%participants reported psychological distress.3.Univariate analysis showed participants with low family function(?2=10.601,p<0.05),poor self-reported health(?2=9.857,p<0.05),advanced tumor stage(?2=4.757,P<0.05),with clinical symptoms(?2=6.452,p<0.05),anxiety symptoms(?2=66.258,P<0.01)and depression symptoms(?2=61.087,p<0.01)are more likely to experience suicidal ideation.4.Psychological strain(OR=1.035,95%CI:1.021?1.048),psychological distress(OR=1.216,95%CI:1.155?1.279)and hopelessness(OR=1.375,95%CI:1.250?1.513)was significantly related to suicidal ideation,respectively.Psychological strain is significantly positively correlated with psychological distress(r=0.471,p<0.01)and hopelessness(r=0.305,p<0.01),respectively.5.Suicidal ideation was entered as dependent variable and the logistic regression was conducted in two steps after controlling covariate variables and moderators.Psychological strain was entered in the first step and psychological distress and hopelessness were added in the second step.Results show the OR of psychological strain is 1.034(95%C1:1.019?1.050)in model 1.And the OR of psychological strain,psychological distress and hopelessness is 1.011(95%CI:0.992?1.029),1.188(95%CI:1.112?1.269),1.276(95%CI:1.131?1.440)in model 2,respectively.The OR of psychological strain decreased after entering psychological distress and hopelessness in the model,which indicates that psychological distress and hopelessness may act as mediators.Then,Psychological strain was entered as independent variable,suicidal ideation was entered as dependent variable,and both psychological strain and hopelessness were entered as mediators.The result shows the direct effect of psychological strain on suicidal ideation is not significant(95%CI:-0.008?0.024,p>0.05),whereas the total indirect effect is significant(95%CI:0.022?0.048,p<0.05).7.Suicidal ideation was entered as a dependent variable and psychological strain was entered as an independent variable.The social support factors and medical factor acted as moderators for each model separately.The regression coefficient of multiplicative interaction term of clinical symptoms and psychological strains was significant(B=-0.047,p =0.008).Conclusion1.The proportion of stomach cancer patients reporting suicidal ideation was high.2.The applicability of Strain Theory of Suicide in Chinese Stomach cancer patients was verified.The psychological strains might be the key factor of suicidal ideation and the higher level of psychological strain,the more likely to have suicidal ideation in patients with stomach cancer.In the relationship between psychological strains and suicidal ideation,hopelessness and psychological distress played as mediators while clinical symptoms acted as moderators.3.Nurses could help patients to cope with psychological issues associated with suicidal ideation appropriately and improve mental health by evaluating psychological strain,psychological distress and hopelessness regularly.4.The present study is the first study to explore the Strain Theory of suicide to a larger group of samples with stomach cancer.The theory itself can be applied to help explicate suicidal behaviors in Chinese patients with stomach cancer.The results would provide theoretical basis and new ideas for suicidal interventions in patients with stomach cancer.Research Two Effectiveness of psychological intervention on suicidal ideation:A meta-analysisAim:There is lack of studies about suicidal ideation intervention for stomach cancer patients.Studies on suicidal ideation intervention for other populations can provide reference to develop interventions for stomach cancer patients.Based on that,the aim of this study is to assess the effectiveness of psychological intervention on suicidal ideation,to analysis the influence of different content,duration and form of intervention on effect and to provide guidance on developing suicidal ideation intervention program for patients with stomach cancer.Methods:Such databases such as PubMed,MEDLINE,Psych Info,Embase,CNKI,WanFang and VIP database were searched to collect randomized controlled trials on effectiveness of psychological intervention for suicidal ideation.Relevant literature published by July 2017 were searched and reviewed according to the inclusion and exclusion criteria.The quality of included studies was evaluated based on Cochrane Reviewers' Handbook,and meta-analysis were performed by using RevMan 5.3 software.Results:3538 English records and 955 Chinese records were obtained at first and finally a total of 24 studies were included in the meta-analysis.The results show the intervention effect of psychological intervention group was more effective in decreasing suicidal ideation when compared to control group[SMD=-0.47,95%CI(-0.67,-0.28)].Subgroup analysis shows a significant difference between intervention and control group of comprehensive intervention group,CBT-based intervention and crisis intervention.Significant treatment eff,ects for interventions which last for 2?8 weeks or 9-24 weeks are also found.Individual intervention and intervention combined individual and group treatment significantly reduced suicidal ideation when compared to control group.The effect of 6 or more months of follow-up was defined as long-term effect.The result reveals the long-term intervention effect of psychological intervention group was more effective in decreasing suicidal ideation when compared to control group[SMD=-0.31,95%CI(-0.47,-0.14)].Conclusion:1.Psychological intervention can reduce suicidal ideation effectively,which enforces the feasibility for psychological intervention effect of suicidal ideation in patients with stomach cancer.2.Comprehensive intervention,CBT-based intervention and crisis intervention can reduce suicidal ideation effectively.Interventions which last for 2-8 weeks or 9-24 weeks are also effective at reducing suicidal ideation.In addition,individual intervention and intervention combined individual and group treatment have significantly effects.All the results above provided useful information for developing suicidal ideation intervention for patients with stomach cancer.Research Three The development of suicidal ideation intervention for patients with stomach cancerAimTo develop suicidal ideation intervention for stomach cancer patients based on the results of cross-sectional study(Research One)and meta-analysis(Research Two).MethodsFirst,to establish the theoretical framework of intervention by analyzing Strain Theory of Suicide,the theory of Psychological Stress,Roy's Adaptation Model,positive psychology theories and theory of Psychological Crisis Intervention comprehensively.The targets of the intervention were determined based on the results of cross-sectional study(Research One)and the theoretical framework.Then the content,the form and the duration of intervention were designed based on meta-analysis.First draft of intervention was formed.Last,the draft was consulted by 10 experts according to Delphi Method.Results1.A suicidal ideation intervention for stomach cancer patients was developed mainly based on Strain Theory of Suicide by conducting two-round Delphi method.It consists of introduction,the procedure and content,and notes for implication.2.The intervention is a comprehensive psychological intervention with individual treatment and lasts for 8 weeks.The frequency is once per week for 40-to-50 minute.3.The process of the intervention is divided into three stages which are building relationships,learning skills and strengthening practice.Health professionals could help patients with stomach cancer to reduce psychological strain and cope with suicidal ideation by improving coping skills,correcting their cognitive model and increasing social support.ConclusionThe suicidal ideation intervention is scientific and feasible which could be applied in patients diagnosed with stomach cancer. |
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