Prevalence and its associated psychological variables of symptoms of depression and anxiety among ovarian cancer patients in China: a cross-sectional study

Suicide rates of cervical cancer patients in the United States - Who is most at risk? A retrospective study of 69,493 patients

OBJECTIVE

This study aims to identify demographic and treatment factors associated with suicide risk among cervical cancer patients in the United States.

METHODS

Data were obtained from the SEER database (2000-2020). Women with cervical cancer and follow-up time were included. Demographics and treatment history for women who died by suicide were compared to those who did not using chi-square tests. Suicide rates were compared to age-matched U.S. WHO 2019 data with the Mantel-Haenszel test. Univariate logistic regression estimated odds ratios for suicide risk, and Kaplan-Meier survival analysis examined overall survival (excluding suicide) by demographic and treatment factors. Linear regression assessed the link between time from diagnosis to treatment and time from diagnosis to suicide.

RESULTS

Among 69,493 cervical cancer patients diagnosed from 2000 to 2020, most were White (75.9 %), aged 30-49 (46.4 %), lower-middle income (52.0 %), from metropolitan counties (88.0 %), and had localized disease (35.0 %). Fifty-eight patients died by suicide, with a suicide risk 8.8 times higher than the general population. Younger age groups (15-29 and 30-49) had the highest risk, being 18.9 and 11.2 times more likely to die by suicide, respectively. Suicide risk was significantly associated with age, ethnicity, stage, year of diagnosis, and chemotherapy, with highest risk in younger, Non-Hispanic, localized stage, diagnosed from 2000 to 2005, and no chemotherapy (p < 0.05). Delayed treatment correlated with shorter time from diagnosis to suicide (R² = 0.124; p = 0.015).

CONCLUSIONS

Suicide rates are significantly elevated among cervical cancer patients, especially in young, Non-Hispanic patients with localized disease and no chemotherapy. Delayed treatment was linked to shorter time to suicide, emphasizing the need for targeted mental health support.

Effects of expressive writing of positive emotions on mental health among patients with ovarian cancer undergoing postoperative chemotherapy

PURPOSE

Patients with ovarian cancer often experience significant psychological distress during postoperative chemotherapy, including anxiety and depression. Expressive writing of positive emotions has shown potential in improving psychological health and fostering post-traumatic growth (PTG) in cancer patients. However, its application to ovarian cancer patients undergoing chemotherapy remains under-explored.

METHODS

A quasi-experimental study was conducted with 82 ovarian cancer patients undergoing postoperative chemotherapy at a tertiary hospital in Changchun, China. Patients were divided into an experimental group (n = 40) receiving expressive writing intervention and a control group (n = 42) receiving routine care. Outcomes were assessed using the Post-Traumatic Growth Inventory (PTGI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at baseline and after a 6-week intervention.

RESULTS

After the intervention, the experimental group exhibited significantly higher PTGI scores (mean ± SD: 73.43 ± 6.95) compared to the control group (63.19 ± 5.91, P < 0.001), with improvements observed across all five PTG dimensions (P < 0.05). The experimental group also showed a greater reduction in SAS (mean ± SD: 38.25 ± 4.31 vs. 45.12 ± 5.17, P < 0.001) and SDS scores (mean ± SD: 42.10 ± 3.86 vs. 48.75 ± 4.62, P < 0.001).

CONCLUSIONS

Expressive writing of positive emotions significantly enhances PTG and reduces anxiety and depression in ovarian cancer patients undergoing chemotherapy. This intervention offers a cost-effective and feasible approach for psychological support in clinical settings.

Post-Traumatic Stress Disorder (PTSD) Among Algerian Cancer Patients: Validity of the Arabic DSM-5 PTSD Checklist (PCL-5) and Associated Factors

BACKGROUND

Cancer patients are at risk of post-traumatic stress disorder (PTSD) throughout their treatment journey due to serious challenges (e.g., complex surgical interventions, severe pain, and side effects from chemotherapy or radiation therapy). This may worsen patients' health and negatively impact their overall treatment journey and well-being. However, this area remains understudied in Algeria. Therefore, there is a need to understand the levels of PTSD symptoms and the associated factors among Algerian patients. To ensure accurate assessment and diagnosis, a validation study was conducted to confirm that the PTSD measurement instrument used was culturally appropriate for the Algerian context. The study's main objectives were to (i) determine the prevalence of PTSD among cancer patients in Algeria, (ii) validate the Arabic DSM-5 PTSD Checklist (PCL-5) among Algerian cancer patients, and (iii) explore the associations between demographic and clinical factors and PTSD among this population.

METHODS

The present study was cross-sectional and comprised 370 cancer patients. All participants were patients receiving treatment in oncology wards across various hospitals. All participants completed the PCL-5. Confirmatory factor analysis (CFA) was used to examine the factor structure of the PCL-5.

RESULTS

The PCL-5 was found to have a four-factor structure. Out of the 370 participants, 154 (41.6%) had PCL-5 scores below the cutoff of 31, indicating lower levels of PTSD symptoms; 216 participants (58.4%) had scores above this threshold, suggesting a likelihood of PTSD. Moreover, PTSD was significantly associated with patients' low educational attainment and more advanced stages of their disease.

CONCLUSIONS

The findings indicated moderate to high PTSD symptoms among cancer patients in Algeria. Moreover, the Arabic PCL-5 demonstrated good psychometric properties confirming that it is a reliable and valid tool for assessing PTSD symptoms among Algerian cancer patients.

