Health-related quality of life in Chinese inpatients with lung cancer treatedin large general hospitals: across-sectional study

Prevalence and network structure of depression and its association with quality of life among older stroke survivors: findings from a national survey in China

Background

Post-stroke depression (PSD) is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life (QoL). To date, few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.

Aims

This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.

Methods

This study was based on the 2017-2018 collection of data from a large national survey in China. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CESD), while QoL was measured with the World Health Organization Quality of Life-brief version. Network analysis was employed to explore the structure of PSD, using expected influence (EI) to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.

Results

A total of 1123 stroke survivors were included, with an overall prevalence of depression of 34.3% (n=385; 95% confidence interval 31.5% to 37.2%). A higher risk of PSD was significantly associated with limited activities of daily living (odds ratio (OR)=1.340; p=0.048), presence of heart diseases (OR=1.589; p=0.002) and more severe anxiety symptoms (OR=1.472; p<0.001). In the network model of depression, the most central symptoms were CESD3 ('feeling blue/depressed', EI: 1.180), CESD6 ('feeling nervous/fearful', EI: 0.864) and CESD8 ('loneliness', EI: 0.843). In addition, CESD5 ('hopelessness', EI: -0.195), CESD10 ('sleep disturbances', EI: -0.169) and CESD4 ('everything was an effort', EI: -0.150) had strong negative associations with QoL.

Conclusion

This study found that PSD was common among older Chinese stroke survivors. Given its negative impact on QoL, appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.

Prevalence and influencing factors of the dyadic psychological stress among patients with lung cancer and their family caregivers: a cross-sectional study

BACKGROUND

A lung cancer diagnosis has a huge impact on the psychological well-being of both patients and family caregivers. However, the current psychological stress status among dyads remains unclear. We aimed to determine the prevalence of anxiety and depression and identify the factors that influence patients with lung cancer and their caregivers.

METHODS

We conducted a cross-sectional study of 254 dyads of lung cancer patients and family caregivers from four tertiary hospitals in Hunan Province, China from January 2021 to June 2021. Besides, we used several instruments to collect data on depression, anxiety, illness perception, mindfulness, self-compassion, and dyadic coping. The independent samples t-test, analysis of one-way variance, Spearman's correlation analysis, and multiple linear regression analysis were employed.

RESULTS

Results showed that 21.3% of patients and 29.5% of caregivers experienced depression, while 22.0% of patients and 33.5% of caregivers reported anxiety. For lung cancer patients, patients' illness perception positively predicted their depression scores and patients' level of mindfulness and level of self-compassion negatively predicted their depression scores; patients' illness perception positively predicted their anxiety scores, and only living with children, patients' mindfulness and self-compassion levels were negatively predicted their anxiety scores. For caregivers, caregivers' level of illness perception and the number of other caregivers positively predicted their depression and anxiety scores, and caregiver's dyadic coping level, residence (county or town, and city), and caregiver's self-compassion level, were negatively predicted their depression and anxiety scores.

CONCLUSION

The prevalence of psychological stress response of lung cancer patients and caregivers was high and influenced by family living situation, number of persons assisting in care, place of residence, patient-caregiver relationship, levels of illness perception, mindfulness, self-compassion, and dyadic coping.

TRIAL REGISTRATION

ClinicalTrial.gov NCT06746948.

Impact of Educational Guidelines on Oral Mucositis Severity and Quality of Life in Oncology Patients Receiving Chemotherapy: A Quasi-Experimental Study

BACKGROUND

Oral mucositis (OM) is a prevalent side effect of chemotherapy that negatively impacts patient quality of life (QoL). Educational guidelines may provide strategies to mitigate these effects.

OBJECTIVE

To evaluate the effectiveness of educational guidelines on the severity of OM and QoL in oncology patients undergoing chemotherapy.

