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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 95-99

Level of depression among cancer patient: A cross-sectional study


Department of Psychiatric, AIIMS, Jodhpur, Rajasthan, India

Date of Submission25-Mar-2021
Date of Decision10-May-2021
Date of Acceptance20-Sep-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Ms. Ritu Dahiya
College of Nursing, AIIMS, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iopn.iopn_25_21

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  Abstract 


Introduction: Cancer is a major public health problem throughout the world. Globally, cancer is the second leading cause of death, new cases were 18.1 million, and cancer was responsible for an estimated 9.6 million deaths in the year 2018. Cancer increases the risk of psychiatric diseases, and one-third of patients with cancer has mental health disorders and is in need of appropriate psychological treatment. Anxiety and depression are widely common psychological distresses among most patients with cancer. The aim of this study was to assess the level of depression among cancer patients. Methodology: The present study was a nonexperimental cross-sectional research design with quantitative approach was conducted on a sample of 400 cancer patients at AIIMS, Jodhpur. The participants were selected by consecutive sampling, and data were collected through face-to-face interview among patients with cancer. A self-reported questionnaire on demographic, clinical profile, and level of depression was assessed by standardized scale PHQ-9. Results: The present study revealed the level of depression among cancer patients, out of them 8.8% were having minimal depression, followed by 20.3% mild depression, 39.8% moderate depression, 17.8% moderately severe depression, and 13.5 were having severe depression. Conclusion: The findings of the study suggested that cancer diagnosis generates a higher sense of distress and leads to cause depression whether minimal or severe. Results of the study show that there is no association between level of depression and selected demographic variables of the study as per Chi-square analysis.

Keywords: Cancer patients, level of depression, PHQ-9


How to cite this article:
Dahiya R, Parihar A, Swami MK, Sevak S. Level of depression among cancer patient: A cross-sectional study. Indian J Psy Nsg 2021;18:95-9

How to cite this URL:
Dahiya R, Parihar A, Swami MK, Sevak S. Level of depression among cancer patient: A cross-sectional study. Indian J Psy Nsg [serial online] 2021 [cited 2022 Aug 15];18:95-9. Available from: https://www.ijpn.in/text.asp?2021/18/2/95/332793




  Introduction Top


Major chronic diseases of the world are cardiac disease, cancer, chronic lung disease, stroke, Alzheimer's, diabetes, renal disease, etc., Among all these diseases, cancer is a major public health problem throughout the world. Globally, cancer is the second leading cause of death, were 18.1 million new cases, and 9.5 million cancer-related deaths, and cancer was responsible for an estimated 9.6 million deaths in the year 2018. Cancer is causing 1 in 6 deaths globally. Cancer is responsible for a large number of deaths, cancer is also increasing the risk of psychiatric diseases, and one-third of patients with cancer are suffering from mental health disorders and have need of adequate psychological treatment, stress, anxiety, and depression are widely known as common psychological disorder among most patients with cancer.[1]

It is a fact that cancer is a life-changing experience for the cancer survivors, their families, and friends. Moreover, one more thing along with cancer its treatment also have rather drastic psychological and physiological effects on the sufferer. Moreover, the physiological effects with cancer include sexual dysfunction, chronic pain, infertility, constant fatigue, numbness, osteoporosis, incontinence, and hair loss. Psychological effects include stress, low confidence, and depression.[2]

By the year 2020 in the United States, estimated cases according to sex and cancer type were listed in descending order and out of them, first, the breast cancer, lung and bronchus cancer, prostate cancer, colon and rectum cancer, melanoma of the skin, bladder cancer, renal pelvis cancer, endometrial cancer, non-Hodgkin lymphoma, kidney and leukaemia, pancreatic cancer, thyroid cancer, and liver cancer. Moreover, approximately 1,806,590 cancer cases will be diagnosed and approximately 4950 new cases each day. Approximately 48,530 new cases will be of ductal carcinoma in situ of the breast diagnosed in women and 95,710 new cases of melanoma in situ of the skin.[3]

According to the WHO, depression is one of the most common psychiatric disorders in the world that is affecting over 120 million people worldwide. Moreover, 38% prevalence was reported for major depression and 58% for depression spectrum syndromes.