The prevalence of anxiety symptoms/disorders in cancer patients: a meta-analysis

OBJECTIVE

Cancer can have negative effects on mental health. The aim of this study was to investigate the prevalence of anxiety symptoms/disorders in cancer patients' worldwide using meta-analysis.

METHODS

The study population was cancer patients who had cancer at the time of the study. The outcome studied in this study was anxiety symptoms/disorders. PubMed and Scopus were searched based on the syntax of keywords, this search was limited to articles published in English until September 2021. For this meta-analysis, data on the prevalence of anxiety were first extracted for each of the eligible studies. The random-effects method was used for the pool of all studies. Subgroup analysis was performed based on sex, anxiety disorders, cancer site, and continents. Heterogeneity in the studies was also assessed.

RESULT

After evaluating and screening the studies, eighty-four studies were included in the meta-analysis. Prevalence of anxiety symptoms/disorders in cancer patients showed that this prevalence is 23% (I2 = 99.59) in the 95% confidence interval between 22-25%. This prevalence was 20% (I 2 = 96.06%) in the 95% confidence interval between 15-24% in men and this prevalence is 31% (I 2 = 99.72%) in the 95% confidence interval between 28-34% in women. The highest prevalence of anxiety was in patients with ovarian, breast, and lung cancers.

DISCUSSION

It showed a high prevalence of anxiety symptoms/disorders in cancer patients, in addition to therapeutic interventions for cancer, the necessary interventions should be made on the anxiety of these patients. Methodological limitation was the heterogeneity between the studies included in the meta-analysis. Some types of cancer sites could not be studied because the number of studies was small or the site of cancer was not identified.

Effect of resilience on quality of life and anxiety in patients with breast cancer

BACKGROUND

The incidence of breast cancer is high, with serious implications in terms of lives and health. Relevant data show that there are approximately 1 million new cases of breast cancer reported annually, with a rising trend. Some patients have poor treatment effects and are prone to anxiety and other negative emotions, which affect their quality of life (QoL).

AIM

To explore the correlation between mental resilience, QoL, and anxiety in patients with breast cancer.

METHODS

Using convenience sampling, 200 patients with breast cancer were selected from the First Affiliated Hospital of Hebei North University. These patients were investigated using the Conner-Davidson Resilience Scale, Self-Rating Anxiety Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire to analyze the impact of resilience in patients with breast cancer on their QoL and anxiety.

RESULTS

The mean (SD) mental resilience score of the patients with breast cancer was 59.68 (± 9.84) points, the anxiety score was 49.87 (± 8.26) points, and the QoL score was 59.73 (± 8.29) points. Overall, they showed low mental resilience, mild anxiety, and medium QoL. Anxiety was negatively correlated with mental resilience and QoL (r = -0.275, r = -0.289, P < 0.05). QoL was positively correlated with mental resilience (r = 0.513, P < 0.05). Anxiety was a mediating variable between mental resilience and QoL, accounting for 8.58% of the mediating effect.

CONCLUSION

Regarding psychological elasticity, anxiety plays an intermediary role in QoL among patients with breast cancer. Medical staff can improve patients' mental resilience by reducing their anxiety and improving their QoL.

Pre-Pandemic Predictivity of Anxious-Depressive Symptoms in Post-Surgical Traumatic Distress in Hysterectomy for Benign Disease and COVID-19 Outbreak: A Case-Control Study

Background: The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic led to several needed containment measures that conditioned the onset of depressive, anxiety, and post-traumatic stress symptoms in the population. These symptoms, especially if not diagnosed and treated, can also occur in patients undergoing medical care or surgery, with a high impact on people's lives and causing low adherence to treatment. The study evaluates whether the spread of the coronavirus disease 2019 (COVID-19) worsened the onset of post-surgical distress and symptoms of anxiety and depression in a population undergoing hysterectomy for benign disease during the pandemic era, comparing it with a population with the same characteristics but recruited before COVID-19. Methods: The sample was evaluated before surgery (T1), post-operatively (T2), and 3 months after surgery (T3) through a sociodemographic questionnaire and through the HADS (Hospital Anxiety and Depression Scale) to evaluate anxious-depressive symptoms and the PCL-5 (Post-traumatic Stress Disorder Checklist for DSM-5) to assess the onset of post-surgical distress. Results: Patients treated after the COVID-19 pandemic showed a higher depressive symptoms rate compared with those treated before (p-value = 0.02); conversely, pre-COVID-19 patients were more prone to develop post-traumatic stress disorder (PTSD) (p-value = 0.04). A significant association between the occurrence of PTSD and anxiety-depressive symptoms registered at T2 (p-value = 0.007) and T3 (p-value < 0.0001) emerged. In the end, the COVID-19 pandemic has exerted a detrimental influence on the mental well-being of the patients under investigation, with a notable exacerbation of their mood disturbances. Conclusions: The findings advocate for the implementation of psychometric and psychodiagnostic assessments to promptly detect high-risk scenarios that could lead to PTSD, compromising treatment compliance and exacerbating the overall outcome, resulting in substantial direct and indirect burdens.

The effectiveness of digital psychosocial interventions on psychological distress, depression, anxiety, and health-related quality of life in patients with gynaecological cancer: a systematic review and meta-analysis

PURPOSE

Patients with gynaecological cancer often experience psychological issues due to multiple stressors. Psychological disturbances have debilitating effects on patients with gynaecological cancer. In recent decades, digital psychosocial interventions have rapidly advanced and been incorporated into mental health interventions. Digital psychosocial interventions could provide patients with several benefits over traditional in-person interventions, including convenience, anonymity, flexible scheduling, and geographic mobility. The aim of this systematic review was to synthesize the effectiveness of digital psychosocial intervention in reducing psychological distress, depression, and anxiety and improving health-related quality of life in patients with gynaecological cancer.

