Female gender is not a proven risk factor for depression in glioma

Abstract

We read Litofsky and Resnick's timely and useful review of depression in brain tumour patients with interest [1]. The authors identified screening for depression as an issue requiring future study. Because screening is often targeted at high-risk groups, it is important to study the risk factors for depression in brain tumour patients.The authors state that female gender is a risk factor for depression in glioma. It is true that some groups have found women with brain tumours to be more likely than men to become depressed [2,3]. However other researchers have not, including one of the authors of the review [4][5][6].We sent a questionnaire to the GP of each glioma patient on our hospital database (Edinburgh, UK), asking whether their patient had suffered depression both before and since the diagnosis of glioma. The diagnosis of depression was based on the clinical judgement of each GP. Response rate was 68% (100/147; 55% male). A pre-glioma (past medical) history of depression was significantly more likely in women (12/45 women compared with 3/55 men; P = 0.004, Fisher's Exact Test). However following glioma presentation the sex difference in depression disappeared and men were equally as likely as women to experience depression (12/55 and 12/45 respectively; P = 0.64).Female gender is not a proven risk factor for depression in glioma. Since general population surveys consistently report that depression is twice as common in women [7], studies reporting a more equal sex distribution for depression in brain tumours may even suggest a relatively increased risk for men.We agree that depression in glioma is a fertile field for research. For now we suggest that men and women with glioma should be considered at equal risk of developing depression, and that efforts should therefore be made to include them equally in any proposed screening programmes.

Association between depression and brain tumor: a systematic review and meta-analysis

“…These studies provided a total sample of 4518 patients (median sample size = 122 patients, range = 22–573 patients) including 25 cross-sectional [ 4 , 5 , 12 , 14 , 19 , 22 – 24 , 33 – 49 ] studies, 12 longitudinal studies [ 6 , 7 , 13 , 20 , 21 , 50 – 56 ]. No randomized controlled trial was eligible.…”

“…17 studies assessed for depression or depressive symptoms using Hospital Anxiety and Depression Scale (HADS-D) [ 4 , 7 , 13 , 14 , 21 , 33 , 35 , 39 – 43 , 45 , 46 , 49 – 51 ], 6 used Beck Depression Inventory (BDI) [ 5 , 6 , 23 , 44 , 52 , 54 , 57 ], 2 used the Zung Self-Rating Depression Scale (Zung SDS) [ 51 , 58 ], 2 used Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM-IV) [ 12 , 47 ], 10 used other methods [ 19 , 20 , 22 , 24 , 34 , 36 , 37 , 48 , 53 , 56 ]. The diagnostic criteria used by the studies were summarized in Table 1 .…”

“…Then we divided all the depression scales used by these studies into clinician-rated scales, self-rated scales and non-depression-specific scales, based on the type of depression assessment. Clinician-rated scales included DSM-IV, Hamilton Rating Scale for Depression (HDS) ≥17 [ 59 ], General Practitioner (GP) records [ 56 ], Inpatient notes [ 24 ] and Physical reports [ 36 ]. And self-rated scales included HADS-D with a cut-off ≥11 [ 60 ], and Patient Health Questionnaire–9 (PHQ-9) ≥10 [ 61 , 62 ], BDI ≥10 [ 63 ], Beck depression inventory-II (BDI-II) ≥14 [ 64 ], Center for Epidemiologic Studies-Depression Scale (CES-D) ≥16 [ 65 ], HADS-D ≥8 [ 60 ], Zung SDS ≥41 [ 66 ].…”

The frequency, longitudinal course, clinical associations, and causes of emotional distress during primary treatment of cerebral glioma

“…9 We found no evidence of an association, suggesting the possibility of a relatively increased risk for distress affecting men during primary treatment. 16 In terms of the causes of distress, there is increasing evidence that "fatigue" and "worry" are consistently present. 6,7 Causes are likely to be multifactorial, but the high frequency of AED prescription may contribute to fatigue in this population.…”

Depression and Quality of Life in Patients with Gliomas: A Narrative Review

“…This study found that female sex was an independent risk factor for SDS depression in patients with gliomas, while gender was not associated with HADS depression [ 22 ]. However, when Rooney et al [ 41 ] applied a depression questionnaire to 100 patients with gliomas (55 men and 45 women) from the Edinburgh Hospital database [ 41 ], both sexes had a similar risk for depressive symptoms after the diagnosis of glioma (12/55 and 12/45, respectively; p = 0.64), whereas women had a significantly higher risk compared to men before the diagnosis of glioma (12/45 and 3/55, respectively; p = 0.004). Thus, after the diagnosis of glioma, the gender difference in depression between men and women disappeared, i.e., female sex was not a risk factor for depression in patients with gliomas [ 41 ].…”