Year : 2014 | Volume
: 19 | Issue : 1 | Page : 35--36
Assessment for prevalence and pattern of depression in cancer patients
Dwipen Kalita1, Manigreeva Krishnatreya2, Bhaskar Sarma Neog3, Kabindra Bhagabati4, Amal Chandra Kataki5, Gayatri Gogoi2, Nazmul Hoque2,
1 Department of Clinical Psychology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
2 Department of Cancer Epidemiology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
3 Department of Psychiatry, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
4 Department of Palliative Medicine, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
5 Department of Gynecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
Room No: 31, Old OPD Block, Dr. B. Borooah Cancer Institute, A K Azad Road, Guwahati - 781 016, Assam
The study aimed to assess the prevalence and severity of depression in cancer patients and to look for any association with sociodemographic profile. Patients registered for various cancers at a regional cancer centre were followed-up between July 2013 to October 2013. Depression in cancer patients was screened using the Mini International Neuropsychiatric Interview (MINI) questionnaire and administered the Hamilton Depression Rating Scale (HDRS) for severity of depression. Out of 183 cancer patients screened, 44 (24%) patients were identified to have depression using MINI. Mild to moderate depression was seen in 68% of married patients, and severe to very severe depression in unmarried and widowed group, severe to very severe depression was more prevalent in the illiterate group of patients (33%), and there was no association of subjective economic inequalities with degrees of depression. Further studies on larger sample size without selection bias will reveal the prevalence of depression in cancer patients.
|How to cite this article:|
Kalita D, Krishnatreya M, Neog BS, Bhagabati K, Kataki AC, Gogoi G, Hoque N. Assessment for prevalence and pattern of depression in cancer patients.J Mental Health Hum Behav 2014;19:35-36
|How to cite this URL:|
Kalita D, Krishnatreya M, Neog BS, Bhagabati K, Kataki AC, Gogoi G, Hoque N. Assessment for prevalence and pattern of depression in cancer patients. J Mental Health Hum Behav [serial online] 2014 [cited 2022 Dec 8 ];19:35-36
Available from: https://www.jmhhb.org/text.asp?2014/19/1/35/143889
Depression is a major cause of concern in cancer patients. Clinical depression is common and more often unrecognized source of suffering in cancer patients.  It is an important factor leading to drop out before the start of cancer directed treatment. Depression also contributes to suicidal tendencies in cancer patients. Prevalence of depression varies depending upon the type and sites of cancer with reported rates of 1% in acute leukemia to 40% in other cancers. , There are two core symptoms of depression namely depressed mood and a marked loss of interest or pleasure in most or all activities.  The aim of this study was to relate the sociodemographic profile of cancer patients with their depression levels and to see if there is any association between educational level, marital status, and economic condition of these patients with degrees of depression.
Materials and Methods
This study has been approved by the Institutional Ethics Committee of our institute. In this analysis patients registered and undergoing treatment for various cancers at a regional cancer centre were followed-up at the department of clinical psychology and psychiatry for evaluation of depression and its levels. The study was carried out from July 2013 to October 2013. The mini international neuropsychiatric interview (MINI) questionnaire version 5.0.0 was used for screening and processing of the symptom for depression. Hamilton's depression rating scale (HDRS) was used for grading of depression (0-7: No depression; 8-13: Mild; 14-18: Moderate; 19-22: Severe; ≥24: Very severe). Patients excluded from this study were, patients with previous history of psychiatric illness, below 18 years of age, bed ridden patients, patients in delirium, and patients with exaggerated symptoms due to the disease or its complications. A self-administered questionnaire on the financial status of the patients was recorded by the clinical psychologist. The economic status of the patients was broadly divided into financial adequacy and financial constraints.
In our cross sectional study, out of 183 cancer patients screened for depression, 44 patients were identified with depression using the MINI. In this study, 31 (70%) patients were males and 13 (30%) patients were females. All the unmarried and widowed patients were females. All the patients in this study group had received and completed the cancer directed treatment.
Severity of depression and marital status
In the married group, mild depression was seen in 18 (47%) patients, moderate depression was seen in 8 (21%) patients, severe depression in 4 (11%) patients, and very severe depression was seen in 8 (21%) patients. In the unmarried females (2 patients), 1 had very severe depression and 1 had moderate depression. In the widowed females, 2 (50%) patients had mild depression and 2 (50%) patients had moderate depression.
