Journal Article Annotations
2024, 4th Quarter

Psychooncology

Annotations by Marie Tobin, MD
January, 2025

Increased risk of hallucinations among people with cancer: Role of loneliness, job satisfaction, sleep and a moderated-mediated model of anxiety and life satisfaction.

PUBLICATION #1 — Psychooncology

Increased risk of hallucinations among people with cancer: Role of loneliness, job satisfaction, sleep and a moderated-mediated model of anxiety and life satisfaction.

Caroline Kamau-Mitchell, Barbara Lopes.

Abstract: J Psychiatr Res. 2024 Dec:180:113-120. doi: 10.1016/j.jpsychires.2024.09.041. Epub 2024 Oct 4.

Being diagnosed with cancer and coping with fears about potential death might trigger acute distress. Previous research found that patients with cancer are 1.85 times more at risk of developing mental illness. Whereas previous studies investigated the risk of schizophrenia, no studies have investigated the risk of individual psychotic symptoms such as hallucinations. This was an analysis of the English Longitudinal Study of Ageing involving 7586 adults of whom 1082 have cancer. There were 19 (0.3%) who self-reported hallucinations, and logistic regression showed that cancer patients had higher odds of hallucinating. Loneliness, discrimination, poor job satisfaction, poor life satisfaction, anxiety, low level of autonomy/control and having restless sleep were also associated with hallucinations. Cancer patients had higher odds of poor life satisfaction, which was also predicted by loneliness, discrimination, job satisfaction, anxiety symptoms, autonomy/control and restless sleep. Further results of a moderated mediation model showed that cancer, loneliness, and job satisfaction were directly associated with hallucinations, and life satisfaction was a mediator. Anxiety symptoms also moderated the relationships with hallucinations. Cancer is associated with a higher risk of hallucinations, and other aspects of mental wellbeing (e.g., anxiety and life satisfaction) are also important. Interventions are needed which safeguard mental health after cancer diagnosis and during treatment.

Annotation

The finding:
In this correlational study of 7586 adults, 1082 were found to have cancer. Nineteen of the adults with cancer reported hallucinations. Participants with cancer had higher odds of hallucinating. Poor life satisfaction mediated the relationship between having cancer and hallucinations. Anxiety moderated the relationship between cancer and hallucinations in that patients with cancer and high anxiety had higher odds of hallucinating compared to people without cancer and with low anxiety. Participants with reported loneliness and poor job satisfaction had higher anxiety and through this had higher odds of hallucinating. Poor autonomy/control and the experience of discrimination increased the odds of hallucinating indirectly through an effect on life satisfaction. Poor or restless sleep increased hallucinations through an effect on anxiety with impacted life satisfaction. Gender was not a significant covariate in the moderated-mediation model.

Strengths and weaknesses:
This is the first study to look at individual psychotic symptoms in patients with cancer. The finding of increased odds of hallucinating with cancer is noteworthy. The study also explores important mediators and moderators of the relationship between cancer and hallucinations. This helps to guide useful preventive interventions. There were also several weaknesses. The study was not designed to specifically study psychotic symptoms in cancer patients. The data come from the English Longitudinal Study of Ageing. Psychotic symptoms were self-reported and may under-represent the true prevalence of hallucinations. Identifying the type of hallucinations would have been helpful. The study is correlational and so causality cannot be inferred.

Relevance:
This study is important because it shows a correlation between having cancer and increased odds of hallucinating. The study also identifies important risk factors for developing hallucinations and highlights the mediator role of life satisfaction and the impact of anxiety on quality of life. Based on identified risk factors the study suggests several interventions to reduce the risk of developing hallucinations in patients with cancer.