Assessment of anxiety/depression among cancer patients before and during the COVID‐19 pandemic

Abstract

Objective: To assess differences in the prevalence of anxiety/depression symptoms among cancer patients before (2019) and during the COVID-19 pandemic (2020); and the associations between anxiety/depression and sociodemographic and health behavior factors among cancer patients before and during the pandemic. Methods: We analyzed data from the 2019 (n = 856) and 2020 (n = 626) Health Information National Trends Survey, a nationally representative survey of United States adults aged ≥18 years. Only adults with a cancer diagnosis were used in the analyses. Anxiety/depression was assessed using the Patient Health Questionnaire-4 (low/none [0-2], mild [3-5], moderate [6-8], and severe [9-12]) and dichotomized as low/none and current anxiety/depression (mild/moderate/severe). Multivariate analysis was performed. Results:The prevalence of anxiety/depression symptoms among cancer patients was 32.7% before the COVID-19 pandemic and 31.1% during the pandemic. The odds of anxiety/depression among patients with fair/poor health status was higher during the pandemic relative to before (before: odds ratio [OR] = 1.85 vs. during: OR = 3.89). Participants aged 50-64 years (before: OR = 0.29, 95% confidence interval [95% CI] = 0.11-0.76; during: OR = 0.33, 95% CI = 0.11-0.97) and ≥65 years (before: OR = 0.13, 95% CI = 0.05-0.34; during: OR = 0.18, 95% CI = 0.07-0.47) had lower odds of anxiety/depression before and during the pandemic compared to those aged 35-49 years. Hispanics/Latinos had higher odds of anxiety/depression (OR = 2.70, 95% CI = 1.11-6.57) before the pandemic and lower odds of anxiety/depression during the pandemic (OR = 0.2, 95% CI = 0.05-1.01) compared to non-Hispanic Whites. Those who completed high school (before: OR = 0.08, 95% CI = 0.01-0.42), some college (before: OR = 0.10, 95% CI = 0.02-0.42), ≥college degree had lower odds of anxiety/depression symptoms (before: OR = 0.05, 95% CI = 0.01-0.26; during: OR = 0.06, 95% CI = 0.01-0.61) compared to those with less than a high school education.

Health-related quality of life and depressive symptoms of patients with chronic diseases and the general population before and during the COVID-19 pandemic in Korea

“…A multivariate logistic regression analysis was performed to examine the prevalence of depressive symptoms in patients with chronic diseases and the general population, in relation to the pre-and pandemic periods of the COVID-19 pandemic; the estimates are presented as the odds ratio (OR) and 95% confidence interval (CI). Potential confounding variables were considered through a preliminary analysis and by reviewing previous studies ( Kim and Kim, 2018 ; Choi et al, 2020 ; Ettman et al, 2020 ; Cerezo and Vicario, 2021 ; Jeppesen et al, 2021 ; Adzrago et al, 2022 ; Myers et al, 2022 ), and sex, age, household income, education level, alcohol consumption, smoking status, BMI, and physical activity were included as covariates. Significant effect modification was not observed in the association between the survey year (the pre-and pandemic periods of the COVID-19 pandemic) and HRQoL/depressive symptoms.…”

Impact of COVID-19, cancer survivorship and patient-provider communication on mental health in the US Difference-In-Difference

“…The D-I-D of the odds of poor mental health was reported as an odds ratio (OR) with a 95% confidence interval (95% CI). D-I-D analyses were adjusted for age, gender, race/ethnicity, education, household income, general health status, and the chronic medical condition of lung disease because these variables were associated with mental health in prior studies 8 , 12 , 21 , 25 or were confounders in our analyses (i.e., changed covariate estimates by more than 10%). The parallel trends assumption was tested quantitatively and also by visual inspection to assess if the trends of poor mental health were consistent in those with and without a history of cancer before the pandemic 42 .…”

“…For these interaction assessments, we included interaction terms in multivariable logistic regression models. As above, variables included in the final models were associated with mental health in prior studies 8 , 12 , 21 , 25 or were a potential confounder in our analyses. We performed imputation for any covariates with missingness, ranging from 0.5% to 22.8% (see footnotes of Table 1 ).…”

“…However, studies in the U.S. have observed mixed findings. Health Information National Trends Survey (HINTS) cross-sectional data reported that the prevalence of depression/anxiety slightly decreased among cancer survivors in the U.S. during COVID-19 (2019 vs. 2020), but did not compare estimates to adults without a history of cancer 25 . Alternatively, the COVID-19 Impact Study using 2020 cross-sectional data reported that cancer survivors had more mental health symptoms, including feeling nervous, anxious, hopeless, lonely, and depressed, than their non-cancer counterparts during COVID-19 26 .…”

“…Prior studies, to our knowledge, have not examined both the impact of COVID-19 and cancer survivorship on mental health, encompassing depression/anxiety and psychological distress. Additionally, chronic medical conditions have not been assessed for potential associations with poor mental health previously among cancer survivors during COVID-19 25 . Moreover, during the pandemic, PCC was significantly associated with cancer survivors’ mental health 28 , and online patient-provider communication (OPPC) became an essential channel to address psychological distress 29 – 31 .…”