Prevalence and risk of psychological distress, anxiety and depression in adolescent and young adult (AYA) cancer survivors: A systematic review and meta-analysis

Abstract

Background: Adolescent and young adult (AYA) cancer survivors (CS) face unique psychosocial challenges, which may affect their mental health. However, there are inconsistencies in AYA definitions and varying prevalence data on psychological distress, anxiety, and depression. We aimed to synthesize published literature on prevalence, risk, longitudinal changes, and predictors for these outcomes and estimate pooled prevalences.

Methods: We searched for observational studies published in English before June 1 2022, in PubMed, PsycINFO, Scopus, and Web of Science. Two researchers extracted independently information on study characteristics, prevalence, and risk. The pooled prevalence (PP) of psychological distress, anxiety, and depression was estimated using random-effects models. Geographical region, treatment status, and assessment instruments were considered in stratified meta-analyses.

Results: Sixty-eight studies were included in the systematic review and 57 in the meta-analyses. We estimated an overall prevalence of 32% (n = 30; 4226/15,213 AYAs; 95% CI, 23%-42%; I² = 99%) for psychological distress, 29% for anxiety (n = 24; 2828/8751 AYAs; 95% CI, 23%-36%; I² = 98%), and 24% (n = 35; 3428/16,638 AYAs; 95% CI, 18%-31%; I² = 98%) for depression. The range of PP of psychological distress varied across geographical regions, treatment status, and assessment instruments. The PP of anxiety varied significantly across continents, while no variations were seen for depression. Studies found higher risks for psychological distress, anxiety, and depression in AYAs compared to older cancer survivors or cancer-free peers.

Conclusions: Our research found that one in three AYA-CS experience psychological distress or anxiety and one in four are affected by depression, highlighting the need for specialized psychological services for AYA-CS in oncology settings and AYA-focused interventions.

Keywords: AYA cancer survivors; anxiety; depression; psychological distress; systematic review.

FIGURE 1

Modified PRISMA flowchart illustrating the study selection process.

FIGURE 2

Meta‐analysis results on prevalence of psychological distress among AYA cancer survivors (30 studies; 15,213 participants). Patterson and colleagues (2021) reported on three different world regions and the respective prevalences have been included separately. The vertical dashed line indicates the crude pooled prevalence.

FIGURE 3

Meta‐analysis results on prevalence of anxiety among AYA cancer survivors (24 studies; 8751 participants). The vertical dashed line indicates the crude pooled prevalence.

FIGURE 4

Meta‐analysis results on prevalence of depression among AYA cancer survivors (35 studies; 16,638 participants). The vertical dashed line indicates the crude pooled prevalence.