Assessment of Anxiety and Depression Levels Among Cancer Patients in A Selected Hospital of Kashmir

Mohammad Azam Dar, Kehkashan Nabi, Insha Rafiq, Iqra Farooq, Arshia Jan, Saima Hameed, Misbah Bakhshi,

doi:10.5281/zenodo.18632049

Research Paper | Open Access
Volume 03 | Issue 02 | Article Id IJSRT/260402010

Assessment of Anxiety and Depression Levels Among Cancer Patients in A Selected Hospital of Kashmir
Mohammad Azam Dar* ¹ Kehkashan Nabi ¹ Insha Rafiq ² Iqra Farooq ² Arshia Jan ² Saima Hameed ² Misbah Bakhshi ²
¹Faculty, Department of Nursing, Islamic university of science and Technology, Awantipora, Kashmir
²B.Sc. Nursing students, SMMCN & MT, Islamic university of science and technology Awantipora, Kashmir

Abstract

Cancer is a serious life threatening disease in current days. It has biological, Psychological and sociological impact on individuals life. People living with this deadly disease often suffer from the Psychological abnormalities. Anxiety and depression are common Psychological responses among cancer patients. Anxiety and depression affects the quality of life of cancer patients. Addressing anxiety and depression is very essential for cancer patients to improve their quality of life and treatment outcomes. Aim:-Determine the prevalence and severity of anxiety and sadness among cancer patients and to identify factors associated with higher levels of these emotional states. Materials and Methods:-Present study was conducted among 90 cancer patients in selected hospital of Kashmir (GMC Srinagar) .The sample for the present Study was selected by convenient sampling technique. A standardized tool HADS and PHQ-9 were used to assess the level of anxiety and depression among cancer patients. The data obtained was analyzed and interpreted in terms of the Objectives. Results: - By using the HADS scale the present study revealed that 75.6% (68) patients were having high prevalence of abnormal anxiety levels,17.8% (16) was having borderline abnormal anxiety level ,6.7% (6) are normal. The current present study also showed that there is a significant association between the age groups and anxiety level .Anxiety levels vary significantly across age groups (p=0.029).Older Participants (above 35 years) have higher levels of anxiety compared to younger groups. Also anxiety levels are significantly associated with marital status (P=0.020) .Married individuals tend to have higher anxiety levels compared to unmarried individuals. By using the patient health questionnaire, the present Study revealed that 14.4%(13) was having severe depression, 54.4% (49) was having moderately severe depression, 30.0% (27) was having moderate depression, 1.1% (1) was suffering from mild depression, and 0.0%(0) was having minimal depression .The Study also revealed that there is a significant association between marital status and depression levels (p = 0.041). Married participants show higher levels of severe and moderately severe depression compared to unmarried individuals. Conclusion:- On the basis of our results we concluded that cancer patients have higher levels of anxiety and depression and there is a need for effective Psychological interventions and mental health support to prevent anxiety and depression among cancer patients.

Keywords

Anxiety, Depression, cancer

Introduction

Cancer is a serious and potentially life-threatening illness which has an effect on physical and emotional well-being of patients and their families. The diagnosis of cancer is a stressful event causing significant psychological distress¹. Anxiety is the feeling of fear, distress, and uneasiness of an imminent endangerment whiles depression is a symptom expressed through tireless sensations of hopelessness, unhappiness, lack of concentration, lack of energy, and insomnia, especially with a cancer diagnosis (Health line 2015)². The National Comprehensive Cancer Network (NCCN) defines cancer-related distress as “multi-factorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment³. While efforts at studying psychological distress in cancer dates far back as the 1980s (Derogatis et al., 1983), results from research groups worldwide revealed widely varying prevalence rates. For example, the frequency of depressive symptoms ranged from as low as 4.5% (Lansky et al., 1985) to as high as over 50% (Craig and Abeloff, 1974). Such discrepant estimates are due to varying conceptualizations of depression, differences in methodology used, and diverse populations studied (Trask, 2004). Of particular concern is the use of screening instruments that are of limited diagnostic reliability⁴. Depression and anxiety affect up to 20% and 10% of patients with cancer respectively, regardless of the point in the cancer trajectory, and whether in curative or palliative treatment⁵. According to official figures accessed by Greater Kashmir, cancer cases in 2017 were recorded as 5731 which is 87 per cent higher than the cases recorded 7years ago in 2011 when 3057 such cases were witnessed. Further, the official data reveals a disturbing trend of year-on-year increase in per cent of cancer cases in the state. In 2011, 3057 cases were detected in Kashmir, which increased to 3288, thus an increase of 7 per cent in comparison to last year.In 2016, 4976 cancer cases were recorded, which put the increase in percentage of cases from previous year at 17 per cent. The overall increase in cancer cases work out at an alarming 87 per cent from 2011 to 2017. Similarly, 28,424 cancer patients have registered with government hospitals of Jammu and Kashmir in the last seven year⁶.