METHODS

Three-step extensive search was performed on 22 December 2022 from nine bibliographic databases, trial registries and grey literature. Experimental studies involving patients with gynaecological cancer utilizing digital psychosocial interventions for the improvement of mental health outcomes were included. Meta-analysis was conducted using RevMan 5.4 software. Heterogeneity was analysed by Cochran's Q test and I2. Subgroup analyses were attempted to evaluate relative effect sizes of subgroup features.

RESULTS

Meta-analysis of nine studies revealed small effect size in reduction of depression post-intervention (d = 0.24, 95% CI - 0.46 to - 0.02) and medium effect size in reduction of psychological distress post-intervention (d = 0.51, 95% CI - 0.81 to - 0.21) and follow-up (d = 0.65, 95% CI - 1.25 to - 0.05) compared to the control group. The effects of digital psychosocial interventions on anxiety and health-related quality of life were not statistically significant.

CONCLUSIONS

Digital psychosocial interventions probably reduced psychological distress and slightly reduced depression amongst patients with gynaecological cancer compared to the control group, which can be integrated into clinical practice. Additional trials with rigorous methodology and bigger sample sizes are needed to validate findings.

TRIAL REGISTRATION

PROSPERO (CRD42023389502).

The Prevalence of Depression and Anxiety in Women with Ovarian Cancer: An Updated Systematic Review and Meta-Analysis of Cross-Sectional Studies

BACKGROUND

The results of this study included the prevalence of anxiety and depression in women with ovarian cancer.

METHODS

A thorough search of numerous databases, including PubMed (Medline), Scopus, Web of Science, Embase, and PsycoInfo, was conducted to identify relevant cross-sectional studies published between July 2013 and October 2021. STATA 16 was used to analyses the data, and a random effects model was used to determine the pooled prevalence and a 95% confidence interval (95%CI).

RESULTS

Of the 18 cross-sectional studies reviewed, 17 reported the prevalence of anxiety and 16 reported the prevalence of depression in patients with ovarian cancer. There was a moderate degree of heterogeneity between studies, as the pooled prevalence of depression was 27% (95%CI: 14%-41%; I2=69.44%). Similarly, there was a greater degree of heterogeneity in the pooled prevalence of anxiety, which was found to be 33% (95%CI: 21%-44%; I2=78.55%).

CONCLUSION

The findings of this study show that, compared to the overall female population, ovarian cancer patients have much greater rates of sadness and anxiety. These results highlight the necessity for healthcare policymakers to prioritize the provision of resources and support for carrying out additional research, such as longitudinal studies or cohorts, to ascertain the efficacy of various treatments or interventions intended to lessen mental health disorders in women diagnosed with ovarian cancer. Healthcare practitioners can enhance the general wellbeing and quality of life for women with this disease by addressing the psychological components of care.

Colorectal Cancer Surgery: Influence of Psychosocial Factors

(1) Background: In the treatment of colorectal cancer, it is important to consider different psychosocial factors. Our first objective was to measure the levels of perceived stress in subjects diagnosed with colorectal cancer awaiting potentially curative surgery. Also, we aimed to analyse what coping styles these patients used, how they perceived their illness, and the subsequent influence of these factors on their levels of stress. (2) Methods: Stress, coping styles and illness perception were assessed in a sample of 107 patients. The instruments used were the Perceived Stress Scale (PSS-14), the Stress Coping Questionnaire (SCQ) and the Brief Illness Perception Questionnaire (BIPQ-R). (3) Results: Patients using active coping styles have lower levels of perceived stress (p = 0.000; p = 0.002) than patients making use of passive coping styles (p = 0.000; p = 0.032; p = 0.001). A multi-linear regression model found that the perception of illness and the use of the negative approach coping style (p = 0.000; p = 0.001) influence an increase in perceived stress, and that a decrease in stress levels was influenced by the problem solving coping style (p = 0.001). (4) Conclusions: Based on our results, we recommend preventive interventions in care patients undergoing colorectal cancer surgery.

Relationship between supportive care needs with coronavirus anxiety and death anxiety of women with gynecologic cancer during the COVID-19 pandemic

AIM

The study aimed to determine the relationship between supportive care needs with coronavirus anxiety and death anxiety of women with gynecologic cancer during COVID-19.

METHODS

The population of the study was women with gynecologic cancer who received chemotherapy in a university hospital. The study sample was calculated using G*Power 3.1.9.4 analysis program and completed with 64 patients who agreed to participate and met the research criteria. The personal information form, supportive care needs survey-short form (SCNS-SF29^Tr ), coronavirus anxiety scale (CAS), and death anxiety scale (DAS) were used for data collection.

RESULTS

The participants' SCNS-SF29^Tr mean score was 105.7 ± 17.26, CAS mean score was 11.19 ± 3.96, and DAS mean score was 40.13 ± 15.5. There was a positive, very high-level correlation between the health system and information and psychological needs subscales of SCNS-SF29^Tr and CAS (r = 0.809, r = 0.878, respectively; p < 0.05). In addition, a high-level relationship was found between the daily life subscale of SCNS-SF29^Tr and CAS (r = 0.674; p < 0.001). A positive low-level relationship was determined between the health system and information, daily life, and psychological needs (except for the sexuality) subscales of SCNS-SF29^Tr and DAS (r = 0.357, r = 0.252, r = 0.353 respectively; p < 0.05).

