Predictors of Suicidal Ideation among Palliative Care Patients (747)

Abstract

1.Review literature on predicators of suicidal ideation among advanced cancer patients.2.Discuss the impact of abuse history and depression on suicidal ideation among advanced cancer patients. I. Background. Previous research suggests that pain interference with activities, depression, and limited social support predict desire for hastened death among patients with advanced cancer. II. Research Objectives. This study examines the impact of multiple predictors on suicidal ideation including pain interference, depression, limited social support, financial stress, and history of physical, emotional, or sexual abuse. III. Methods. Two hundred seventy-one consecutive new palliative care outpatients completed the Brief Pain Inventory (BPI), and an Initial Psychosocial Pain Assessment that included the DSM-IV criteria for depression. Performed by a licensed clinical psychologist, the interview assessed patient history of physical, emotional, or sexual abuse (yes/no), patient level of support (limited vs. good or excellent), and patient financial difficulties (none vs. limited/very limited). The logistic regression included abuse history and support (Step 1), financial distress (Step 2), BPI pain severity and interference (Step 3), and DSM-IV-TR Major Depression (Step 4) regressed onto suicidal ideation (yes/no). IV. Results. Eighteen percent (n=69) of patients reported thinking about ending their life. Twenty-three percent of those expressing suicidal ideation reported an actual plan for ending their lives, but only 2 people (3%) expressed intent requiring emergent intervention. There was no relationship between suicidal ideation and age, race, gender, education, employment status, or disease status. Abuse history (Wald=5.20, P=.023) and depression (Wald=8.88, P=.003) were significant predictors of suicidal ideation. Patients were two and six times more likely to report suicidal ideation if they had a history of abuse or major depression. V. Conclusion. Palliative care patients with depression and abuse histories are at greater risk for suicidal ideation. VI. Implications for Research, Policy, or Practice. Implications for this study point to a need for depression and abuse history screening among advanced cancer patients as well as close monitoring for suicidal ideation among patients with increased risk.