METHODS

A quasi-experimental study was conducted. Patients (n = 108) were randomly assigned to an intervention group receiving educational guidelines or a control group receiving routine care. Outcomes were assessed at baseline and at one and three months post-intervention. Data were collected using a structured interview including assessments of personal characteristics, clinical data, chemotherapy side effects, OM severity, and QoL.

RESULTS

Baseline QoL scores were comparable between groups. Post-intervention, the intervention group experienced significant improvements in QoL (p ≤ 0.05), while the control group showed a decline. OM severity was significantly reduced in the intervention group compared to the control group at both time points (p ≤ 0.05).

CONCLUSION

Educational guidelines are an effective intervention for reducing OM severity and improving QoL in oncology patients receiving chemotherapy. Implementation of these guidelines can enhance patient well-being and support optimal treatment outcomes.

Health-related quality of life and its influencing factors among lung cancer patients receiving immune checkpoint inhibitors: A cross-sectional study

PURPOSE

The aim of this study was to examine the level of health-related quality of life (HRQOL) of lung cancer patients receiving immune checkpoint inhibitors (ICIs) and analyze its influencing factors.

METHOD

A cross-sectional study was conducted. From April 2022 to March 2023, 560 lung cancer patients receiving ICIs at three medical bases in Guangzhou, China were recruited using a convenient sampling method. A general information questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Social Support Rating Scale (SSRS) and the Medical Coping Modes Questionnaire (MCMQ) were used for collecting data on sociodemographic and clinical characteristics, HRQOL, social support and medical coping mode. A descriptive analysis was conducted to describe HRQOL. Multiple regression analysis was applied to determine the factors influencing HRQOL.

RESULTS

For lung cancer patients receiving ICIs, the mean score of HRQOL was 59.21 ± 19.86. Multivariate analysis indicated that acceptance-resignation coping mode (β = -0.37, P < 0.01), Eastern Cooperative Oncology Group (ECOG) score (β = -0.35, P < 0.01), combination of chemotherapy and/or bevacizumab (β = -0.14, P < 0.01), and subjective support (β = 0.07, P = 0.04) all contributed to 42.7% of the variance in HRQOL of the patients receiving ICIs.

CONCLUSIONS

It is imperative to address and resolve the HRQOL issue for lung cancer patients receiving ICIs. The findings suggest nurse practitioners should be aware of a variety of factors that influence HRQOL and provide tailored inventions to patients as early as possible to help them achieve better HRQOL.

Social determinants of health and lung cancer surgery: a qualitative study

Introduction

Social determinants of health (SDOH) are non-clinical factors that may affect the outcomes of cancer patients. The purpose of this study was to describe the influence of SDOH factors on quality of life (QOL)-related outcomes for lung cancer surgery patients.

Methods

Thirteen patients enrolled in a randomized trial of a dyadic self-management intervention were invited and agreed to participate in semi-structured key informant interviews at study completion (3 months post-discharge). A conventional content analysis approach was used to identify codes and themes that were derived from the interviews. Independent investigators coded the qualitative data, which were subsequently confirmed by a second group of independent investigators. Themes were finalized, and discrepancies were reviewed and resolved.

Results

Six themes, each with several subthemes, emerged. Overall, most participants were knowledgeable about the concept of SDOH and perceived that provider awareness of SDOH information was important for the delivery of comprehensive care in surgery. Some participants described financial challenges during treatment that were exacerbated by their cancer diagnosis and resulted in stress and poor QOL. The perceived impact of education varied and included its importance in navigating the healthcare system, decision-making on health behaviors, and more economic mobility opportunities. Some participants experienced barriers to accessing healthcare due to insurance coverage, travel burden, and the fear of losing quality insurance coverage due to retirement. Neighborhood and built environment factors such as safety, air quality, access to green space, and other environmental factors were perceived as important to QOL. Social support through families/friends and spiritual/religious communities was perceived as important to postoperative recovery.

Discussion

Among lung cancer surgery patients, SDOH factors can impact QOL and the patient's survivorship journey. Importantly, SDOH should be assessed routinely to identify patients with unmet needs across the five domains. SDOH-driven interventions are needed to address these unmet needs and to improve the QOL and quality of care for lung cancer surgery patients.

