Article
Asking the right questions: Identifying suicidal ideation in patients with intracranial tumors
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Authors
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Anne-Katrin Hickmann
- Zentrum für Minimalinvasive und Endoskopische Neurochirurgie, Klinik Hirslanden, Zürich, Switzerland; Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
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Minou Nadji-Ohl
- Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
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Nikolai J. Hopf
- Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany; Neurochirurgicum, Zentrum für Minimalinvasive und Endoskopische Neurochirurgie, Stuttgart, Germany
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Oliver Ganslandt
- Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
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Naureen Keric
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Johannes-Gutenberg-Universität, Mainz, Germany
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Mirjam Renovanz
- Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany; Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Johannes-Gutenberg-Universität, Mainz, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Patients with high-grade gliomas fulfill the criteria for cancer patients at high risk for suicidal ideation, yet the incidence of suicide is low. We investigated the incidence of suicidal ideation (SI), depression and familial support in patients with intracranial tumors prospectively over the first 9 months after diagnosis.
Method: Patients were included immediately following surgery, and re-evaluated after 3, 6 and 9 months using the 21 item-including Beck-Depression Inventory (BDI) indicating severe depression with a score ≥ 18. Additionally, we constructed a questionnaire on SI und familial support according to the structure of the BDI (Lickert Scale, 4 possible answers). Patients with prior history of psychological comorbidity were excluded. Sociodemographic and clinical data were evaluated. Patients with extra-axial tumors served as control-group.
Results: 83 patients were included with slight female predominance (56.6%). (intra-axial: n = 45: extra-axial: n = 38). At 14.6 % of screenings feelings of sadness were reported, with a significant predominance in patients with intra-axial tumors (20 % vs. 9.2%, p 0.012). With the self-constructed questionnaire in 9.2 % of screenings (n = 24) SI was identified in 17 patients (21.5 %). “Having made plans” was admitted in two cases. However, the BDI revealed SI in 13 patients (15.7 %) at 18 screenings (5.4%). “Having made plans” was never indicated. The question about SI was omitted most frequently (n = 14, 82% of all incomplete datasets). No patient actively committed suicide. Patients reporting SI had significantly higher BDI-scores (p = 0.000). Yet, the majority presented with a BDI score < 18 (n = 17, 70.8 %). They were more often German speaking (n = 23, 95.8 %). The majority had no high school diploma (n = 19, 79.2 %). In patients with intra-axial tumors and SI, incomplete tumor resection was more common (n = 9, 64.3 %; n = 1, 10 % in the extra-axial group).
Conclusions: Brain tumor patients experience SI regardless of histopathology. SI was not necessarily linked to depressive symptoms. Asking specific questions about SI seems to be necessary, as screening tools like the BDI did not identify all patients in our patient sample. Patients should be screened specifically and regularly for SI especially. The association seen between extent of resection, native language and education may help clinicians to identify patients at risk and in possible need for intervention.
