Center for Medical Ethics and Health Policy Staff Publications
Publication Date
10-1-2022
Journal
Psychooncology
DOI
10.1002/pon.6014
PMID
35986586
PMCID
PMC10754031
PubMedCentral® Posted Date
12-28-2023
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
Adolescent, Child, Depression, Female, Humans, Latent Class Analysis, Male, Pain, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Prevalence, Risk Factors, Suicidal Ideation, adolescent, cancer, child, depression, fatigue, nausea, oncology, pain, psycho-oncology, sleep
Abstract
Objective: This study describes the prevalence of suicidal ideation (SI) during acute lymphoblastic leukemia (ALL) therapy and investigates the influence of clinical factors and physical symptoms on SI.
Methods: The Children's Depressive Inventory (CDI-2) was administered to ALL patients (diagnosed 2012-2017) at start of consolidation, delayed intensification (DI), maintenance cycle 1 (MC1), and maintenance cycle 2 (MC2) in a multi-site study. SI was present if patients endorsed the item "I want to kill myself." Logistic regression models evaluated associations between SI and sociodemographic factors; depressive symptoms; and below average, average, and above average symptom clusters identified using latent class analysis of pain, nausea, fatigue, and sleep.
Results: Participants (n = 175) were 51% male, 75% high-/very high-risk disease, with a median age of 11.2 years at diagnosis (range: 7-18 years). Overall, 14.9% of patients (75% under age 12 years) endorsed SI during treatment, including 4% at start of consolidation, 9% at DI, 8% at MC1, and 4% at MC2. Non-Hispanic Other patients were 10.9-times (95% CI: 2.30-53.40) more likely than non-Hispanic Whites to endorse SI (p = 0.003). The frequency of SI was higher in patients experiencing above average (53.3%) compared to below average (4.1%, p = 0.003) symptoms. Depressive symptoms were consistently associated with SI.
Conclusions: SI during the initial year of childhood ALL was more prevalent in children under the age of 12 years, from ethnic groups not typically associated with increased risk, and who endorsed increased physical and depressive symptoms. Findings highlight the need for improved screening of mental health problems to mitigate symptoms of distress.