The effects of different surgical approaches on the psychological status, medical coping mode and quality of life of patients with lung cancer

Objective

This study aimed to compare the effects of robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and thoracotomy on the psychological status, medical coping mode, and quality of life of patients with lung cancer.

Methods

A total of 158 patients with lung cancer were selected from the thoracic surgery center of a third-grade hospital in Hunan Province, China, from September to November 2020. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Medical Coping Modes Questionnaire (MCMQ), and Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36) were used to assess the effects of the surgical approaches on the study parameters before and 48–96 h after surgery. The t-test and analysis of variance were used to analyze the data.

Results

The results revealed that the patients’ depression increased, their short-term quality of life decreased, and they tended to adopt a positive coping mode after surgery (p &lt; 0.05). The RATS and VATS groups differed in avoidance dimension of medical coping modes (p &lt; 0.05). The VATS and thoracotomy groups differed in the body pain dimension of quality of life (p &lt; 0.05). Different surgical approaches had no effect on the psychological status, medical coping modes except the avoidance dimension, and quality of life except the body pain dimension.

Conclusion

Surgical approaches have little effect on the psychological status, medical coping modes, and quality of life of patients with lung cancer; however, their depression increased and quality of life decreased after the surgery.

Determination of the factors contributing to depression and anxiety in advanced stage lung cancer patients

Background

The diagnosis of cancer and initiation of treatment disrupt physical, emotional, and socio-economical stability of the patients by reducing the quality of lives and ultimately leading to depression and anxiety. We aimed to observe the indicators for anxiety and depression among lung cancer (LC) patients by comparing with other cancer (OC) patients.

Methods

This study has been conducted between 2017 and 2019. Questionnaires were provided for both LC and OC patients.

Results

Two hundred and thirty patients with the ages varied between 18 and 86 (median: 64.0) were included in the study. A total of 115 patients (case group) were diagnosed as LC, and the remaining were with OC diagnosis (control). No difference was determined between the groups in means of median anxiety and depression scores. Patients who required assistance in hospital procedures, daily life activities, and self-care had higher depression and anxiety scores (p < 0.05) compared to those did not require assistance. Anxiety and depression scores in OC groups showed a remarkable difference according to performance status (p < 0.001). The depression score of the patients who stated that they did not know their social rights was remarkably higher than those of the patients who stated that they know their social rights. We found no relationship between depression and anxiety scores because of disease caused income loss and expense increase.

Conclusion

For LC patients, declaration of requirement for assistance and supportive care in daily life can be an important indication for anxiety and depression. Lung cancer patients, especially those informed by health care professionals and provided psychosocial support following the information, require a patient-specific professional management approach.

Determinants of quality of life of cancer patients at a tertiary care medical city in Riyadh, Saudi Arabia

BACKGROUND

Incidences of cancer are increasing at an unprecedented rate in Saudi Arabia, making it a major public health concern. Cancer patients are faced with physical, psychological, social, and economic challenges, all of which can impact quality of life (QoL).

OBJECTIVES

This study aims to explore the sociodemographic, psychological, clinical, cultural, and personal factors that could affect the overall QoL of cancer patients.

METHODS

A total of 276 cancer patients who attended the King Saud University Medical City's oncology outpatient clinics between January 2018 to December 2019 were included. QoL was assessed with the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Psychosocial factors were assessed with several validated scales.

RESULTS

QoL was poorer among patients who were female (p = 0.001), have visited a psychiatrist (p = 0.028); were taking psychiatric medications (p = 0.022); and had experienced anxiety (p < 0.001), depression (p < 0.001), and distress (p < 0.001). The most used method to self-treat was Islamic Ruqya (spiritual healing; 48.6%), and the most often perceived cause for developing cancer was evil eye or magic (28.6%). Good QoL outcomes were associated with biological treatment (p = 0.034) and satisfaction with health care (p = 0.001). A regression analysis showed that female sex, depression, and dissatisfaction with health care were independently associated with poor QoL.