Severity of depression and economic inequalities
In the present study 25 (57%) patients were subjectively financially adequate (FA) and the rest 19 (43%) patients were subjectively financially constrained (FC). In the FA group mild depression was seen in 11 (44%) patients, moderate depression in 7 (28%) patients, severe depression in 2 (8%), and very severe depression in 5 (20%) patients. In the FC group, mild depression was seen in 9 (48%) of patients, moderate depression in 4 (20%) patients, severe depression in 2 (10%), and very severe depression in 4 (22%) patients. Statistical analysis for associating the economic inequality and the severity of depression was done using the Chi-square test, which showed no significant difference (Chi-square coefficient = 0.066, P = 0.7966, df: 1).
Severity of depression and educational status
In the literate group of patients, mild depression was seen in 44% (13/29) of patients, 27% (8/29) patients were having moderate depression, 7% (2/29) patients were having severe, and very severe depression was seen in 21% (6/29) patients. In the illiterate group of patients, 47% (7/15) had mild depression, 20% (3/15) patients had moderate depression, severe depression was seen in 13% (2/15) and very severe depression was seen in 20$ (3/15) (20%).
Amongst the different psychiatric disorders in cancer patients the prevalence of depression is high.  Chochinov et al. has shown in the terminally ill cancer patients depression rates ranges from 13% to 26% and Hosaka and Aoki reported as high as 28% in cancer patients. , In this cross sectional study, 24% of patients with cancer had depression. This is an under estimate of the actual number due to exclusion criteria of the present study. The rates were dependant on how stringent diagnostic system was applied and how the physical symptoms were classified. Lack of awareness of psychiatric distress symptoms amongst oncologists leads to drop out from cancer directed treatment. In this study, all the patients had received and completed the cancer directed treatment in spite of their severity of depression due to the referrals from the respective oncologists for the management of their psychiatric distress. This has highlighted the importance of understanding the psychological distress by concerned oncologists and referral of these patients for psychological and psychopharmacological treatment. Sociodemographic inequalities in a homogenous and developed society can significantly contribute to different out comes in the cancer survival,  and in a developing society like ours with significant disparities among different groups it may influence more so in the management of cancer patients suffering from depression. In analysis, the association of severity of depression with subjective economic inequality is insignificant, as depression of varying degrees is seen both in patients with subjective financial constraints and those with financial adequacy.
The failure to detect and treat elevated levels of psychological distress may jeopardize the outcome of cancer therapies, decrease patient's quality of life and increase health care cost.  In this study because of early recognition of psychiatric distress there was excellent compliance to cancer directed treatment.
Further studies on large sample size without selection bias will reveal the prevalence of depression in cancer patients and no significant association of degrees of depression with sociodemographic parameters could be established in this study. Early recognition of psychiatric distress for the identification of depression is an integral part in the comprehensive management of cancer patients.
|1||Massie MJ, Holland JC. Overview of normal reactions and prevalence of psychiatric disorders. In: Holland JC, Rowland JH, editors. Handbook of Psycho-Ocology: Psychological Care of the Patient with Cancer. New York: Oxford University Press; 1989. p. 273-82.|
|2||Colón EA, Callies AL, Popkin MK, McGlave PB. Depressed mood and other variables related to bone marrow transplantation survival in acute leukemia. Psychosomatics 1991;32:420-5.|
|3||Bukberg J, Penman D, Holland JC. Depression in hospitalized cancer patients. Psychosom Med 1984;46:199-212.|
|4||American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4 th ed. Washington, DC: American Psychiatric Association; 1991.|
|5||Mishra SK, Mohapatra PK, Bhattacharya K, Gupta T, Agarwal JP. Prevalence of psychiatric disorder in asymptomatic or minimally symptomatic cancer patients on treatment. J Cancer Res Ther 2006;2:136-9.|
|6||Chochinov HM, Wilson KG, Enns M, Lander S. Prevalence of depression in the terminally ill: Effects of diagnostic criteria and symptom threshold judgments. Am J Psychiatry 1994;151:537-40.|
|7||Hosaka T, Aoki T. Depression among cancer patients. Psychiatry Clin Neurosci 1996;50:309-12.|
|8||Lagerlund M, Bellocco R, Karlsson P, Tejler G, Lambe M. Socio-economic factors and breast cancer survival - a population-based cohort study (Sweden). Cancer Causes Control 2005;16:419-30.|
|9||Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology 2001;10:19-28.|