CONCLUSION

Gynecologic cancer participants had unmet supportive care needs in all subscales except for the sexuality. The participants had higher supportive care needs, high-level coronavirus anxiety, and medium-level death anxiety. In addition, the participants' all supportive care needs have increased as their coronavirus anxiety levels have increased. The participants' supportive care needs have increased, except for sexuality, as their death anxiety levels have increased.

Symptom distress and suicidal ideation among Chinese ovarian cancer patients: A moderated mediation model of depression and suicide resilience

Objective

The aim of this study was to examine whether depression mediates the relationship between symptom distress and suicidal ideation in Chinese patients with ovarian cancer, and whether this mediating effect was moderated by suicide resilience.

Methods

From March to October 2022, this cross-sectional study was performed in a three Grade 3A hospital and an oncology specialty hospital in Wuhan, Hubei Province, China. Ultimately, 213 ovarian cancer patients completed anonymous self-report. Bootstrapping method was used for regression analysis to test the mediating and moderating effects.

Results

Among the 213 participants, 29.58% (n = 63) exhibited significant suicidal ideation. Symptom distress was positively associated with suicidal ideation, and depression partially mediated this relationship. Suicide resilience moderated the relationship between depression and suicidal ideation. In ovarian cancer patients with low suicide resilience, the effect of symptom distress on suicidal ideation through depression was greater, while in patients with high suicide resilience, this effect was attenuated.

Conclusion

Our study suggests that symptom distress could be more likely to lead to suicidal ideation as depression levels increase in ovarian cancer patients. Fortunately, suicide resilience could attenuate this negative effect.

Changes in Depression and Sleep Quality and Associated Factors in Women Receiving Chemotherapy for Ovarian Cancer: An Observational Study

BACKGROUND

Although women with ovarian cancer experience depression and poor sleep quality, little is known about how various factors, particularly self-efficacy, might be associated with these conditions.

OBJECTIVES

The aim of this study was to examine the prevalence of and changes in depression and sleep quality and the factors associated with these conditions in a cohort of women with ovarian cancer before, during, and after chemotherapy.

METHODS

A prospective repeated-measures design was adopted in this study. Participants were women with ovarian cancer who were expected to receive 4 to 6 cycles of chemotherapy and were recruited at a medical center in Taiwan. The participants were asked to complete a questionnaire that included the Symptom Distress Scale, Center for Epidemiologic Studies Depression Scale, General Self-efficacy Scale, and Pittsburgh Sleep Quality Index. The data were collected before, during, and after the course of chemotherapy.

RESULTS

Overall, 24.6% to 36.9% of women were at risk for depression; 75.4% to 80.0% of women had poor sleep quality. There were no significant changes in depressive symptoms and sleep quality throughout the course of chemotherapy. More severe depressive symptoms were associated with higher levels of symptom distress and lower self-efficacy. Poorer sleep quality was associated with higher levels of symptom distress.

CONCLUSIONS

Among participants, more depressive symptoms and poorer sleep quality were associated with higher levels of symptom distress or lower self-efficacy.

IMPLICATIONS FOR PRACTICE

Healthcare providers should continuously assess depression and sleep quality in women with ovarian cancer. These symptoms may be improved by strengthening self-efficacy and relieving symptom distress.

Perceived stress in different countries at the beginning of the coronavirus pandemic

OBJECTIVE

The coronavirus has spread around the world, causing an ongoing pandemic. After the lockdown and quarantine protocols, an evaluation of the population's current emotional state was made through a web-based survey available in both English and Spanish. The objective was to observe how respondents perceived stress and worry as a result of COVID-19.

METHODS

The survey gathered data across three sections: socio-demographic data, the Perceived Stress Scale (PSS-10) by Cohen, and additional queries on current worries and behaviors due to this pandemic.

RESULTS

The survey received 1523 respondents from 48 countries. The mean of the PSS-10 score was 17.4 (SD 6.5). Significantly higher scores were observed among women, young adults, students, and those who expressed concern about getting infected and considered themselves high-risk. No significant differences were observed between health professionals and other professions.

CONCLUSIONS

We describe an increase in stress levels due to the COVID-19 and point out groups at high risk. These findings could help to address the mental health care that is needed.

Higher stress and symptom severity are associated with worse depressive symptom profiles in patients receiving chemotherapy

PURPOSE

In a sample of oncology patients, identify subgroups of patients with distinct depressive symptom profiles and evaluate for differences in demographic and clinical characteristics, levels of stress and resilience, and the severity of common co-occurring symptoms.

METHODS

Patients (n = 1327) had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Demographic and clinical characteristics, stress, resilience, and co-occurring symptoms were evaluated at enrollment. Depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression (CES-D) scale a total of six times over two cycles of chemotherapy. Latent profile analysis (LPA) was used to identify subgroups of patients (i.e., latent classes) with distinct depressive symptom profiles using the six CES-D scores.

RESULTS

Based on the findings from the LPA, 47.3% of the patients were classified as "None"; 33.6% as "Subsyndromal"; 13.8% as "Moderate"; and 5.3% as "High". Compared to None class, patients in the Subsyndromal, Moderate, and High classes had a lower functional status, a higher comorbidity burden, and a self-reported diagnosis of depression or back pain. Those patients with higher levels of depressive symptoms reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms.

CONCLUSIONS

Inter-individual variability in depressive symptoms was associated with demographic and clinical characteristics, multiple types of stress and levels of resilience, as well as with the increased severity of multiple co-occurring symptoms. The risk factors associated with worse depressive symptom profiles can assist clinicians to identify high risk patients and initiate more timely supportive care interventions.

