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Cited by 103Cancer survivorship and careMental Health Treatment and AccessCOVID-19 and Mental Health

Depression, Anxiety, and Other Mental Disorders in Patients With Cancer in Low- and Lower-Middle–Income Countries: A Systematic Review and Meta-Analysis

Open access
Walker, Zoe J., Xue, Siqi, Jones, Michael P., Ravindran, Arun V.·2021·JCO Global Oncology
DOI 10.1200/go.21.00056PMC PMC8457869
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Abstract

PURPOSE: Cancer is a growing public health issue in low- and lower-middle–income countries (LLMICs), but the mental health consequences in this setting have not been well-characterized. We aimed to systematically evaluate the available literature on the prevalence, associates, and treatment of mental disorders in patients with cancer in LLMICs. METHODS: We systematically searched Medline, PsycINFO, EMBASE, and CINAHL. We performed a random effects meta-analysis to determine the pooled prevalence of major depression or anxiety disorders in this population, defined by Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria. We qualitatively reviewed studies that examined the prevalence of depressive or anxiety disorders defined by self-report tools, the prevalence of other mental disorders, associated factors of depressive and anxiety symptoms, and the treatment of mental disorders in this population. RESULTS: Forty studies spanning a 15-year period were included in the review. The pooled prevalence defined by Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria was 21% for major depression (95% CI, 15 to 28) and 18% for anxiety disorders (95% CI, 8 to 30). Depressive and anxiety symptoms were most frequently associated with advanced disease and low levels of education. Among the four studies evaluating treatment, three evaluated the effectiveness of psychotherapy and one evaluated a yoga program. CONCLUSION: The prevalence of depression and anxiety in patients with cancer generally appears higher in LLMICs than in upper-income countries. Our findings demonstrate the existence of a significant and underappreciated disease burden. We suggest that clinicians remain vigilant to psychiatric symptoms. Improved screening and treatment are likely to improve quality of life and reduce both morbidity and mortality.

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  • Depression and anxiety are more common in female people with cancer.

    “Depression and anxiety are more common in female PWC.3,8-11”

    From Mindfulness and Psychosocial Symptoms in People with Cancer: Testing Rumination and Experiential Avoidance as Mediators, and Sex as a Moderator. (2025) · cites this paper as [8]

    The Results section (page not specified) reports that being female correlated with a higher likelihood of depression among patients with cancer. It explicitly says findings for anxiety were mixed, so the claim that both conditions are more common in female patients is not fully supported. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • A meta-analysis including over 9,000 people living with cancer from low- and middle-income countries reported a prevalence of interview-confirmed anxiety disorders of 18%.

    “The meta-analysis, including over 9,000 PLWC from low-and middle-income countries, reported a prevalence of interview-confirmed anxiety disorders of 18% (Walker et al. 2021).”

    From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Walker et al. 2021

  • A meta-analysis of 40 studies in 15 low- and middle-income countries reported a pooled prevalence of 21% for major depression.

    “Another meta-analysis of 40 studies conducted in 15 low-and middle-income countries spanning the regions of East Asia and Pacific, South Asia, Middle East and North Africa, and Sub-Saharan Africa reported a pooled prevalence of 21% for major depression (Walker et al. 2021).”

    From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Walker et al. 2021

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Research works printed but not linked: 2

  1. [27]Iqbal M Syed GMS Siddiqui KS: Mental disorders in cancer patients: Observations at a tertiary care centre in Pakistan [3] (multiple letters). Pak J Med Sci 18: 109- 116, 2002
  2. [65]Ostuzzi G Matcham F Dauchy S, et al: Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 4: CD011006, 2018 29683474 PMC6494588

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Authors
Walker, Z. J., Xue, S., Jones, M. P., & Ravindran, A. V.
Affiliations
  • Centre for Addiction and Mental Health (CA)
  • University of Toronto (CA)
Corresponding author
Ravindran, Arun V.
ORCID
Venue
JCO Global Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2021-12
Volume
7
Issue
7
Pages
1233-1250
ISSN
2687-8941 (ISSN-L)
DOI
10.1200/go.21.00056
PMC
PMC8457869
OpenAlex
W3192811719
Cited by
103
References
59
Citations by year
2026: 18 · 2025: 19 · 2024: 24 · 2023: 25 · 2022: 16 · 2021: 1
FWCI
2.00
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JCO Global Oncology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
cancer, depression, anxiety disorders, mental illness, low- and lower-middle-income countries, prevalence, risk factors, advanced disease, educational attainment, psychotherapy, yoga, mental health screening, mental health services
MeSH terms
Anxiety, Anxiety Disorders, Depression, Major Depressive Disorder, Developing Countries, Humans, Neoplasms, Quality of Life

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