CONCLUSIONS

This study demonstrates that several factors could influence cancer patients' QoL. For instance, female sex, depression, and dissatisfaction with health care were all predictors of poor QoL. Our findings support the need for more programs and interventions to improve the social services for cancer patients, along with the need to explore the social difficulties oncology patients face and address such obstacles through improving social services by expanding the scope of social workers' contribution. Larger multicenter longitudinal studies are warranted to examine the generalizability of the results.

Suicidal Ideation Is Associated With Excessive Smartphone Use Among Chinese College Students

BACKGROUND

Suicidal ideation is the first step and a strong predictor of suicide. College students are at a considerably high risk of suicidal ideation, and smartphones are commonly used in this group. However, the relationship between suicidal ideation and smartphone use among Chinese college students is unclear. The current study aimed to investigate the prevalence of suicidal ideation among Chinese college students and its association with smartphone use and addiction factors.

METHODS

A total of 439 college students participated the survey. We collected the demographic information, physical health, psychosocial factors (depressive symptoms, social support, sleep quality), characteristics of smartphone use, and mobile phone addiction (MPA). Suicidal ideation was measured with a single question, "did you feel that life was not worth living in the past 1 year?"

RESULTS

The prevalence of suicidal ideation ("Yes" response) in the past year among Chinese college students was 7.5%. In binary logistic regression analysis, suicidal ideation was significantly correlated with less subjective social support (OR: 2.49, p = 0.049), lower utilization of social support (OR: 13.28, p = 0.012), more depressive symptoms (OR:4.96, p = 0.005), and more than 5 h of daily smartphone use (OR: 2.60, p = 0.025).

CONCLUSION

Considering the widely use of smartphones in Chinese colleges and the correlation with suicidal ideation, excessive phone use among college students should be given more attention by administrators and health workers. It is necessary to obtain more information about the intention of smartphone use, make full use of smartphones for health education, and monitor excessive use of smartphones, while improving social support and coping mechanisms for depression, to identify suicidal ideation and prevent suicidal behavior among Chinese college students.

Proportion and related factors of depression and anxiety for inpatients with lung cancer in China: a hospital-based cross-sectional study

BACKGROUND

Lung cancer was often accompanied by depression and anxiety. Nowadays, most investigations for depression and anxiety were concentrated in western medical hospitals, while few related studies have been carried out in the tradition Chinese medicine (TCM) ward. It was necessary to understand the proportion and related factors of depression and anxiety in the inpatients with lung cancer in TCM hospital.

METHODS

This study adopted cross-sectional research method, which enrolled a total of 222 inpatients with lung cancer in TCM hospital. PHQ-9 and GAD-7 scales were used to assess depression and anxiety for the inpatients, respectively. Demographic and clinical data were also collected. Statistical methods of the univariate analysis and the multivariate logistic regression model were used.

RESULTS

The proportion of depression and anxiety in the inpatients with lung cancer were 58.1% and 34.2%, respectively. Multivariate logistic regression analysis prompted that the common related factor of depression and anxiety was the symptom of insomnia(odds ratio [OR] 3.274, 95%CI 1.723-6.219; OR 2.201, 95%CI 1.132-4.277). Constipation and gender were the two anther-related factors of depression(OR 1.458, 95%CI 0.372-1.606; OR 1.298, 95%CI 0.151-1.588).

CONCLUSION

Depression and anxiety were common for the inpatients with lung cancer in TCM hospital. Gender, insomnia, and constipation were related factors for depression, and insomnia was related factor for anxiety. Therefore, medical workers should pay close attention to the emotional changes of these high-risk patients and intervene the symptoms as early as possible.

Spiritual Needs of Lung Cancer Patients and Their Relation to Psychological Distress and Quality of Life

Background

This study aimed to investigate the spiritual needs of patients suffering from lung cancer in relation to their mental health and quality of life.