Depression has a great impact on emotional health as well as on recovery of disease. All data are suggesting that, as depression has great impact on psychological well-being, so systematic screening can be performed using standardized tools. Only screening is not sufficient for depression, but it must be followed by an adequate clinical diagnosis based on specific identification of emotional and cognitive symptoms of depression. The prevalence of depression in cancer patients is increasing, so the oncological teams are expected to do the depression diagnosis and make the first antidepressants prescription by themselves and suggest behavior therapy.[4]

A comprehensive meta-analysis was conducted by Krebber et al. to assess the prevalence of depression in cancer patients. Moreover, for this, the researcher conducted a meta-analysis on 66 studies and the aim was to determine the prevalence of depression among cancer patients in oncological setting, hematological, and other care settings. The study revealed that 16.3% (95% confidence interval = 13%–20%), are suffering from major depression in nonpalliative care settings, and for data collection, they use psychiatric interviews according to the DSM-IV criteria or International Classification of Diseases 10 criteria of depression.[5]

In the literature, there are many studies which are suggesting that cancer patients suffer from depression and anxiety, but this study will help to identify the level of depression among the cancer patients who are coming to AIIMS, Jodhpur, whether they are suffering from depression or not. Because a few studies have been conducted in India, and no study has been conducted in Jodhpur yet. Moreover, I have tried to include all the demographic variables which may be associated with the level of depression so that association can be find out. Therefore, researcher felt the need to assess the level of depression among cancer patients at AIIMS, Jodhpur.

Objectives of the study

  • To find out level of depression among cancer patients at AIIMS Jodhpur
  • To find out association between level of depression among cancer patients and selected demographical variable.


Assumption

The study assumes that patient with cancer will have depression.


  Methodology Top


The study was conducted to assess the level of depression among cancer patients at AIIMS Jodhpur. The researcher has used the quantitative research approach. The nonexperimental cross-sectional design was selected to assess the level of depression. The population of the current study comprises a total of 400 patients with cancer were selected from oncology OPD and IPD at AIIMS, Jodhpur, using consecutive sampling technique. Sample size was calculated through Cochran formula. In the present study, the researcher used a self-reported questionnaire on demographic profile and PHQ-9 to assess the level of depression among cancer patient. Moreover, the PHQ-9 is a 9-question instrument given to patients in a primary care setting to screen for the presence and severity of depression. The permission of standardized tool was not obtained as this tool is available to use without permission as mentioned by pfizer inc., the legal copyright holder of PHQ-9.

Data were collected through questionnaire method. The whole process takes 10–15 min for consent, demographical variables, and for the depression scale. First, all participants fill the consent form and then self-reported demographic variables form and at last the standardized PHQ-9 scale form was filled by the participants. The whole data were collected in a time period of 2 months by the researcher herself only. Those participants who were illiterate their data were collected through their guardians, who were able to fill data, otherwise excluded from the study. For inclusion criteria, the researcher includes participants of all type of cancer patients in all stages that were diagnosed with cancer at least 6 months prior with age group more than 18 years. For data collection, participants were taken from OPD or day care patients who were meeting inclusion and exclusion criteria. Ethical permission was obtained from the ethical committee (IEC certificate reference number: AIIMS/IEC/2020-21/3006). Informed consent was taken from each study participant before involvement in the study. Participants were assured of confidentiality and autonomy to withdraw self from the study at any time of data collection procedure. Data were analyzed by SPSS version 20 (IBM Corp. Released 2020. IBM SPSS Statistics for windows, version 27.0. Armonk, NY: IBM Corp).


