A descriptive analysis of depression and pain complaints among patients with cancer in a low income country

Abstract

BackgroundIn high income countries, cancer is one of the leading causes of death, with co-morbid depression contributing to the risk of increased mortality. However, both cancer and depression are neglected conditions in low income countries. The current study assessed the magnitude of depression and the association of pain complaints with depression among patients with cancer in a low income country.MethodIn this cross-sectional study participants were 390 patients with established diagnosis of cancer, who were recruited consecutively when visiting a tertiary treatment centre in Addis Ababa, Ethiopia. The occurrence of depression was determined using the nine items Patient Health Questionnaire (PHQ-9). Major depressive disorder was confirmed: (1) when five or more of the PHQ-9 symptoms were endorsed as occurring for at least ‘more than seven days’, with the exception of suicidal ideation item which counted as a positive rating if it had occurred even once in the previous fifteen days. (2) one of the symptoms has to be either depressed mood or loss of interest. Pain complaint was measured by Numeral Rating Scale (NRS) and severity of pain was assessed using Verbal Rating Scale (VRS).ResultsThe prevalence of major depressive disorder was 16.4% (95%CI: 13.1%, 20.4%), and subthreshold depression was 17.4% (95%CI: 14.0%, 21.5%). Pain complaints occurred in 69.0% (95%CI: 64.3%, 73.4%) of the participants. The odds of having a major depressive symptom was over four times higher among participants who had pain.LimitationsThe study was cross sectional and liable to recall bias. Recruitment was carried out in a tertiary referral hospital, which might lead to the selection of more economically well-off and educated participants limiting generalizability of the study. Moreover, we did not control for cancer types, which may be related to pain and the experience of depression. Some of the somatic symptoms in PHQ9 may also be related to the cancer itself.ConclusionsThis study highlights the clinical significance of both depression and pain complaints in patients with cancer in a low income country. Exploration of the impact of depressive disorders on quality of life and outcome of cancer is an important area for further research in low income countries.

Anxiety and depression among cancer patients: prevalence and associated factors at a Rwandan referral hospital

“…[19] The results revealed that the depression prevalence was higher than anxiety, as over two-thirds had depression (67.7%), and only half had anxiety (52.1%). These findings were similar to three studies: in China, the depression was a more significant psychological disorder among cancer patients than anxiety; [22] in Ethiopia the depression rate was 58.44%, higher than the anxiety rate of 51%; [23] and in Iran, the depression rate was 32% and anxiety 26.7%. [21] In contrast, two other studies used the HADS instrument and reported higher anxiety prevalence and lower depression levels among cancer patients.…”

“…300 patients were interviewed from both the outpatient and inpatient department using The Aga Khan University Anxiety and Depression Scale (AKUADS) and a significant problem in a study in LMIC where cancer patients were four times more likely to suffer from a major depressive disorder. [22] Cancer stage was significantly associated with anxiety, and these results are similar to studies conducted in Indonesia, [29] and Portugal. [30] The current study revealed that depression had a significant association with treatment type, especially in cancer patients receiving chemotherapy (68.7%), similar to another study.…”

High burden of depression among cancer patients on chemotherapy in University of Gondar comprehensive hospital and Felege Hiwot referral hospital, Northwest Ethiopia

“…The magnitude of depression in this study was consistent with other studies conducted among Chinese cancer patients (66.72%) [8] whereas this figure was higher than a study conducted in Addis Ababa [12], Iran [4] and meta-analysis done by Krebber et al [7]. This discrepancy could be attributable to the difference in the study populations in terms of types of cancer, the tool used for screening or other socio-demographic variations and severity of depression considered.…”

“…Cancer, the most stressful event that a person may experience often triggers depression [4,5]. The prevalence of depression among cancer exceeds that observed in the general population [6] and it ranges from 16.4% to 66.72% [4,[7][8][9][10][11][12]. Depression among cancer patients affects treatment since they have to take medications for both cancer and depression [4], affect acceptance of adjuvant cancer treatment [13], adherence [14] extend hospitalization, reduces the quality of life [15,16], and increases the risk of suicide [17].…”

Distress Assessment and Response Systems in Patients With Cancer Pain

“…Studies conducted abroad have demonstrated a high rate of pain when the DART was used as a screening tool in cancer patients [6]. A cross-sectional study conducted by Alemayehu M et al [7] showed that the prevalence of moderate-to-severe depression in 390 cancer patients was 16.4% (95% CI: 13.1-20.4). In the current study, the incidence rates for self-reported depression and anxiety were 33.8% and 20.1%, respectively, in patients with moderate-to-severe pain.…”