The effects of psychological interventions on depression and anxiety among Chinese adults with cancer: a meta-analysis of randomized controlled studies

Abstract

BackgroundOur previous studies found the high prevalence of depression and anxiety among Chinese cancer patients, and many empirical studies have been conducted to evaluate the effects of psychological interventions on depression and anxiety among Chinese cancer patients. This study aimed to conduct a meta-analysis in order to assess the effects of psychological interventions on depression and anxiety in Chinese adults with cancer.MethodsThe four most comprehensive Chinese academic database- CNKI, Wanfang, Vip and CBM databases-were searched from their inception until January 2014. PubMed and Web of Science (SCIE) were also searched from their inception until January 2014 without language restrictions, and an internet search was used. Randomized controlled studies assessing the effects of psychological interventions on depression and anxiety among Chinese adults with cancer were analyzed. Study selection and appraisal were conducted independently by three authors. The pooled random-effects estimates of standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated. Moderator analysis (meta-regression and subgroup analysis) was used to explore reasons for heterogeneity.ResultsWe retrieved 147 studies (covering 14,039 patients) that reported 253 experimental-control comparisons. The random effects model showed a significant large effect size for depression (SMD = 1.199, p < 0.001; 95% CI = 1.095-1.303) and anxiety (SMD = 1.298, p < 0.001; 95% CI = 1.187-1.408). Cumulative meta-analysis indicated that sufficient evidence had accumulated since 2000–2001 to confirm the statistically significant effectiveness of psychological interventions on depression and anxiety in Chinese cancer patients. Moderating effects were found for caner type, patients’ selection, intervention format and questionnaires used. In studies that included lung cancer, preselected patients with clear signs of depression/anxiety, adopted individual intervention and used State-Trait Anxiety Inventory (STAI), the effect sizes were larger.ConclusionsWe concluded that psychological interventions in Chinese cancer patients have large effects on depression and anxiety. The findings support that an adequate system should be set up to provide routine psychological interventions for cancer patients in Chinese medical settings. However, because of some clear limitations (heterogeneity and publication bias), these results should be interpreted with caution.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-956) contains supplementary material, which is available to authorized users.

Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta‐analyses

“…Overall , lower compared to previously conducted meta-analyses. [21][22][23][24][25]27,31,32 In contrast to these previous reports, our study applied much stricter inclusion criteria only extracting data from large and high-quality studies. Our study further closely examined moderators of effectiveness.…”

“…Evidence for their effectiveness was summarised in 1 early meta-analysis by Sheard Two meta-analyses conducted in China reported large ESs (ES: >0.8) in reducing symptoms of anxiety; however, these studies may not be representative of the patient experience elsewhere. 23,24 Other meta-analyses focused on differences in effectiveness according to cancer stage, type or intervention methods (psychoeducation, psychosocial, behavioural), and reported widely ranging ESs. [25][26][27][28][29][30][31][32] Previous analyses did not apply strict inclusion criteria which may have contributed to the large differences in ESs.…”

Depressive symptoms and positive affect in Chinese and United States breast cancer survivors: a cross-cultural comparison

“…Nevertheless, methods of cancer prevention and control have improved in China so that many Chinese women are living longer after a diagnosis of breast cancer. With this increase in survival, psychosocial concerns including depression and quality of life (QOL) has gained increasing attention in China [4, 5]. Studies on breast cancer patients have found depressive symptoms ranging from 26 to 36% in Chinese samples and around 30% in US samples compared to 4.5 to 9.3% for women in the general US population [6–9].…”

Depression, Anxiety and Quality of Life of Cancer Survivors

“…And cancer is also considered as a serious and potentially life-threatening illness, cancer patients do experience a range of psychological and physical medical challenges. 3 The main problems of long-term cancer survivors are in the areas of emotional and/or social support, health habits, spiritual/philosophical view of life and body image concerns. 4 Cancer survivors struggle emotionally, needing to adjust to changes treatment has made to their body; have to cope with short-term and long-term side effects of their cancer or its treatment; have to live with the knowledge that their cancer cannot be cured, even though they feel healthy; have difficulties accessing information about their condition or any after-effects they may experience; struggle financially as the household income decreases; experience problems returning to the workplace.…”