Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Surgery, Aga Khan University, Karachi, Pakistan
BMJ Open. 2020 Sep 9;10(9):e032748. doi: 10.1136/bmjopen-2019-032748.
The prevalence of depression among patients with primary brain tumour ranges from 15% to 40% globally. Several individual and clinical factors contribute to the development of depression. However, their association with depression in Pakistani setting has not yet been assessed. Thus, we aim to study the factors associated with depression among adult patients with primary brain tumour at a tertiary care hospital in Karachi, Pakistan.
A prospective cross-sectional study.
This study was conducted at a tertiary care hospital of Karachi, Pakistan.
This study included 132 patients with confirmed diagnosis of primary brain tumour (initially diagnosed on MRI of the brain with contrast and later confirmed on histology of surgical specimen) in various stages of treatment.
The primary outcome of this study was to assess depression and its associated factors among adult patients with primary brain tumour. Depression was assessed using a validated screening tool Patient Health Questionnaire-9 (PHQ-9). Scores of 10-27 on PHQ-9 were indicative of screen positive for depressive symptoms. A set of the structured pre-tested questions was used to evaluate patient-related, tumor-related and treatment-related factors.
Fifty-one (39%, CI: 33.33-46.94) patients in our study screened positive for depressive symptoms on PHQ-9. There was a significant association between depressive symptoms and Karnofsky Performance Scores (KPS) (prevalence ratio: 3.25 and CI: 1.87-5.62) after controlling covariates. Propensity scores predicted a positive association between KPS (functional status) and unemployment, treatment stage, and tumour recurrence. Tumor-related and treatment-related factors including tumour grade, location, type and hemispheric lateralisation were found insignificant.
Depression is common in patients with primary brain tumour. Impaired functional status has a direct impact on depression in these patients. Incorporating the psychosocial domain earlier in the course of treatment needs to be considered for better neuro-oncology management of patients with primary brain tumour.
全球范围内，原发性脑肿瘤患者的抑郁患病率为 15%至 40%。一些个体和临床因素促成了抑郁的发生。然而，这些因素与巴基斯坦患者的抑郁情况之间的关联尚未得到评估。因此，我们旨在研究巴基斯坦卡拉奇一家三级护理医院的成年原发性脑肿瘤患者中与抑郁相关的因素。
前瞻性横断面研究。
这项研究在巴基斯坦卡拉奇的一家三级护理医院进行。
本研究纳入了 132 名经确诊患有原发性脑肿瘤（最初在脑磁共振成像（MRI）中进行诊断，并通过手术标本的组织学进一步确认）且处于不同治疗阶段的患者。
本研究的主要结果是评估成年原发性脑肿瘤患者的抑郁情况及其相关因素。抑郁通过经过验证的筛查工具患者健康问卷-9（PHQ-9）进行评估。PHQ-9 的评分在 10-27 分之间表示有抑郁症状。使用一套结构化的预测试问题来评估与患者相关、肿瘤相关和治疗相关的因素。
在我们的研究中，51 名（39%，95%置信区间：33.33-46.94）患者 PHQ-9 筛查呈阳性，表明存在抑郁症状。在控制了混杂因素后，抑郁症状与 Karnofsky 表现评分（KPS）之间存在显著关联（患病率比：3.25，95%置信区间：1.87-5.62）。倾向评分预测了 KPS（功能状态）与失业、治疗阶段和肿瘤复发之间的正相关关系。肿瘤相关和治疗相关因素，包括肿瘤分级、位置、类型和大脑半球侧化，结果无统计学意义。
抑郁在原发性脑肿瘤患者中较为常见。功能状态受损对这些患者的抑郁有直接影响。在治疗过程中更早地纳入社会心理领域，需要考虑对原发性脑肿瘤患者进行更好的神经肿瘤学管理。