Methodology

A cross-sectional quantitative study design was employed to investigate 110 lung cancer patients receiving chemotherapy. A four-part self-assessment instrument was used to gather the data comprising a sheet containing demographic and clinical information, Spiritual Needs Questionnaire, The Depression, Anxiety, and Stress Scale-21 Items, and the 12-item Health Survey. Descriptive inferential statistics were applied.

Results

Of the 110 patients, 71.8% were men, the mean age was 64.25 (±9.3) years, and 71.8% were married. In total, 40.9% of the patients were retired, and 92.7% had a public insurance company. Regarding education, 30% were primary school graduates and 31.8% were high school graduates. Regarding the clinical features of the sample, 23.6% of the patients had small-cell carcinoma, 71.9% had non-small-cell carcinoma, and 4.5% had large-cell carcinoma. Spiritual needs have a negative effect on the mental health component of quality of life (p < 0.001) and can increase psychological distress in lung cancer patients.

Conclusions

In contrast to the findings of other international studies, spiritual needs appeared to be lower; however, similar to other studies, spiritual needs increased in those suffering from depression and anxiety. Moreover, the subtype of lung cancer also appeared to play a role.

Relationship Between Childhood Left-Behind Experience and Quality of Life Among Chinese University Freshmen: Place of Origin Matters

Background: Childhood left-behind experience (LBE) has a long-term detrimental effect on the mental health of Chinese University students, but it remains unclear whether childhood LBE negatively impacts the quality of life (QOL) of University students and whether the LBE-QOL association differs between students of rural origin and students of urban origin. This study examined the LBE-QOL relationship and the interactive effect between LBE and place of origin on QOL among Chinese University freshmen. Methods: By using a two-stage random cluster sampling approach, a total of 5,033 freshmen were recruited from two comprehensive universities. The students completed an online, self-administered questionnaire that included sociodemographic variables, a 2-week physical morbidity assessment, and assessments of depressive symptoms, academic stress, and QOL. The Chinese six-item QOL scale was used to assess QOL. Multiple linear regression was used to test the independent LBE-QOL association and the interaction between LBE and place of origin. Results: Students with childhood LBE had significantly lower QOL scores than those without LBE (60.1 ± 13.1 vs. 64.3 ± 11.7, p < 0.001). After adjusting for the potential confounding effects of other sociodemographic variables, 2-week physical morbidity, depressive symptoms, and academic stress, childhood LBE was significantly associated with a lower QOL score (β: -3.022, p < 0.001) and the LBE-place of origin interaction was still significantly associated with the QOL score (β: -2.413, p < 0.001). Overall, compared to non-LBE, LBE was associated with a QOL score decrease of 5.93 among freshmen of urban origin and of 3.01 among freshmen of rural origin. Conclusion: In Chinese University freshmen, childhood LBE is independently associated with poor QOL, and the LBE-QOL association is greater among freshmen from urban backgrounds than among freshmen from rural backgrounds.

Coping Strategies, Locus of Control, and Quality of Life in Patients with Early-Stage Breast Cancer

Patients with cancer are included in vulnerable groups with a low quality of life. Accordingly, this study aimed to explore the relationship between coping strategies and locus of control with the quality of life in women with early-stage breast cancer. A total of 224 women with breast cancer (M_age = 36.82; SD_age = 11.21) were selected using convenience sampling from general hospitals and cancer treatment centers in Tehran, Iran, and completed measures included Multidimensional Coping Inventory, Locus of Control of Behavior Scale, and World Health Organization Quality of Life. The results of the current study showed significant relationships between coping strategies and locus of control with the quality of life in women suffering from breast cancer. Moreover, the results of hierarchical multiple regression analysis indicated that the locus of control (β = - .47), task-focused coping style (β = .27), and emotion-focused coping strategy (β = - .19) were significant predictors of the patients' quality of life. Quality of life of the women with early-stage breast cancer may be improved by helping them to adopt more task-focused coping strategies and internal locus of control.

