Depression, Anxiety, and Other Mental Disorders in Patients With Cancer in Low- and Lower-Middle–Income Countries: A Systematic Review and Meta-Analysis

Abstract

PURPOSE Cancer is a growing public health issue in low- and lower-middle–income countries (LLMICs), but the mental health consequences in this setting have not been well-characterized. We aimed to systematically evaluate the available literature on the prevalence, associates, and treatment of mental disorders in patients with cancer in LLMICs. METHODS We systematically searched Medline, PsycINFO, EMBASE, and CINAHL. We performed a random effects meta-analysis to determine the pooled prevalence of major depression or anxiety disorders in this population, defined by Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria. We qualitatively reviewed studies that examined the prevalence of depressive or anxiety disorders defined by self-report tools, the prevalence of other mental disorders, associated factors of depressive and anxiety symptoms, and the treatment of mental disorders in this population. RESULTS Forty studies spanning a 15-year period were included in the review. The pooled prevalence defined by Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria was 21% for major depression (95% CI, 15 to 28) and 18% for anxiety disorders (95% CI, 8 to 30). Depressive and anxiety symptoms were most frequently associated with advanced disease and low levels of education. Among the four studies evaluating treatment, three evaluated the effectiveness of psychotherapy and one evaluated a yoga program. CONCLUSION The prevalence of depression and anxiety in patients with cancer generally appears higher in LLMICs than in upper-income countries. Our findings demonstrate the existence of a significant and underappreciated disease burden. We suggest that clinicians remain vigilant to psychiatric symptoms. Improved screening and treatment are likely to improve quality of life and reduce both morbidity and mortality.

Prevalence and correlates of major depressive disorders among patients with cancer at Kamuzu Central Hospital in Malawi

“…Despite such ndings, other reports elsewhere had still indicated that several factors ranging from age, sex, marital status, educational status, occupation, pain, type of cancer, phase of treatment and social support were associated with depression among sub-groups of cancer patients [16]. In LMICs, depressive and anxiety symptoms were most frequently associated with advanced disease and low levels of education among most patients [14]. In North-west Ethiopia, depression was associated with high education status, unemployment, underweight and being on chemotherapy for more than six months [16].…”

“…Some patients have an overpowering reaction that interferes with their everyday activities, culminating into depressive symptoms that could last for days, or longer [9]. A systematic review of forty studies over a 15-year period from Low and Middle Income Countries (LMICs) in 2021 reported a pooled prevalence of 21% for major depression and 18% for anxiety disorders using different sets of screening tools [14]. Another systematic review of sixty-six studies in 2012 reported that prevalence of depression in de ned subgroups ranged between 5-16% in outpatients, 4-14% in inpatients, 4-11% in mixed outpatient and inpatient samples and 7-49% in palliative care [12].…”

“…Studies on the factors associated with depressive disorders among patients with cancer have had mixed results. [14]. A systematic review of longitudinal studies from high income countries focusing on patients with head and neck cancers showed that most socio-demographic and clinical factors were not important in relation to depression over time [18].…”

“…Therefore, this study was aimed at estimating the prevalence of depressive disorders among cancer patients at Kamuzu Central Hospital (KCH) using a patient health questionnaire (PHQ-9), a depression screening tool which was validated in Malawi [21]. Quantifying and characterizing such burden of mental disorders in this subgroup of patients may inform and re ne the development of cancer care services in Malawi and/or similar settings [14].…”

Spiritual well‐being and its relationship with patient characteristics and other patient‐reported outcomes in peritoneal dialysis patients: Findings from the PDOPPS

“…Stemming from the Standardized Outcomes in Nephrology‐PD (SONG‐PD) survey results, life participation was one of the top‐ranked outcomes reported by patients, caregivers and healthcare professionals 9 . It is also well‐known that depression symptoms are common in the context of this incurable disease 10 . Thus, the emotional responses of many patients depend not only on the chronicity and severity of the disease itself, but also on the patients' ability to adjust to such illness.…”