BACKGROUND

Depression and anxiety had negative effects on the quality of life of cancer patients, thus hospital anxiety and depression scale is a useful instrument for screening these problems. This research was performed to assess the level of anxiety and depression among cancer patients⁷. Cancer diagnosis can have a major impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. Research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. Cancer patients frequently experience psychological problems related to reactions to cancer diagnosis, cancer type and stage, treatment effects, recurrence, fear of end of life and financial burden. Depression and anxiety cause both Psychological and Physiological disturbances among cancer patients⁸. Researchers and health care professionals have recognized the need to better understand and address the psychological aspects of cancer care. This has led to the development of various studies and tools to search as hospital anxiety and depression scale, to assess and address the emotional wellbeing of cancer patients. The specific origin of each individual study may vary, but our goal was to improve the understanding and support for mental health in the context of cancer.

Need:

Anxiety and depression are common among cancer patients due to the emotional distress, uncertainty and fear associated with treatment process and poor prognosis. Assessing these mental health aspects helps in understanding their psychological burden. By identifying the prevalence and intensity of anxiety and depression health care providers can develop targeted intervention to improve mental health support and overall quality of life for cancer patients. After the critical analysis of the previous supporting studies researcher felt the need to conduct the study to assess the level of anxiety and depression among cancer patients in selected hospital of Kashmir.

RESEARCH METHODOLOGY

A Quantitative research approach and a Descriptive research design were used to assess the level of anxiety and depression among cancer patients. Convenient sampling technique was utilized to select the targeted participants with a total number of 90 samples for the study conducted in GMC Srinagar.

Sampling Criteria:

Inclusion criteria: -

Cancer patients only.
Cancer patients who were willing to participate.

b) Exclusion criteria: -

General hospital patients.
Patients who were under the age of 18 years

Data Collection Tool:

A standardized tool Hospital anxiety and depression scale (HADS-A) for anxiety and Patient health questionnaire (PHQ-9) for depression were used to collect data.

Ethical Considerations:

The research was conducted after approval from institutional ethical committee (IEC IUST Protocol) of IUST Awantipora Kashmir.
Permission was taken from the GMC Srinagar to conduct the study.
Informed consent was taken from each participant during data collection.
Confidentiality of participants was maintained.
No ethical issues confronted with conducting the study.

RESULTS:

Table No 1: Shows the demographic profile of the subjects N= 90

Variables	Opts	Percentage %	Frequency(f)
Age	18-23 years	11%	10
	24-29 years	12%	11
	30-35 years	24%	22
	Above 35 years	52%	47
Gender	Male	49%	44
Gender	Female	51%	46
Education	No formal education	36%	32
	Middle	41%	37
	Higher secondary	12%	11
	Any other	11%	10
Occupation	Employed	48%	43
	Unemployed	31%	28
	Self employed	21%	19
Income	51,000-60,000	22%	20
	41000, -50000	33%	30
	31,000-40,000	26%	23
	21,0000-30,000	12%	11
	>=20,000	7%	6
Marital Status	Married	63%	57
Marital Status	Unmarried	37%	33

Table no 2: Shows the frequency & percentage distribution level of anxiety

Criteria Measure of Anxiety Score
Level of Scores	Percentage	Frequency
Abnormal. (11-21)	75.6%	68
Borderline Abnormal. (8-10)	17.8%	16
Normal. (0-7)	6.7%	6
Maximum =21 Minimum=0

Figure no. 1: illustrates the pyramidal diagram showing the percentage distribution level of Anxiety

Figure 7 revealed that 75.6% participants had Abnormal level of Anxiety, 17% had Borderline level of Anxiety and 6.7% participants were Normal.