Improving Social Support to Increase QoL in Lung Cancer Patients

Lung cancer is the most common cause of cancer deaths in the world. According to the World Health Organization, over 2 million new lung cancer cases were reported worldwide in 2018, and there were 1.76 million deaths from the disease. Due to its non-specific symptoms, the disease is usually detected at an advanced stage, which gives few treatment options and a short survival rate after diagnosis. That is why improving QoL in the last months of a patient's life is enormously important. The purpose of this study was to analyse original papers in order to determine whether an increase in social support is important in improving QoL for lung cancer patients. Both the direct influence of social support on QoL and indirect influences such as stigma or depression, etc. were taken into consideration. We conducted a review of 22 papers published in English in the period 2005-2020, which were selected using the following keywords: lung cancer, social support, quality of life. Evidence was found for the connections between the improvement of social support and an increase in the QoL of lung cancer patients. It is crucial, and worth whatever effort is required, to increase social support for lung cancer patients, as it is one of the most important factors in improving QoL. According to the studies, a good QoL and minimalised symptoms of the disease are much more important for lung cancer patients than the length of their life.

Problematic Internet use and the risk of suicide ideation in Chinese adolescents: A cross-sectional analysis

To evaluate the relationships between problematic Internet use (PIU) and suicidal ideation (SI) among adolescents, we encompassed 12,507 participants (16.6 ± 0.8 years). The occurrence of mood disorders, quality of life (QOL), personality traits and SI were compared in adolescents with and without PIU. Multilevel logistic regression models, trend analysis and interaction analysis were employed. A total of 2,809 (22.46%) adolescents reported SI. PIU was assessed using Internet Addiction Test score (IATs), and 3,442 (27.52%) participants met the criteria for PIU (IATs ≥ 40). PIU was significantly and independently associated with SI [AOR for suicidal ideation (vs. IATs < 40): 1.00 for 40-59 points; 1.3 (CI, 1.2-1.5): 60-79 points; 1.7 (CI, 1.4-2.1): 80-100 points; and 2.2 (CI, 1.2-3.9)]. Trend analysis demonstrated that PIU increased the risk of SI in each of the subgroups (p for trend ≤ 0.001 for each). Interaction analysis showed an association of PIU and SI that were dependent on mood disorders, QOL, impulsivity and aggression (p-value for interaction < 0.05). These findings highlight the need for a range of cross disciplinary health interventions to afflicted families, students, and clinicians, to increase the awareness of adverse PIU effects.

Smartphone Use and Sleep Quality in Chinese College Students: A Preliminary Study

BACKGROUND

Chinese college students are at high risk of sleep problems, and smartphone use is common among this population. However, the relationship between smartphone use characteristics and sleep problems in Chinese college students has been inadequately studied. In this preliminary study, we examined the association of poor sleep quality with smartphone use in a sample of Chinese college students from a health vocational college in Changsha, China.

METHODS

A total of 439 college students completed a self-report questionnaire containing the Pittsburgh Sleep Quality Index (PSQI) and questions regarding demographic information, psychosocial factors, physical health, smartphone use characteristics, and mobile phone addiction (MPA).

RESULTS

The results showed that the prevalence of poor sleep quality (PSQI > 7) in Chinese college students was 9.8%. In multiple logistic regression analysis, poor sleep quality was significantly associated with male gender (OR: 2.80, P: 0.022), not having good physical health (OR: 2.61, P: 0.020), headache (OR: 2.47, P: 0.014), more severe depressive symptoms (OR: 2.17, P: 0.049), > four years of smartphone use (OR: 3.38, P: 0.001), > five hours of daily smartphone use (OR: 2.19, P: 0.049), and more severe inability to control MPA craving (OR: 2.04, P: 0.040).

CONCLUSION

Our findings suggest that excessive smartphone use and MPA are associated with poor sleep quality in a sample of Chinese college students from a health vocational college. Because of the limited sample representativeness and cross-sectional design of this study, large-scale prospective representative studies are warranted to confirm these associations.

