A cross-sectional study on associations of physical symptoms, health self-efficacy, and suicidal ideation among Chinese hospitalized cancer patients.

BACKGROUND: Epidemiological studies have shown increased risk of suicide in cancer patients compared with the general population. The present study aimed to examine the association between physical symptoms and suicidal ideation in Chinese hospitalized cancer patients and test the modifying effect of health self-efficacy on the association. METHODS: A cross-sectional study was conducted with 544 hospitalized cancer patients in two general hospitals in northeast China via face-to-face interviews. Suicidal ideation was measured by using the first four items on the Yale Evaluation of Suicidality scale and then dichotomized into a positive and negative score. Multivariate logistic regression analyses were conducted to examine the impacts of physical symptoms, health self-efficacy, and their interactions on suicidal ideation. RESULTS: The suicidal ideation rate was 26.3% in the enrolled cancer patients. Logistic regression showed that insomnia (aOR = 1.84, 95% CI 1.13 to 3.00, p = 0.015) and lack of appetite (aOR = 2.14, 95% CI 1.26 to 3.64, p = 0.005) were significantly associated with suicidal ideation. Low health self-efficacy had a marginally significant exaggerating effect on the association between pain and suicidal ideation (aOR = 2.77, 95% CI 0.99 to 7.74, p = 0.053), after adjusting for significant socio-demographics, clinical characteristics, and depression. CONCLUSIONS: These findings demonstrate significant associations between physical symptoms (insomnia and/or lack of appetite) and suicidal ideation and highlight the potential modifying role of health self-efficacy in the identification and prevention of suicide among cancer patients.

Reliability and validity of the Fear of Intimacy Scale in China.

Participants in China (n = 343) and the United States (n = 283) completed measures to assess the reliability and validity of the Fear of Intimacy Scale (Descutner & Thelen, 1991) with a Chinese population. Internal consistency was strong in both cultures, and the factor structure was also similar between cultures, with confirmatory factor analysis (CFA) identifying three-factor models in both samples. As evidence of convergent validity, the scale was positively correlated with depression and negatively correlated with social support and self-esteem. There were gender differences between cultures, but low levels of femininity were predictive of fear of intimacy in both cultures. The influence of individualism and collectivism varied, with high levels of individualism more predictive of a fear of intimacy in China than in the United States.

Self-reported symptoms of ADHD among college students in China and the United States.

OBJECTIVE: The present study examined ADHD symptoms among college students in China and the United States. METHOD: A total of 283 (45%) American and 343 (55%) Chinese students completed the Wender Utah Rating Scale (WURS) and the Current Symptoms Scale (CSS), in addition to other measures. RESULTS: Both of the ADHD measures appear to be reliable and valid, with good internal consistency, similar factor structures, and predicted relationships with other variables, such as depression and self-esteem. However, differences exist between the cultures in gender and overall reported symptom severity. CONCLUSION: ADHD symptomatology is present among college students in China in a pattern similar to that found in American college students. The WURS and the CSS appear to be effective screening measures for the disorder in China, although further research on gender and cultural differences is necessary.

Characteristics of Chinese suicide attempters: an emergency room study.

Studying the characteristics of attempted suicide is helpful in knowing the background of some completed suicides and improving prevention or intervention strategies. This current study analyzed data of 74 suicide attempters and 92 accident injured patients admitted to 6 hospital emergency rooms in an area of Northeastern China and found both similarities and differences between Chinese and Western suicide attempters. The data show that more women than men attempted suicide. Perhaps because of the unavailability of firearms to Chinese civilians, pesticide was the most lethal means of suicidal behavior. The stressful life events that account for the majority of suicidal incidents were mostly familial or marital problems. Compared with accident victims, these Chinese suicide attempters were younger, poorer, more likely to believe in a religion/superstition, more likely to perceive gender inequality, and less likely to experience support from either family or community. The traditional culture downplaying the status of women coupled with a belief in the transmigration of life may play an important role in the suicide of Chinese young women.

Studying Chinese suicide with proxy-based data: reliability and validity of the methodology and instruments in China.

This study examined the reliability and validity of the instruments as used in the psychological autopsy method in China. With data from 130 informants on 66 completed suicides and 130 informants on 66 normal community controls and 66 controls themselves, the validity was examined by comparing the responses of informants and the responses (gold standards) of the target participants in the control group. All the tested instruments were shown to be reliable, and proxy respondents were generally good judges of targets' suicidal intention, social support, depression, life events, personality traits, and mental disorders. Additionally, interrater reliabilities of the five interviewers were very good on selected scales. This study has laid a partial foundation for future psychological autopsy projects to be held in Chinese culture.

Studying suicide with psychological autopsy: social and cultural feasibilities of the methodology in China.

As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides.

An Overview of Suicide Research in China.

Chinese suicide research did not start until the end of 1970s, when China opened its door to the West through reforming its economy. Although limited Chinese suicide research conducted overseas is published and known to the West, studies conducted by Chinese researchers and published in Chinese language, which may be of more significance, are rarely known or cited in the West. Further, researchers in China with direct observation of the suicidal environment may understand the suicide differently than scholars overseas with second hand information, and therefore derive different explanations of Chinese suicide. This current study overviews suicide research conducted in China and published in Chinese during the past two decades and compares the findings with what has been reported in Western publications. Six research books and 429 journal articles are reviewed. As units of analyses, all journal articles are quantified with 151 variables analyzed. Results support findings of previous studies in terms of the suicide rates by gender, age, and rural/urban location. A unique phenomenon in Chinese suicide noticed in the study is that married Chinese are at higher risk of suicide than the non-married. Hypotheses for future research are suggested based on the articles reviewed.