  Results Top


As per [Table 1], out of 400 participants, 47.5% were from the age group >50 years followed by 41.5% from the 31–40 years. In the participants, males and females are almost equal; males are 50.8% followed by females 49.3%. Mostly patients were married (95.8%) followed by 2.8% unmarried. Nearly 35.5% of the participants were having primary education followed by 29% who are having no formal education. Out of total participants, 38% of participants were from the income group <10000 ₹ followed by 10001–20000 ₹ were 22%. In family type, 56.8% of the participants were from the extended family type, followed by 25.8% from joint family and 17.5% from the nuclear family. History of depression was absent in 97% and was present in only 3% of participants. Nearly half of the participants were not using any substance (46.8%), followed by tobacco 27.8%. Almost all of the participants were not having any negative event 90.2% and 9.8% were having negative event.
Table 1: Frequency and percentage distribution of participants in terms of demographic variables (n=400)

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[Table 2] reveals that, among 400 respondents, 60.5% of the participants were from 6 months to 1 year diagnostic duration followed by 30.5% in 1–3-year diagnostic duration. In stage of disease, 39% of the respondents were in the Stage II of disease followed by 31.8% in III stage. Moreover, in the type of treatment, 29% of participants were on the chemotherapy treatment, followed by 26.3% in adjuvant group, 24% from radiotherapy, and 20.8% were with surgery. Out of total participants, 27% were having urogenital cancer followed by 21.8% having gastrointestinal cancer, 18.3% having head-and-neck cancer and breast cancer and 14.8% from lung cancer.
Table 2: Frequency and percentage distribution of participants in terms of clinical variables (n=400)

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[Table 3] reveals about the level of depression among cancer patients at AIIMS, Jodhpur, found to be, 8.8% are having minimal depression, followed by 20.3% mild depression, 39.8% moderate depression, 17.8% moderately severe depression, and 13.5 are having severe depression. Moreover, association was not found with the level of depression.
Table 3: Mean, percentage and level of depression among cancer patients (n=400)

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  Discussion Top


The present study was conducted to assess the level of depression among cancer patient at AIIMS, Jodhpur. Total 400 cancer patient were enrolled in the study by consecutive sampling.

The results of the present study showed that nearly 47.5% of the cancer patients were in age group >50 years which somewhat similar to the study done by Degefa et al. in this 42% of total sample in the age group of 18–40 year of age.[6]

In the participants, males and females are almost equal; male are 50.8% followed by females 49.3% which is contradicted with the study conducted by Degefa et al. in this male were 36%, but females were 64% of total sample.[6]

In the present study, mostly patients were married (95.8%), followed by 2.8% unmarried and 1.5% was widow or divorced which contradicted to the study by Degefa et al., in which 66.3% married, single 11.7%, and divorced 11.0%.[6]

In the current study, 29% were having no formal education, 35.5% of the participants were having primary education, 24% were having secondary education, and only 11.5% were having higher education which contradicted to the study carried out by Degefa et al., no education was in 3%, 29% were having elementary education, 25% were having higher secondary education, and 37% were having formal education up to college and above.[6]

In family type, 56.8% of the participants were from the extended family type followed by 25.8% joint and 17.5% from the nuclear family which is contradicted to the study conducted by Purkayastha et al., in which 58.5% belong to nuclear family, joint belong to 3.3%, and 38.1% belong to other category.[7]

In stage of disease, 31.8% of patients were in the Stage III, which is somewhat similar to the study carried out by Hong and Tian which shows that 34.5% were having Stage III of their disease.[8]

Moreover, in the type of treatment, 29% of participants were on the chemotherapy treatment, 26.3% in adjuvant group, 24% from radiotherapy, and 20.8% were with surgery which contradicted to the study carried out by Hinz et al., in which 89.9% undergone surgery and they also take radiation therapy (30.8%) and 35.5% were undergoing through chemotherapy.[9]

In the present study, out of total participants, 27% were having urogenital cancer, 21.8% were having gastrointestinal cancer, 18.3% were having head-and-neck cancer, 18.3% were suffering from breast cancer, and 14.8% from lung cancer which is similar to a study carried out by Hong and Tian, in which 18.5% head-and-neck cancer, 14% lung cancer, and 6.24% breast cancer.[8]