Prevalence and risk factors of depression in patients with lung cancer: protocol for a systematic review and meta-analysis

INTRODUCTION

Patients with lung cancer often experience heavy psychological distress, especially depression, which results in poorer quality of life, shorter survival time and greater mortality. Our aim is to summarise data on the prevalence and risk factors of depression in patients with lung cancer.

METHODS AND ANALYSIS

We will search PubMed, EMBASE, MEDLINE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang and Chinese Biomedicine Literature Database (SinoMed) for studies on the prevalence and risk factors of depression in patients with lung cancer, which should be published from 1 January 1975 to 25 November 2018 in English/Chinese. Two reviewers will independently screen studies, extract data and assess the risk of bias. We will use RevMan V.5.0 and STATA V.12.0 software for statistical analysis. The I² test will be used to identify the extent of heterogeneity. Publication bias will be assessed by generating a funnel plot and performing the Begg and Egger test. The quality of the systematic review will be evaluated using the AMSTAR ('A Measurement Tool to Assess Systematic Reviews') criteria and 'The Grading of Recommendations Assessment, Development and Evaluation'.

ETHICS AND DISSEMINATION

Since this is a review involving analysis of publicly available data, ethical approval is not required. The final results of this study will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018118167.

Internet addiction and poor quality of life are significantly associated with suicidal ideation of senior high school students in Chongqing, China

Background

Adolescence is a vulnerable period of life, and many mental health and behavioral problems emerge during this particular period, including depression, internet addiction (IA), and suicidal behaviors. Poor quality of life (QOL) and IA have been found to be significantly associated with suicidal ideation (SI) among Chinese university students, of whom most have been adults. Nevertheless, their associations with SI are rarely studied among Chinese adolescents. The objective of this study was to examine these relationships in a representative adolescent sample of Chinese senior high school students, who are experiencing an enormous transition from childhood to adulthood.

Methods

By using multi-stage sampling, a total of 26,688 students were successfully recruited from 29 senior high schools of a very large City in western China, Chongqing municipality. In this cross-sectional online survey, students’ demographic and lifestyle characteristics were collected with a standardized questionnaire. The Young’s IA Test, the Chinese Six-item QOL questionnaire, and item 15 of the Symptom Checklist-90-R were used to measure IA, QOL, and SI, respectively.

Results

The 1-month prevalence of SI was 11.5% among students of senior high schools in Chongqing, China. Students with SI had significantly higher QOL scores (17.3 ± 3.7 vs. 13.7 ± 3.8, P < 0.001) and higher prevalence of IA (49.6% vs. 25.6%, P < 0.001) than those without SI. After controlling for demographic, lifestyle, and clinical covariates, IA (odd ratio (OR) = 1.15, P = 0.003) and a high QOL score (OR = 1.09, P < 0.001) remained significantly associated with SI.

Conclusion

Suicidal ideation is prevalent among Chinese adolescents and it is associated with IA and poor QOL. Measures aimed at reducing IA and improving QOL may help prevent suicidal behaviors among Chinese adolescents.

Prostate cancer with bone metastasis in Beijing: an observational study of prevalence, hospital visits and treatment costs using data from an administrative claims database

OBJECTIVES

To estimate the prevalence of prostate cancer with bone metastasis in Beijing, and to estimate hospital visits and direct treatment costs among male urban employees with the disease in Beijing.

DESIGN

Cross-sectional observational study.

SETTING AND PARTICIPANTS

Patients with prostate cancer and bone metastasis from the Urban Employee Basic Medical Insurance database covering the employed population of Beijing, China, from 2011 to 2014.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence, treatment costs and healthcare visits of patients with prostate cancer and bone metastasis.

