Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis.

BACKGROUND: Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. METHODS: Patients aged 10 or above who received their first cancer-related hospital admission (2002-2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. RESULTS: In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. CONCLUSIONS: Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.

Moving towards independent living in Ghana: Narratives from young adults about their kinship care experience.

INTRODUCTION: In most sub-Saharan African countries, studies on the impact of out-of-home care experience on the transition of young adults leaving care are limited to those leaving institutional or foster care with no empirical evidence on the experiences of those moving out of kinship care. This study reports findings from interviews with young adults with experience of kinship care in Ghana, about what lessons their kinship care experiences provided in their transition to adulthood. METHOD: Twenty-five young adults aged 21-25 years (17 males, 8 females) with kinship care experience from rural communities in Ghana were purposively selected. Using a semi-structured interview guide, a qualitative short narrative approach was employed. Consistent patterns from the short narratives were analysed using the qualitative thematic approach. RESULTS: Key themes identified from the participants' narratives were a) learning from life experiences b) better decision making and c) development of resilient strategies. Young adults reported that they shaped their lives with lessons from negative experiences, advice received from caregivers and management skills obtained from the unskilled income generating activities they undertook whilst in kinship care. CONCLUSION: The study provides evidence for policymakers to consider kinship care as an effective, suitable and cost-effective alternative care arrangement for children in need of adequate parental care in Ghana. When assessing kin's suitability to provide care, some emphasis should be on caregivers' needs and assessment of activities engaged in by children living in kinship care. Social workers should provide counselling and education support to children moving out of kinship care.