The current study revealed that majority (39.8%) of respondents were suffering from moderate depression, followed by 20.3% from mild depression, 17.8% from moderately severe depression, 13.5%) severe depression, and 8.8% of respondents were suffering with minimal depression which contradicted to the study carried out by Purkayastha et al., in which out of total study participants, 21.5% had depression and 78.5% did not had any depression. Among those with depression, 6% had mild depression, 7% had moderate depression, 4% had moderately severe depression, and 4% had severe depression.[7]

The present study is supported by a study conducted by Garg S and Garg A (2020), in which 34% of participants were having moderate depression.[10]

In the current study, all demographic variables and clinical variables are nonsignificantly associated with the level of depression among cancer patients which contradicted to the study conducted by Berihun et al., in which sex of the participant was found to be associated with depression. It indicated that females were more affected by depression.[11]


  Conclusion Top


The findings of the current study revealed that almost all cancer patients are suffering from some kind of depression. Moreover, the level of depression is not associated with demographic variables and clinical variables. Hence, the members of health-care team should focus on screening of depression among cancer patient and adequate measures should be used to stop further suffering of patient and to improve their quality of life.

Acknowledgment

Researchers would like to acknowledge the ethical committee, the principal, faculty members of college of nursing AIIMS Jodhpur, oncology setting of AIIMS Jodhpur, and participants of research study for their support and valuable time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cancer Key Facts, World Health Organization; 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer. [Last accessed on 2019 Oct 16].  Back to cited text no. 1
    
2.
Physiological and Psychological Effects of Cancer. Medical Division; 2016. Available from: https://mediv.dp.ua. [Last accessed on 2020 Dec 15].  Back to cited text no. 2
    
3.
Cancer Statistics. National Cancer Institute; 2020. Available from: https://www.cancer.gov/about-cancer/unders-tanding/statistics. [Last accessed on 2020 Dec 15].  Back to cited text no. 3
    
4.
Maria Die T. Depression in cancer patients. Anxiety and depression in cancer patients. European Society of Medical Oncology. 2004 (32):57-71 Available from: https://oncologypro.esmo.org/content/ download/36584/726126/. [Last accessed on 2019 Sep 06].  Back to cited text no. 4
    
5.
Krebber AM, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014 Feb;23(2):121-30. doi: 10.1002/pon.3409. Epub 2013 Sep 16. PMID: 24105788; PMCID: PMC4282549.  Back to cited text no. 5
    
6.
Degefa M, Dubale B, Bayouh F, Ayele B, Zewde Y. Validation of the PHQ-9 depression scale in Ethiopian cancer patients attending the oncology clinic at Tikur Anbessa specialized hospital. BMC Psychiatry 2020;20:446.  Back to cited text no. 6
    
7.
Purkayastha D, Venkateswaran C, Nayar K, Unnikrishnan UG. Prevalence of depression in breast cancer patients and its association with their quality of life: A cross-sectional observational study. Indian J Palliat Care 2017;23:268-73.  Back to cited text no. 7
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8.
Hong JS, Tian J. prevalence of anxiety and depression and their risk factors in Chinese cancer patients. National Library of medicine. 2014 Feb;22(2):453-9. doi: 10.1007/s00520-013-1997-y.  Back to cited text no. 8
    
9.
Hinz A, Mehnert A, Kocalevent RD, Brähler E, Forkmann T, Singer S, et al. Assessment of depression severity with the PHQ-9 in cancer patients and in the general population. BMC Psychiatry 2016;16:22.  Back to cited text no. 9
    
10.
Garg Swastika, Garg Anupama. A Study to Assess Depression among Cancer Patients at Our Tertiary Care Hospital Ajmer: An Hospital Based Study. International Journal of Medical Research Professionals. 2020 Jan; 6(1): 16-18. Available at: https://imsear.searo.who.int/handle/123456789/203555 [Last accessed on 2021 May 20].  Back to cited text no. 10
    
11.
Berihun F, Haile S, Abawa M, Mulatie M, Shimeka A. Prevalence and correlates of anxiety and depression among cancer patients in the University of Gondar comprehensive specialized hospital, Northwest Ethiopia. Archives of depression and anxiety. 2017;3:042-8. [doi: 10.17352/2455-5460.000022]. [Last accessed on 2021 Jan 12].  Back to cited text no. 11
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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