Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
JCO Glob Oncol. 2021 Jul;7:1233-1250. doi: 10.1200/GO.21.00056.
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.
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.
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.
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.
癌症是低收入和中低收入国家（LLMICs）日益严重的公共卫生问题，但这方面的心理健康后果尚未得到很好的描述。我们旨在系统评估 LLMIC 中癌症患者精神障碍的患病率、相关性和治疗方法的现有文献。
我们系统地搜索了 Medline、PsycINFO、EMBASE 和 CINAHL。我们进行了随机效应荟萃分析，以确定该人群中主要抑郁或焦虑障碍的总患病率，该人群通过精神障碍诊断和统计手册或国际疾病分类标准定义。我们对研究进行了定性审查，这些研究检查了通过自我报告工具定义的抑郁或焦虑障碍的患病率、其他精神障碍的患病率、抑郁和焦虑症状的相关因素以及该人群的精神障碍治疗方法。
综述包括了跨越 15 年的 40 项研究。通过精神障碍诊断和统计手册或国际疾病分类标准定义的总患病率为重度抑郁症 21%（95%CI，15 至 28），焦虑症 18%（95%CI，8 至 30）。抑郁和焦虑症状最常与晚期疾病和低教育水平相关。在评估治疗的四项研究中，有三项评估了心理治疗的有效性，一项评估了瑜伽计划。
癌症患者中抑郁和焦虑的患病率在 LLMICs 中通常高于高收入国家。我们的研究结果表明存在重大且被低估的疾病负担。我们建议临床医生保持对精神症状的警惕。改善筛查和治疗可能会提高生活质量并降低发病率和死亡率。
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