Table No 3: Descriptive statistics of Anxiety N= 90

Descriptive Statistics	Mean	Median	S. D	Maximum	Minimum	Range	Mean %
Anxiety Score	12.68	13	3.40	21	1	20	60.37
Maximum=21 Minimum=0

Figure no. 2: illustrates the Conical Shaped diagram representing descriptive statistics level of Anxiety.

Table No 4: Table Showing Association of Scores and Demographic Variables

Demographic Data		Levels of Anxiety (N=90)			Association with Anxiety Score
Variables	Opts	Abnormal	Borderline Abnormal	Normal	Chi Test	P Value	Df	Table Value	Result
Age	18-23 Years	7	2	1	14.021	0.029	6	12.592	Significant
	24-29 Years	4	5	2
	30-35 Years	17	5	0
	Above 35 Years	40	4	3
Gender	Male	33	8	3	0.014	0.993	2	5.991	Not Significant
	Female	35	8	3
Education	No Formal Education	25	3	4	9.665	0.139	6	12.592	Not Significant
	Middle	26	10	1
	Higher Secondary	10	0	1
	Any Other	7	3	0
Occupation	Employed	34	5	4	4.348	0.361	4	9.488	Not Significant
	Unemployed	22	5	1
	Self Employed	12	6	1
Income	51,000-60,000	12	4	4	12.326	0.137	8	15.507	Not Significant
	41000, -50000	22	7	1
	31,000-40,000	21	2	0
	21,0000-30,000	9	1	1
	>=20,000	4	2	0
Marital Status	Married	43	13	1	7.839	0.020	2	5.991	Significant
	Unmarried	25	3	5

Table no 6: Shows the Frequency & Percentage distribution level of PHQ-9. N= 90

Criteria Measure Of Phq-9 Score
Level Of Scores	Percentage	Frequency
Severe Depression.(20 - 27)	14.4%	13
Moderately Severe Depression.(15 - 19)	54.4%	49
Moderate Depression.(10 - 14)	30.0%	27
Mild Depression.(5 - 9)	1.1%	1
Minimal Depression.(1 - 4)	0.0%	0
Maximum =27 Minimum=0

Figure no. 3: Illustrates the pyramidal diagram showing the percentage distribution level of Depression

Figure no. 4: illustrates the bar diagram representing Mean, Median& SD of Depression Score

Hence, the results of present study revealed that 75.6% (68) patients were having high prevalence of abnormal anxiety levels,17.8% (16) was having borderline abnormal anxiety level ,6.7% (6) are normal. The current present study also showed that there is a significant association between the age groups and anxiety level. Anxiety levels vary significantly across age groups (p=0.029). Older Participants (above 35 years) have higher levels of anxiety compared to younger groups. Also, anxiety levels are significantly associated with marital status (P=0.020). Married individuals tend to have higher anxiety levels compared to unmarried individuals. By using the patient health questionnaire, the present Study revealed that 14.4% (13) was having severe depression, 54.4% (49) was having moderately severe depression, 30.0% (27) was having moderate depression, 1.1% (1) was suffering from mild depression, and 0.0% (0) was having minimal depression. The Study also revealed that there is a significant association between marital status and depression levels (p = 0.041). Married participants show higher levels of severe and moderately severe depression compared to unmarried individuals.

CONCLUSION:

The results of the study revealed that the majority of the patients had abnormal level of anxiety and moderately severe depression. It also reveals that there is significant association between level of anxiety with age and marital status and level of depression with marital status.