The relationship between spiritual well-being, hope and depression in gynecologic oncology patients

The authors' aim in this study was to determine the relationship between spiritual well-being, hope and depression in gynecologic oncology patients. This is a descriptive and correlational study. The patients received a total of 41.59 ± 12.11 points from the Spiritual Well-Being Scale, 5.57 ± 4.19 points from the Beck Hopelessness Scale, and 14.92 ± 11.61 points from the Beck Depression Scale. Gynecologic oncology patients had high spiritual well-being levels and low hopelessness and depression levels, and their hopelessness and depression levels decreased and hope levels increased as their spiritual well-being levels increased.

Mental distress, quality of life and physical symptoms in Chinese women with ovarian cancer receiving olaparib treatment during the COVID-19 pandemic

OBJECTIVES

Women with ovarian cancer (OC) have experienced unprecedented challenges since the novel coronavirus disease-2019 (COVID-19) outbreak in China. We aim to evaluate the experience of psychological status, physical symptoms and quality of life (QoL) and investigate the impact of COVID-19 pandemic on OC patients receiving olaparib.

METHODS

The survey was conducted online from April 22 to May 12 in 2020. Demographic and clinical questions were listed to collect general information. The degree of insomnia, depression, anxiety, stress symptoms and QoL were assessed by the Chinese versions of the Insomnia Severity Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised, and the General Functional Assessment of Cancer Therapy, respectively. Multivariate logistic regression analysis was conducted to analyze the risk factors for mental distress and QoL.

RESULTS

A total of 56 respondents coming from 15 various provinces in China participated in the survey. The prevalence of insomnia, depressive, anxiety, stress symptoms and reduced QoL were 37.5, 51.8, 37.5, 30.4, and 51.8%, respectively. Unfavorable disease status, shorter period of olaparib administration, adverse events of olaparib and delay in cancer care were correlated with mental health problems. Reduced QoL was also significantly associated with psychological distress.

CONCLUSIONS

This study emphasized that mental health problems and reduced QoL should gain more attention in women with OC who are receiving oral olaparib at home. Appropriate psychological healthcare strategies are necessary for OC patients during the COVID-19 pandemic.

Influence of COVID-19 pandemic on stress levels of urologic patients

Introduction

Several studies have shown the consequences of COVID-19 pandemic on perceived stress of different populations, but none of them analyzed urological patients who underwent elective surgery.

Methods

We enrolled prospectively patients who underwent elective surgery between March and October 2020. A survey on COVID-19 and the 4-item Perceived Stress Scale (PPS-4) questionnaire were administered at hospital admission. Demographic and medical history data were also collected. Uni- and multivariate analyses were performed to identify independent predictors of higher PSS-4 values (≥7).

Results

A total of 200 patients were enrolled. Mean PSS-4 value resulted 6.04. Patients with PSS-4 value ≥7 resulted 43.5% (87/200). In multivariate analysis, PSS-4 value ≥7 was independently associated (p < 0.05) with female gender (OR 6.42), oncological disease (OR 2.87), high (>5 in a range between 0 and 10) fear of intrahospital transmission of SARS-CoV-2 infection (OR 4.75), history of bladder instillation (OR 0.26), and current smokers (OR 0.27)

Conclusion

High PSS-4 values at hospital admission in urologic surgical patients are positively correlated with female gender, fear of intrahospital transmission of SARS-CoV-2 infection, and oncological disease. PSS-4 questionnaire could be useful to select patients for whom a preadmission counselling is necessary to improve the management of their high stress level.

Effect of stress and avoidant coping on depression and the moderating role of age among men who have sex with men: Findings from a 6-month prospective cohort study

BACKGROUND

Men who have sex with men (MSM) are at increased risk of mental health problems. Few studies have examined the risk factors for mental health problems of Chinese MSM and identified potential moderators using a longitudinal design.

OBJECTIVES

The present study examined the effect of stress and avoidant coping on depression among MSM, and the moderating role of age on such relationship.

METHODOLOGY

A 6-month observational prospective cohort study was conducted among Chinese MSM. Respectively 592 and 402 MSM completed a survey at baseline and 6-month follow-up.

RESULTS

The prevalence of probable depression was 36.1% at baseline and 34.1% at 6-month follow-up. After adjusting for background characteristics and baseline depression score, both stress (β = .22, p<.05) and avoidant coping (β = .14, p<.05) showed significant positive relationship with depression at 6-month follow-up. The interaction effect of age and stress / avoidant coping was also significant. The effect of stress on depression was stronger among younger MSM, and the effect of avoidant coping on depression was significant among younger MSM but non-significant among older MSM.

CONCLUSIONS

Mental health promotion for MSM should reduce stress and avoidant coping, and specific intervention should be designed for younger MSM.

Hospital anxiety and depression scale exhibits good consistency but shorter assessment time than Zung self-rating anxiety/depression scale for evaluating anxiety/depression in non-small cell lung cancer

This study aimed to compare Zung self-rating anxiety/depression scale (SAS/SDS) and hospital anxiety and depression scale (HADS) regarding the detection rate, detection consistency, and time of assessment in non-small cell lung cancer (NSCLC) patients.Totally 290 NSCLC patients who underwent surgical resection were consecutively recruited and clinical data of patients were collected. Patients' anxiety and depression were assessed using HADS and SAS/SDS when they were discharged from hospital and consumption of the time for completing HADS and SAS/SDS was recorded.The anxiety detection rates by SAS (57.9%) and HADS-A (51.0%) were of no difference (P = .095). Also, there was no difference in anxiety severity detected by the 2 scales (P = .467). Additional correlation analysis revealed that both anxiety scores (r = 0.702, P < .001) and detected anxiety (Kappa = 0.626, P < .001) were consistent by SAS and HADS-A. Regarding depression, depression detection rate by SDS (47.6%) was higher than that of HADS-D (39.3%) (P = .044); the depression severity by SDS was more advanced than that by HADS-D (P = .002). The subsequent correlation analysis showed that both depression scores (r = 0.639, P < .001) and detected depression (Kappa = 0.624, P < .001) were consistent by SDS and HADS-D. In addition, the time for HADS assessment (7.6 ± 1.2 minutes) was shorter than SAS/SDS assessment (16.2 ± 2.1 minutes) (P < .001).HADS could be a better choice for assessing anxiety and depression in NSCLC patients, benefiting from its shorter assessment time but consistent detection rate compared with SAS/SDS.

