The DOI matches its Crossref record; 63 of the 63 references it cites were found in a registry or an index.
Depression, Anxiety, and Other Mental Disorders in Patients With Cancer in Low- and Lower-Middle–Income Countries: A Systematic Review and Meta-Analysis
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Naghavi, M., Abajobir, A. A., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S. F., Aboyans, V., Adetokunboh, O., Afshin, A., Agrawal, A., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)32152-9 · Cited by 4,821
Allemani, C., Weir, H. K., Carreira, H., Harewood, R., Spika, D., Wang, X.-S., Bannon, F., Ahn, J. V., Johnson, C. J., Bonaventure, A., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(14)62038-9 · Cited by 2,614
Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70002-x · Cited by 2,449
Bray, F., Jemal, A., Grey, N., Ferlay, J., & Forman, D. (2012) · The Lancet Oncology · doi:10.1016/s1470-2045(12)70211-5 · Cited by 2,225
Depression and cancer mortality: a meta-analysis
Pinquart, M., & Duberstein, P. R. (2010) · Psychological Medicine · doi:10.1017/s0033291709992285 · Cited by 1,083 · cited 1×
“Literature from developed countries clearly confirms that patients with cancer have higher rates of depression and anxiety than the general population(3-5) and that cancer comorbidity with depression results in greater morbidity and poorer cancerrelated outcomes.(6,7)”
BackgroundKrebber, A. M. H., Buffart, L. M., Kleijn, G., Riepma, I. C., de Bree, R., Leemans, C. R., Becker, A., Brug, J., van Straten, A., Cuijpers, P., et al. (2014) · Psycho-Oncology · doi:10.1002/pon.3409 · Cited by 908
Niedzwiedz, C. L., Knifton, L., Robb, K. A., Katikireddi, S. V., & Smith, D. J. (2019) · BMC Cancer · doi:10.1186/s12885-019-6181-4 · Cited by 756
Cramer, H., Lauche, R., Klose, P., Lange, S., Langhorst, J., & Dobos, G. J. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010802.pub2 · Cited by 442
Study quality assessment tools
Graves, N., Wloch, C., Wilson, J. A., Barnett, A. G., Sutton, A. J., Cooper, N. J., Merollini, K. M. D., McCreanor, V., Cheng, Q., Burn, E., et al. (2016) · Cited by 440
Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis
Singer, S., Das-Munshi, J., & Brähler, E. (2010) · Annals of Oncology · doi:10.1093/annonc/mdp515 · Cited by 392
Jacobsen, P. B., & Jim, H. S. (2008) · CA: A Cancer Journal for Clinicians · doi:10.3322/ca.2008.0003 · Cited by 382
Skarstein, J., Aass, N., Fosså, S. D., Skovlund, E., & Dahl, A. A. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00080-5 · Cited by 301
Abbey, G., Thompson, S. B. N., Hickish, T., & Heathcote, D. (2015) · Psycho-Oncology · doi:10.1002/pon.3654 · Cited by 280
Evidence‐based treatment of depression in patients with cancer
Li, M., Fitzgerald, P., & Rodin, G. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.39.7372 · Cited by 236
Banerjee, B., Vadiraj, H. S., Ram, A., Rao, R., Jayapal, M., Gopinath, K. S., Ramesh, B. S., Rao, N. H. R., Kumar, A., Nagarathna, R., et al. (2007) · Integrative Cancer Therapies · doi:10.1177/1534735407306214 · Cited by 225
Hart, S. L., Hoyt, M., Diefenbach, M., Anderson, D. R., Kilbourn, K., Craft, L., Steel, J., Cuijpers, P., Mohr, D., Berendsen, M., et al. (2012) · Journal of the National Cancer Institute · doi:10.1093/jnci/djs256 · Cited by 217
National cancer control plans: a global analysis
Romero, Y., Trapani, D., Johnson, S., Tittenbrun, Z., Given, L. S., Hohman, K., Stevens, L. M., Torode, J., Boniol, M., & Ilbawi, A. (2018) · The Lancet Oncology · doi:10.1016/s1470-2045(18)30681-8 · Cited by 206
Antidepressants for the treatment of depression in people with cancer
Ostuzzi, G., Matcham, F., Dauchy, S., Barbui, C., & Hotopf, M. H. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011006.pub2 · Cited by 184