RECOMMENDATIONS:

Based on the findings of the study, following recommendations were put forward for future research:

Apart from providing chemotherapy there is need of providing the psychological intervention so that reduce anxiety and depression.
To generalize the results, a similar study might be repeated on large sample.
It is possible to perform a study by including more demographic information.

Different research approaches and designs can be employed to conduct the same study.

REFERENCE

Jadoon NA, Munir W, Shahzad MA, Choudhry ZS. Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study. BMC cancer. 2010 Dec; 10:1-7.
Kyei KA, Oswald JW, Njoku AU, Kyei JB, Vanderpuye V. Anxiety and depression among breast cancer patients undergoing treatment in Ghana. African Journal of Biomedical Research. 2020 May 31;23(2):227-32.
BASHIR T. Psychological Distress and Anxiety among Cancer Patients.
Tan SM, Beck KR, Li H, Lim EC, Krishna LK. Depression and anxiety in cancer patients in a Tertiary General Hospital in Singapore. Asian journal of psychiatry. 2014 Apr 1; 8:33-7.
Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. Bmj.2018 Apr 25;361.
BASHIR T. Psychological Distress and Anxiety among Cancer Patients.
Chiragh S, Ahmed I, Jameel A. Anxiety and depression in cancer patients-a survey in medical oncology department of a tertiary care hospital. Journal of Postgraduate Medical Institute. 2020 Jul 14;34(1).
Hassan MA, Mahmoud AE, Kalash S, Kadi T, Bakhos N, Abou Zeidane R, Amhaz G, Bizri M, Assi HI. Prevalence of depression and anxiety among newly diagnosed cancer patients: a single centre experience in the Middle East. ecancermedicalscience. 2024;18.
Gupta, P. Gupta, S.S. and Shyam, R. (2010) sexual dysfunction in Spinal Code injured patients. In R. Shyam and S.R. Khan (edt) Psychology and Health Promotions (2010), Global vision, New Delhi.
Holman, E.A. and Silver, R.C. (1998). Getting “stuck” in the past: Temporal orientation and coping with trauma. J. Personality & Social Psychology, 74: 1146-1163.
Kendall, P.C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A. and Warman, M. (1997).
Therapy for youths with anxiety disorders: A second randomized trial. J. Consulting & Clinical Psychology, 65: 366-380.
Koolhaas, J.M., Korte, S.M., DeBoer, S.F., Van Der Vegt, B.J., Van Reenen, C.G., Hopster, H., De Jong, I.C., Ruis, M.A.W., and Blokhuis, H.J. (1999). Coping styles in animals: Current status in behavior and stress-physiology. Neuroendocrine & Biobehavioral Reviews, 23: 925935.
Mikulincer, M. and Florian, V. (1996). Coping and adaptation to trauma and loss. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research, applications. (pp. 554-572). New York: John Wiley & Sons.
Mitchell AJ. Screening for cancer-related distress: when is implementation successful and when is it unsuccessful? Acta Oncol 2013; 52:216–24.
Hem E, Loge JH, Haldorsen T, Ekeberg Ø. Suicide risk in cancer patients from 1960 to 1999. J Clin Oncol 2004; 22:4209–16.
Yousaf U, Christensen ML, Engholm G, Storm HH. Suicides among Danish cancer patients 1971–1999. Br J Cancer 2005; 92:995–1000.
Fisch M. Treatment of depression in cancer. J Natl Cancer Inst Monogr 2004; 32:105–11.
Lloyd-Williams M, Dennis M, et al. A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 2004; 18:558–63.
Montgomery C, Lydon A, et al. Psychological distress among cancer patients and informed consent. J Psychosom Res 1999; 46:241–5.
Ell K et al. Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol 2008; 26:4488–96.
Rayner L, et al. Antidepressants for depression in physically ill people. Cochrane review; 2010: issue 4.
Musselman DL, Lawson DH, et al. Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med 2001; 344:961–6.
Cipriani A et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009; 373:746–58.
Holland JC, Romano SJ, et al. A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psychooncology 1998; 7:291–300.