The Mediating Role of Hope in the Relationship Between Perceived Stress and Post-Traumatic Stress Disorder Among Chinese Patients with Oral Cancer: A Cross-Sectional Study

PURPOSE

Cancer diagnosis and treatment are long-term traumatic stressors. Depression and anxiety are known to be prevalent in patients with cancer, but post-traumatic disorder (PTSD) has been overlooked frequently in this population. This study aimed to estimate the prevalence of PTSD and examined the mediating role of hope in the relationship between perceived stress and PTSD symptoms in Chinese patients with oral cancer.

METHODS

A total of 230 oral cancer patients were recruited to complete a questionnaire including the Posttraumatic Stress Checklist-Civilian Version (PCL-C), the Perceived Stress Scale-10 (PSS-10) and the Herth Hope Index (HHI). Analysis of variances (ANOVA)/t-test, Person's r and hierarchical linear regression analysis methods were conducted to assess the associations among perceived stress, hope and PTSD symptoms. Asymptotic and resampling strategies were used to explore the mediating role of hope.

RESULTS

The prevalence of PTSD symptoms was 6.05% in Chinese patients with oral cancer. Perceived stress was positively related to PTSD symptoms, explaining 39.9% of the variance. In addition, hope was negatively related to PTSD symptoms, explaining 5.9% of the variance. Besides, the proportion of mediation of hope was 30.06%.

CONCLUSION

Perceived stress was positively associated with PTSD symptoms, and hope was negatively associated with PTSD symptoms. Furthermore, hope played partial mediating role in the relationship between perceived stress and PTSD symptoms. Thus, more attention should be paid to patients' PTSD status, and take measures is to relieve stress and increase hope.

Anxiety and depression symptoms among ovarian cancer patients in China: a cross-sectional study†

Objective

To investigate the prevalence of cancer-related depression and anxiety in western China among patients with ovarian cancer and analyze their influencing factors.

Methods

In this prospective cross-sectional study, qualified patients were asked to fill in questionnaires. Multivariate analysis and binary logistic regression analysis were used to test the associations among symptoms of depression and anxiety, coping styles, and influencing factors.

Results

A total of 270 ovarian cancer inpatients who met the criteria for participation in the study completed the questionnaires. The levels of depression and anxiety that prevailed in ovarian cancer patients were 47.03% and 57.77%, respectively. Among them, 90.38% of cancer-related anxiety patients and 91.33% of cancer-related depression patients showed mild symptoms. The chi-square test showed that there were statistically significant differences (P < 0.05) in the fields of education level and income. T-test showed that cancer-related depression and anxiety were associated with coping style, and the difference had statistical significance (P < 0.05). Furthermore, multivariate analysis showed that the education level and coping style were the independent influencing factors of depression and anxiety.

Conclusions

The present study suggested that about half of the ovarian cancer patients had with depression and anxiety symptoms. The majority of the cancer-related depression and symptoms were mild. Educational level and coping style should be considered during the interventions of cancer-related depression and anxiety.

Stressor-Oriented MUlticomponent Intervention and the WeLl-Being of Patients with Alzheimer's Disease: A Randomized Controlled Trial (SOUL-P)

BACKGROUND

Patients with Alzheimer's disease (AD) experience various stressors that negatively impact well-being. Most studies have, however, small effect size and are limited by the experiences of severe patients. Therefore, we conducted a single-blind, randomized controlled trial, which has included patients at different stages.

OBJECTIVE

The stressor-oriented multicomponent program was designed as an intervention for AD patients to enhance well-being.

METHODS

Patients were randomly assigned to control or SOUL-P conditions according to disease severity. The SOUL-P group received 15 intensive sessions over 6 months and 6 maintenance sessions over a 6-month follow-up by a multidisciplinary team comprising psychologists, occupational therapists, and community nurses. The control group received a similar number of sessions by community nurses. Stress-related outcomes (primary stressors and well-being outcomes) were obtained from in-person baseline and follow-up interviews conducted at 6- and 12-months post-baseline. A treatment compliance survey was conducted at the intervention endpoint for patients.

RESULTS

Of the 863 patients screened, 218 (25.3%) were eligible. At 6 months, compared to controls, SOUL-P patients had improved quality of life (QoL) (p < 0.001; Cohen d = 0.56), depression (p = 0.020; Cohen d = -0.33), neurobehavioral symptoms (p = 0.034; Cohen d = -0.30), perceived stress (p = 0.030; Cohen d = -0.31), and family conflict (p = 0.026; Cohen d = -0.32). QoL, depression, perceived stress, and family conflict were still significantly different at 12 months. Most patients were satisfied with SOUL-P, while caregivers in the SOUL-P group reported overloading tasks.

CONCLUSION

SOUL-P may reduce perceived stress and improve psychological outcomes in AD patients. Stressor-based interventions, patient-oriented goals, and a multidisciplinary team are essential features for a successful SOUL-P.

