Are depressive symptoms more common among British South Asian patients compared with British White patients with cancer? A cross-sectional survey

Abstract

ObjectivesThis cross-sectional survey investigated whether there were ethnic differences in depressive symptoms among British South Asian (BSA) patients with cancer compared with British White (BW) patients during 9 months following presentation at a UK Cancer Centre. We examined associations between depressed mood, coping strategies and the burden of symptoms.DesignQuestionnaires were administered to 94 BSA and 185 BW recently diagnosed patients with cancer at baseline and at 3 and 9 months. In total, 53.8% of the BSA samples were born in the Indian subcontinent, 33% in Africa and 12.9% in the UK. Three screening tools for depression were used to counter concerns about ethnic bias and validity in linguistic translation. The Hospital Anxiety and Depression Scale (HADS-D), Patient Health Questionnaire-9 (both validated in Gujarati), Emotion Thermometers (including the Distress Thermometer (DT), Mini-MAC and the newly developed Cancer Insight and Denial questionnaire (CIDQ) were completed.SettingLeicestershire Cancer Centre, UK.Participants94 BSA and 185 BW recently diagnosed patients with cancer.ResultsBSA self-reported significantly higher rates of depressive symptoms compared with BW patients longitudinally (HADS-D ≥8: baseline: BSA 35.1% vs BW 16.8%, p=0.001; 3 months BSA 45.6% vs BW 20.8%, p=0.001; 9 months BSA 40.6% vs BW 15.3%, p=0.004). BSA patients used potentially maladaptive coping strategies more frequently than BW patients at baseline (hopelessness/helplessness p=0.005, fatalism p=0.0005, avoidance p=0.005; the CIDQ denial statement ‘I do not really believe I have cancer’ p=0.0005). BSA patients experienced more physical symptoms (DT checklist), which correlated with ethnic differences in depressive symptoms especially at 3 months.ConclusionsHealth professionals need to be aware of a greater probability of depressive symptomatology (including somatic symptoms) and how this may present clinically in the first 9 months after diagnosis if this ethnic disparity in mental well-being is to be addressed.

British Indian carers of stroke survivors experience higher levels of anxiety and depression than White British carers: findings of a prospective observational study

“…A large study of White British and South Asian patients attending a diabetes screening clinic in Leicestershire reported no difference in levels of depression between the two groups, utilising the World Health Organisation-Five (WHO-5) Wellbeing Index, as a screening tool (Aujla, 2009). However, a cross-sectional survey of White British and British South Asian cancer patients in Leicestershire found nearly double the level of depression in the South Asian group with significantly higher self-reported rates of fatalism, helplessness, hopelessness and denial (Lord et al, 2013). Therefore, differences in levels of anxiety and depression reported in our study may be stroke related and cannot be attributed solely to differences in baseline characteristics between the ethnic groups.…”

Mental Health and Stress Among South Asians

“…58 In one study among SAs, who may already face disproportionate rates of depressive and anxiety disorders, mental health issues can be further exacerbated by a cancer diagnosis. 59 Lord et al recently studied the coping strategies of SA cancer patients in the UK. Ninety-four British SAs (BSA) and 185 British White (BW) cancer patients completed questionnaires rating their coping mechanisms, using the Mini-Mac scale, 59 and were screened for depressive symptoms using multiple instruments, including the PHQ-9.…”

“…59 Lord et al recently studied the coping strategies of SA cancer patients in the UK. Ninety-four British SAs (BSA) and 185 British White (BW) cancer patients completed questionnaires rating their coping mechanisms, using the Mini-Mac scale, 59 and were screened for depressive symptoms using multiple instruments, including the PHQ-9. A positive screen for depressive symptoms was associated with maladaptive coping strategies.…”

“…59 BSA patients had a higher prevalence of maladaptive coping strategies, including helplessness/hopelessness (33% BSA, 12.4% BW), fatalism (based on indicators such as “I’ve put myself in the hands of God”; 75.5% BSA, 32.4% BW), and denial of having cancer (20.2% BSA, 4.3% BW). 59 After nine months, the disparity in the prevalence of depressive symptoms between the two groups remained the same. Compared to BW, BSA reported significantly more physical symptoms, including more pain, mouth sores, nausea, and fevers.…”

“…Lord et al suggests that BSA’s higher levels of physical pain may have confounded the increase in depressive symptoms over the 9-month study period. 59 …”