RESULTS

A total of 1672 individuals were identified as having prostate cancer. Of these, 737 (44.1%) had bone metastasis, and among these, this was already present at the time of initial prostate cancer diagnosis in 27.0% (199/737). Mean age was 74.6 years (SD ±9.1). Prevalence of prostate cancer with bone metastasis increased from 5.3 per 100 000 males in 2011 to 8.3 per 100 000 males in 2014. The total annual health expenditure per patient (in 2014 American dollars) during the study period was $15 772.1 (SD=$16 942.6) ~$18 206.3 (SD=$18 700.2); 88% of these costs were reimbursed by insurance. Medication accounted for around 50% of total healthcare costs. Western drugs accounted for over 80% of medical costs with endocrine therapy being the most commonly prescribed treatment. There was an average 6.7% increase in expenditure related to diagnostical and therapeutical procedures over study years.

CONCLUSIONS

The increase in the prevalence of prostate cancer with bone metastasis and associated healthcare costs in China reveals the growing clinical and economical burden of this disease. The high prevalence of bone metastasis among patients with prostate cancer seen in our study suggests that efforts may be needed to improve symptoms awareness and promote early help-seeking behaviour among the Chinese population.

Prevalence and risk factors of anxiety and depression in Chinese patients with lung cancer：a cross-sectional study

Background: Lung cancer is very common in China. The low cure rate, limited overall survival, and continuous therapies lead the patients to experience considerable psychological distress. Traditional Chinese medicine therapy is one unique treatment method in China. Nevertheless, most patients in the existing studies on anxiety and depression were treated in western medical hospitals. Therefore, it is necessary to identify the prevalence and risk factors of these emotional disorders in lung cancer patients treated in traditional Chinese medical hospitals. These findings may assist in clinical intervention.

Patients and methods: A total of 315 patients with lung cancer were enrolled. Individuals completed the Hospital Anxiety and Depression Scale to assess their levels of anxiety and depression. Demographic and clinical data were also collected. Binary logistic regression analysis was used to identify factors that significantly predicted anxiety and depression.

Results: The anxiety and depression prevalence rates of lung cancer patients were 43.5% and 57.1%, respectively. In the univariate analysis, patients without surgery, who were young, or who received radiotherapy were more likely to experience anxiety. Patients without surgery, who were young, or who had late-stage cancer, were more likely to experience depression. Binary logistic regression analysis showed that the risk factors of both anxiety and depression were lack of surgery and young and middle age (＜65, especially 45–65 years).

Conclusion: Anxiety and depression were very common in lung cancer patients. Lack of surgery, young, and middle age, were independent risk factors for anxiety and depression. Therefore, medical workers should pay close attention to the emotional changes of young or middle-aged patients, or patients without the chance to undergo surgery.

Quality of life of older Chinese adults receiving primary care in Wuhan, China: a multi-center study

BACKGROUND

Quality of life (QOL) is an important primary care outcome, but the QOL of older adults treated in primary care is understudied in China. This study examined QOL and its associated factors in older adults treated in Chinese primary care.

METHODS

A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire, concerning socio-demographics, major medical conditions, loneliness, and depression. QOL and depression were measured with the Chinese six-item QOL questionnaire and the shortened Geriatric Depression Scale, respectively. Multiple linear regression was used to identify factors associated with poor QOL.

RESULTS

The average QOL score of primary care older adults was (20.7 ± 2.5), significantly lower than that of the Chinese general population. Factors significantly associated with poor QOL of Chinese primary care older adults included engaging in manual labor before older adulthood (unstandardized coefficient [β]: -0.702, P < 0.001), no living adult children (β: -1.720, P = 0.001), physical inactivity (β: -0.696, P < 0.001), having ≥ four major medical conditions (β: -1.813, P < 0.001), hearing problem (β: -1.004, P = 0.017), depression (β: -1.153, P < 0.001), and loneliness (β: -1.396, P < 0.001).

CONCLUSIONS

Older adults treated in Chinese primary care have poorer QOL than the general population. Addressing psychosocial problems at Chinese primary care settings could be helpful in improving QOL in Chinese older adults.