Factors Associated with Depression Assessed by the Patient Health Questionnaire-2 in Long-Term Cancer Survivors

Abstract

Background: This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors.

Methods: A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire.

Results: We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81-14.02) was associated with the increased risk of depression.

Conclusion: These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation.

Keywords: Depression; Fatigue; Koreans; Survivors.

Figure 1. Comparisons of the number of physical symptoms between the non-depressive and the depressive group. Depression was defined by the PHQ-2. The depressive group had a PHQ-2 score of 1 or 2, and the non-depressive group had a PHQ-2 score of 0. P-value for the differences between non-depressive and depressive group was obtained by t-test. PHQ, Patient Health Questionnaire.

Figure 2. Comparisons of Fatigue Severity Scale score between non-depressive and depressive group. Depression was defined by PHQ-2. The depressive group had a PHQ-2 score of 1 or 2, and the non-depressive group had a PHQ-2 score of 0. Fatigue Severity Scale ranges between 9 (no fatigue) and 63 (most fatigue). The P-value for the differences between non-depressive and depressive groups was obtained by t-test. PHQ, Patient Health Questionnaire.