The impact of depressive symptoms on health value in patients with gynecologic cancer: A comparison with physical symptoms and performance status

OBJECTIVE

The importance of managing depressive symptoms is frequently underestimated in the clinic. In this study, the effects of depressive symptoms on health utility value (HUV) in gynecologic cancer patients are evaluated. In addition, the effects were compared with those of performance status and physical symptoms.

METHODS

Patient-reported outcome data from 274 gynecologic cancer patients were prospectively collected. HUV was measured using the 3-level version of the EuroQoL 5-dimension descriptive system (EQ-5D-3L) and the EuroQoL visual analog scale (EQ-VAS). The Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depressive symptoms. The impact of depressive symptoms on HUV was analyzed using the generalized linear model.

RESULTS

Moderate-severe depressive symptoms were significantly associated with a decrease in HUV in gynecologic cancer patients (p < 0.0001 for the EQ-5D-3L and EQ-VAS). Severe fatigue and severe pain were also associated with a decrease in HUV (p = 0.018 and p < 0.0001 for the EQ-5D-3L and EQ-VAS; p < 0.0001 for the EQ-5D-3L, respectively), and the effect sizes were comparable to that of moderate-severe depressive symptoms. In addition to the patients with moderate-severe depressive symptoms, the patients with mild depressive symptoms also experienced a significant decrease in HUV (p < 0.0001 for the EQ-5D-3L and EQ-VAS). The effect size for mild depressive symptoms was comparable to those for mild fatigue or mild pain.

CONCLUSIONS

Even mild depressive symptoms may significantly compromise HUV in gynecologic cancer patients, and the effect is comparable to that of performance status or physical symptoms. Gynecologic oncologists should put more effort into properly preventing, detecting, and managing depressive symptoms.

The effectiveness of online interventions for patients with gynecological cancer: An integrative review

OBJECTIVE

With advantages of easy accessibility and various multimedia interactivity formats, online interventions have been developed to improve health outcomes for patients with a variety of gynecological cancers, but evidence regarding their effectiveness for such patients is not well-understood. This review aimed to synthesize study findings that were published in English or Chinese regarding the effectiveness of online interventions on the quality of life, symptom distress, social support, psychological distress, sexual well-being, and body image in patients with gynecological cancer.

METHODS

This integrative review adhered to five steps, including problem identification, literature search, quality appraisal, data analysis, and presentation. Ten electronic databases (MEDLINE, ScienceDirect, SpringerLink, PubMed, Wiley Online Journals, Web of Science, OVID, CINAHL Plus with Full Text, China National Knowledge Infrastructure, and Cochrane Library) were searched from the inception of each database to April 2019 in accordance with the rigid and explicit inclusion and exclusion criteria. Version 2018 of the Mixed Methods Appraisal Tool was used for the quality appraisal of the articles.

RESULTS

Out of 276 articles, 24 potentially eligible articles were initially identified. A manual search retrieved an additional eligible three articles. After nine articles were excluded, ten quantitative, six qualitative, and two mixed-methods articles were finally included. Online interventions improved quality of life and body images in patients with gynecological cancer, but there were inconclusive effects on symptom distress, social support, psychological distress, and sexual well-being.

CONCLUSIONS

Online interventions have been increasingly used as clinically promising interventions to promote health outcomes among patients with gynecological cancer. Studies with more rigorous designs and sufficient sample sizes are needed to elucidate the effectiveness of such online interventions. Healthcare workers can incorporate existing or new online interventions into their routine care to improve health outcomes for patients with gynecological cancer.

The Association Between Resilience and Mental Health in the Somatically Ill

BACKGROUND

Resilience refers to an individual's positive adaptation to the experience of adversity. The maintenance of mental health is commonly considered a sign of successful coping with adverse conditions. The goal of the present meta-analysis was to investigate the association between resilience and mental health in patients with a somatic illness or health problem.

METHODS

Studies were included if they reported measures of association between resilience, as assessed using a version of Wagnild and Young's Resilience Scale, and self-reported mental health. A systematic literature search was conducted in the Medline, Web of Science, PsycInfo, PubPsych, and ProQuest databases and in the dissertation catalogue of the German National Library. In addition, a manual search was carried out. The study was registered with PROSPERO (registration number: CRD42017054822).

RESULTS

55 studies involving a total of 15 003 patients were included in the meta-analysis. Assuming a random-effects model, the weighted mean Pearson correlation between resilience and mental health was r = 0.43 (95% confidence interval [0.39; 0.48], p<0.001). This association was robust, although the heterogeneity among individual effect sizes was substantial (I2 = 89.6%). Correlations tended to be weaker in unpublished studies than in published ones.

CONCLUSION

Despite substantial heterogeneity across studies, the findings suggest a strong association between resilience and mental health in the somatically ill. In clinical practice, a lack of resilience as a resource for successful coping might indicate a need for psychosocial support during treatment for somatic illness.

Comparison of Hospital Anxiety and Depression Scale (HADS) and Zung Self-Rating Anxiety/Depression Scale (SAS/SDS) in Evaluating Anxiety and Depression in Patients with Psoriatic Arthritis

BACKGROUND

This study aimed to compare the Hospital Anxiety and Depression Scale (HADS) and the Zung Self-Rating Anxiety/Depression Scale (SAS/SDS) in evaluating anxiety and depression in psoriatic arthritis (PsA) patients.

METHODS

A total of 70 PsA patients were enrolled. Demographic and clinical characteristics were collected after enrollment. HADS-A and SAS were used to evaluate the anxiety of PsA patients, while HADS-D and SDS were used to evaluate the depression of PsA patients.

