Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas, USA.
Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston, Texas, USA.
Psychooncology. 2022 Oct;31(10):1782-1789. doi: 10.1002/pon.6014. Epub 2022 Aug 27.
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.
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.
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.
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.
本研究描述了急性淋巴细胞白血病（ALL）治疗期间自杀意念（SI）的发生率，并探讨了临床因素和躯体症状对 SI 的影响。
在一项多中心研究中，对 2012-2017 年间确诊的 ALL 患者，在巩固治疗开始时、延迟强化（DI）、维持周期 1（MC1）和维持周期 2（MC2）时使用儿童抑郁量表（CDI-2）进行评估。如果患者对“我想自杀”这一项表示肯定，则认为存在 SI。采用潜在类别分析疼痛、恶心、疲劳和睡眠的平均症状群，使用逻辑回归模型评估 SI 与社会人口因素、抑郁症状以及平均以下、平均和平均以上症状群之间的关联。
参与者（n=175）中 51%为男性，75%为高危/极高危疾病，诊断时的中位年龄为 11.2 岁（范围：7-18 岁）。总体而言，14.9%的患者（75%年龄小于 12 岁）在治疗期间出现 SI，其中巩固治疗开始时为 4%，DI 时为 9%，MC1 时为 8%，MC2 时为 4%。非西班牙裔其他患者发生 SI 的可能性是非西班牙裔白人的 10.9 倍（95%CI：2.30-53.40，p=0.003）。与平均以下症状（4.1%，p=0.003）相比，经历平均以上症状（53.3%）的患者发生 SI 的频率更高。抑郁症状与 SI 始终相关。
在儿童 ALL 治疗的最初 1 年内，年龄小于 12 岁的儿童、来自通常与风险增加无关的种族群体以及出现躯体和抑郁症状增加的儿童，更易出现 SI。这些发现强调需要加强对心理健康问题的筛查，以减轻痛苦症状。
