Chelsea and Westminster Hospital, Imperial College Healthcare Trust, London, UK.
Swansea University Medical School, Swansea, UK.
Br J Dermatol. 2024 Jun 20;191(1):24-35. doi: 10.1093/bjd/ljae011.
The psychological burden of cutaneous malignant melanoma (CM) is all-encompassing, affecting treatment adherence, recurrence and mortality. However, the prevalence and risk factors of anxiety and depression in CM remain unclear.
To establish a benchmark pooled prevalence of anxiety and depression in CM, to provide magnitudes of association for clinical, therapeutic and demographic correlates, and to elucidate temporal trends in anxiety and depression from the time of diagnosis.
This review followed the MOOSE guidelines. MEDLINE, Embase, PsychINFO, Web of Science and the Cochrane Library were queried from database inception to 24 August 2023. Study selection, data extraction and quality assessment were performed by two independent authors, utilizing both the Joanna Briggs Institute (JBI) and National Institutes of Health risk-of-bias tools for the latter. The GRADE approach was used to rate the certainty of evidence. Prevalence rates, 95% confidence intervals (CIs) and prediction intervals (PIs) were derived using a random-effects model and estimating between- and within-study variance.
Nine longitudinal and 29 cross-sectional studies were included (7995 patients). Based on the JBI and NIH tools, respectively, quality assessment found 20 and 17 to be at low risk of bias, 12 and 15 to be at moderate risk and 6 and 5 to be at high risk of bias. The prevalence of anxiety [30.6% (95% CI 24.6-37.0; PI 18-47%)] and depression [18.4% (95% CI 13.4-23.9; PI 10-33%)] peaked during treatment, declining to pretreatment levels after 1 year [anxiety: 48% vs. 20% (P = 0.005); depression: 28% vs. 13% (P = 0.03)]. Female sex [odds ratio (OR) 1.8, 95% CI 1.4-2.3; P < 0.001], age < 60 years (OR 1.5, 95% CI 1.2-2.0; P = 0.002) and low educational level (OR 1.5, 95% CI 1.2-2.0; P < 0.001) were likely to result in a large increase in the odds of anxiety. Depression was 12.3% higher in those with stage IV vs. those with stage I CM (P = 0.05). Relative to immune checkpoint inhibition, the rates of depression were 22% (P = 0.002) and 34% (P < 0.001) higher among patients with advanced-stage CM receiving interferon-α and chemotherapy, respectively. A significant reduction in self-reported depression scores was demonstrated over time (P = 0.003).
Notably, anxiety and depression in CM affect women, those younger than 60 years of age and the less educated, with up to 80% higher odds of anxiety in these groups. Anxiety and depression surge during chemotherapy and interferon treatment, especially in advanced CM. Our findings facilitate risk stratification and underscore the need for multidisciplinary vigilance.
皮肤恶性黑色素瘤（CM）的心理负担是全面的，影响治疗的依从性、复发和死亡率。然而，CM 中焦虑和抑郁的患病率和风险因素仍不清楚。
建立 CM 中焦虑和抑郁的基准患病率，为临床、治疗和人口统计学相关性提供关联程度，并阐明从诊断时开始的焦虑和抑郁的时间趋势。
本综述遵循 MOOSE 指南。从数据库成立到 2023 年 8 月 24 日，对 MEDLINE、Embase、PsychINFO、Web of Science 和 Cochrane 图书馆进行了检索。两名独立作者进行了研究选择、数据提取和质量评估，分别使用了 Joanna Briggs 研究所（JBI）和美国国立卫生研究院的风险偏倚工具。使用 GRADE 方法对证据的确定性进行评级。使用随机效应模型和估计组内和组间方差来得出患病率、95%置信区间（CI）和预测区间（PI）。
纳入了 9 项纵向研究和 29 项横断面研究（7995 名患者）。根据 JBI 和 NIH 工具，分别有 20 项和 17 项研究被认为具有低风险偏倚，12 项和 15 项研究具有中等风险偏倚，6 项和 5 项研究具有高风险偏倚。焦虑的患病率[30.6%（95%CI 24.6-37.0；PI 18-47%）]和抑郁的患病率[18.4%（95%CI 13.4-23.9；PI 10-33%）]在治疗期间达到峰值，在 1 年后降至治疗前水平[焦虑：48%比 20%（P = 0.005）；抑郁：28%比 13%（P = 0.03）]。女性[比值比（OR）1.8，95%CI 1.4-2.3；P<0.001]、年龄<60 岁（OR 1.5，95%CI 1.2-2.0；P = 0.002）和低教育水平（OR 1.5，95%CI 1.2-2.0；P<0.001）可能导致焦虑的几率大幅增加。与 I 期相比，IV 期 CM 患者的抑郁发生率高 12.3%（P = 0.05）。与免疫检查点抑制相比，接受干扰素-α和化疗的晚期 CM 患者的抑郁发生率分别高 22%（P = 0.002）和 34%（P<0.001）。随着时间的推移，自我报告的抑郁评分显著降低（P = 0.003）。
值得注意的是，CM 中的焦虑和抑郁会影响女性、年龄小于 60 岁和受教育程度较低的人群，这些人群的焦虑风险增加高达 80%。焦虑和抑郁在化疗和干扰素治疗期间激增，尤其是在晚期 CM 中。我们的研究结果有助于进行风险分层，并强调需要多学科警惕。