RESULTS

Similar results were observed in detecting the rate of anxiety by HADS-A and SAS (27.1 vs. 21.4%, p = 0.424), and there was no difference in classifying the severity of anxiety by HADS-A and SAS (p = 0.347). The Spearman test also disclosed that HADS-A score was positively associated with SAS score (p <0.001). The rates of depression were similar by HADS-D and SDS (27.1 vs. 40.0%; p = 0.108). However, different results were observed in grading the severity of anxiety by HADS-D and SDS (p = 0.009), and no correlation was observed between HADS-D and SDS scores (p = 0.138). The consumption of time for HADS assessment was shorter than that for SAS/SDS assessment (p < 0.001). In addition, a positive correlation of HADS-A score with patients' global assessment (PGA) (p = 0.022) and fatigue scores (p = 0.028) was discovered, and HADS-D score was positively associated with PGA score (p = 0.019). SAS or SDS score presented less correlation with clinical features of PsA patients, which illuminated that only SAS score was positively associated with duration of psoriasis (p = 0.030).

CONCLUSION

HADS seems to be a better option for anxiety and depression assessment than SAS/SDS in PsA patients.

Psychometric properties of the Chinese version of the Center for Epidemiologic Studies Depression Scale-Revised in patients with cancer: A cross-sectional study

BACKGROUND

Depressive symptoms are common in patients with cancer and more prevalent in Chinese patients. The Center for Epidemiologic Studies Depression Scale is one of the most widely used self-report scales to assess depressive symptoms in both community and hospitalized samples. A revised Center for Epidemiologic Studies Depression Scale has been created, but the evidence on psychometric properties is limited.

OBJECTIVES

To develop the Chinese version of the scale, and to examine the cross-cultural validity, structural validity, construct validity, internal consistency, test-retest reliability, measurement error, responsiveness, and floor/ceiling effect of the scale among patients with cancer according to the recommendation in the consensus-based standards for the selection of health status measurement instruments checklist.

DESIGN

A cross-sectional survey design with 33 participants (approximately 10%) completing the follow-up survey for evaluating the test-retest reliability.

SETTINGS

Randomly selected eight wards of an oncology hospital in China.

PARTICIPANTS

Of the 595 patients we approached in the randomly selected eight wards, 310 gave their informed consent and completed the survey.

METHODS

The Chinese version of the Center for Epidemiologic Studies Depression Scale-Revised was developed by four researchers (two translators and two reviewers) who were proficient in both English and Chinese. Participants completed the scale and the depression module of the Patient Health Questionnaire. Principal components analyses, Spearman's correlation, the Mann-Whitney U test, Cronbach's alpha, and the intraclass correlation coefficient were used.

RESULTS

The cross-culture validity was excellent based on the consensus-based standards for the selection of the health status measurement instruments checklist. A two-factor structure was determined: somatic symptoms and affective-cognitive symptoms. The sufficient construct validity was supported by that the score of the Center for Epidemiologic Studies Depression Scale-Revised was strongly correlated with the depression module of the Patient Health Questionnaire score (rho = 0.73, p <  0.001) and patients who had received chemotherapy (p =  0.002)/radiotherapy (p =  0.035) reported higher scores of depression than those who have not. The Cronbach's alphas of the total scale and subscales ranged from 0.82-0.88. The test-retest reliability was sufficient (intraclass correlation coefficient = 0.73-0.81, all p <  0.001) for total scale and subscales. The smallest detectable change was 2.98 and the responsiveness was adequate, with no floor/ceiling effect.

CONCLUSIONS

This study supports the Chinese version of the Center for Epidemiologic Studies Depression Scale-Revised as a valid and reliable measurement of depressive symptoms in patients with cancer.

Associations of perceived stress with the present and subsequent cortisol levels in fingernails among medical students: a prospective pilot study

Purpose

Cortisol in fingernails could retrospectively reflect cumulative stress over a long period. However, the association between fingernail cortisol and perceived stress needs to be validated. This exploratory study aimed to investigate the associations of perceived stress with the present and subsequent cortisol levels in fingernails of the subjective stress measurement among medical students.

Methods

Students were recruited from a medical university in Shenyang, China. The final sample consisted of 51 students (16 men, 35 women). On the Day 30 of our data and fingernail collection procedure, the 10-item Perceived Stress Scale was used to measure perceived stress. Fingernail samples were collected twice, on Days 15 (denoted as FD15) and 45 (denoted as FD45) of the procedure, and participants were asked to grow fingernails for 15 days in each collection. Cortisol was determined by an enzyme immunoassay method using the ELISA kit. Multiple linear regression was performed to examine the association between perceived stress and cortisol level. The Bonferroni correction was made for multiple comparisons.

Results

The level of cortisol was 5.65 pg/mg (SD =1.88) for FD15 and 5.41 pg/mg (SD =1.63) for FD45. Perceived stress was not associated with the cortisol level of FD15 (β=−0.014, P=0.924), but it was significantly and positively associated with the cortisol level of FD45 (β=0.436, P=0.003), which remained significant after Bonferroni correction. The associations between fingernail cortisol and demographic variables (gender, age, BMI, and physical activity) were not significant.

Conclusion

This study was the first to investigate fingernail cortisol in China. Perceived stress was positively associated with the subsequent cortisol levels in fingernails, but not the present. The findings suggested that fingernail cortisol could indicate stress exposure in the past. Furthermore, a simple and easy self-reported measure could reflect cumulative stress as measured by fingernail cortisol.