Reference

Jadoon NA, Munir W, Shahzad MA, Choudhry ZS. Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study. BMC cancer. 2010 Dec; 10:1-7.
Kyei KA, Oswald JW, Njoku AU, Kyei JB, Vanderpuye V. Anxiety and depression among breast cancer patients undergoing treatment in Ghana. African Journal of Biomedical Research. 2020 May 31;23(2):227-32.
BASHIR T. Psychological Distress and Anxiety among Cancer Patients.
Tan SM, Beck KR, Li H, Lim EC, Krishna LK. Depression and anxiety in cancer patients in a Tertiary General Hospital in Singapore. Asian journal of psychiatry. 2014 Apr 1; 8:33-7.
Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. Bmj.2018 Apr 25;361.
BASHIR T. Psychological Distress and Anxiety among Cancer Patients.
Chiragh S, Ahmed I, Jameel A. Anxiety and depression in cancer patients-a survey in medical oncology department of a tertiary care hospital. Journal of Postgraduate Medical Institute. 2020 Jul 14;34(1).
Hassan MA, Mahmoud AE, Kalash S, Kadi T, Bakhos N, Abou Zeidane R, Amhaz G, Bizri M, Assi HI. Prevalence of depression and anxiety among newly diagnosed cancer patients: a single centre experience in the Middle East. ecancermedicalscience. 2024;18.
Gupta, P. Gupta, S.S. and Shyam, R. (2010) sexual dysfunction in Spinal Code injured patients. In R. Shyam and S.R. Khan (edt) Psychology and Health Promotions (2010), Global vision, New Delhi.
Holman, E.A. and Silver, R.C. (1998). Getting “stuck” in the past: Temporal orientation and coping with trauma. J. Personality & Social Psychology, 74: 1146-1163.
Kendall, P.C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A. and Warman, M. (1997).
Therapy for youths with anxiety disorders: A second randomized trial. J. Consulting & Clinical Psychology, 65: 366-380.
Koolhaas, J.M., Korte, S.M., DeBoer, S.F., Van Der Vegt, B.J., Van Reenen, C.G., Hopster, H., De Jong, I.C., Ruis, M.A.W., and Blokhuis, H.J. (1999). Coping styles in animals: Current status in behavior and stress-physiology. Neuroendocrine & Biobehavioral Reviews, 23: 925935.
Mikulincer, M. and Florian, V. (1996). Coping and adaptation to trauma and loss. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research, applications. (pp. 554-572). New York: John Wiley & Sons.
Mitchell AJ. Screening for cancer-related distress: when is implementation successful and when is it unsuccessful? Acta Oncol 2013; 52:216–24.
Hem E, Loge JH, Haldorsen T, Ekeberg Ø. Suicide risk in cancer patients from 1960 to 1999. J Clin Oncol 2004; 22:4209–16.
Yousaf U, Christensen ML, Engholm G, Storm HH. Suicides among Danish cancer patients 1971–1999. Br J Cancer 2005; 92:995–1000.
Fisch M. Treatment of depression in cancer. J Natl Cancer Inst Monogr 2004; 32:105–11.
Lloyd-Williams M, Dennis M, et al. A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 2004; 18:558–63.
Montgomery C, Lydon A, et al. Psychological distress among cancer patients and informed consent. J Psychosom Res 1999; 46:241–5.
Ell K et al. Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol 2008; 26:4488–96.
Rayner L, et al. Antidepressants for depression in physically ill people. Cochrane review; 2010: issue 4.
Musselman DL, Lawson DH, et al. Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med 2001; 344:961–6.
Cipriani A et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009; 373:746–58.
Holland JC, Romano SJ, et al. A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psychooncology 1998; 7:291–300.

Mohammad Azam Dar

Corresponding author

Faculty, Department of Nursing, Islamic university of science and Technology, Awantipora, Kashmir

Kehkashan Nabi

Co-author

Faculty, Department of Nursing, Islamic university of science and Technology, Awantipora, Kashmir