Yang, Y., Liu, L., Wang, Y., Wu, H. L., Yang, X., Wang, J., & Wang, L. (2013) · BMC Cancer · doi:10.1186/1471-2407-13-393 · Cited by 172
Cancer Control Opportunities in Low- and Middle-income Countries
Huerta, E. E., & Grey, N. (2007) · CA A Cancer Journal for Clinicians · doi:10.3322/canjclin.57.2.72 · Cited by 137
Laoutidis, Z. G., & Mathiak, K. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-140 · Cited by 126
The ACTION Study Group (2017) · BMC Medicine · doi:10.1186/s12916-016-0768-2 · Cited by 114
Incidence of suicide death in patients with cancer: A systematic review and meta-analysis
Du, L., Shi, H.-Y., Yu, H.-R., Liu, X.-M., Jin, X.-H., Yan-Qian, Fu, X.-L., Song, Y.-P., Cai, J.-Y., & Chen, H.-L. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.07.082 · Cited by 100 · cited 1×
“Suicide was beyond the defined scope of this study and warrants exploration given the higher rate of suicide in patients with cancer.(68) The dearth of treatment studies identified in this review highlights opportunities for future research, such as assessing antidepressants from the WHO essential medications list or…”
BackgroundGrassi, L. G., Watson, M., & on behalf of the IPOS Federation of Psycho‐Oncology Societies' co‐authors (2012) · Psycho-Oncology · doi:10.1002/pon.3154 · Cited by 97
Distress overlaps with anxiety and depression in patients with head and neck cancer
Pandey, M., Devi, N., Thomas, B. C., Kumar, S., Krishnan, R., & Ramdas, K. (2006) · Psycho-Oncology · doi:10.1002/pon.1123 · Cited by 96
Quality of Life and Psychological Well-Being of Breast Cancer Survivors in Jordan
Abu-Helalah, M. A., Al-Hanaqta, M. M., Alshraideh, H. A., AbdulBaqi, N., & Hijazeen, J. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.14.5927 · Cited by 96
A systematic review of substance use and substance use disorders in patients with cancer
Yusufov, M., Braun, I. M., & Pirl, W. F. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.04.016 · Cited by 72
Chittem, M., Norman, P., & Harris, P. R. (2012) · Psycho-Oncology · doi:10.1002/pon.3149 · Cited by 70
Treatment of depression in adults with cancer: a systematic review of randomized controlled trials
Walker, J., Sawhney, A., Hansen, C., Ahmed, S., Martin, P., Symeonides, S., Murray, G., & Sharpe, M. (2013) · Psychological Medicine · doi:10.1017/s0033291713001372 · Cited by 66
Grassi, L. G., Fujisawa, D., Odyio, P., Asuzu, C. C., Ashley, L., Bultz, B. D., Travado, L., Fielding, R., & on behalf of the IPOS Federation of Psycho‐oncology Societies' coauthors (2016) · Psycho-Oncology · doi:10.1002/pon.4228 · Cited by 66
Berhili, S., Kadiri, S. E., Bouziane, A., Aissa, A., Marnouche, E., Ogandaga, E., Echchikhi, Y., Touil, A., Loughlimi, H., Lahdiri, I., et al. (2016) · The Breast · doi:10.1016/j.breast.2016.10.015 · Cited by 63
Woelbert, E., Lundell-Smith, K., White, R., & Kemmer, D. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30469-7 · Cited by 60
Popoola, A. O., & Adewuya, A. O. (2011) · Psycho-Oncology · doi:10.1002/pon.1968 · Cited by 54
Onyechi, K. C. N., Onuigbo, L. N., Eseadi, C., Ikechukwu-Ilomuanya, A. B., Nwaubani, O. O., Umoke, P. C. I., Agu, F. U., Otu, M. S., & Utoh-Ofong, A. N. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13090929 · Cited by 49
Coping Strategies in Egyptian Ladies with Breast Cancer
Elsheshtawy, E., Abo-Elez, W. F., Ashour, H., Farouk, O., & Elzaafarany, M. (2014) · Breast Cancer Basic and Clinical Research · doi:10.4137/bcbcr.s14755 · Cited by 48
Månsson, Å., Amin, M. A., Malmström, P., Wijkström, H., Enein, H. A., & Månsson, W. (2007) · Urology · doi:10.1016/j.urology.2007.07.071 · Cited by 42
Prevalence of depression and anxiety disorder in cancer patients: An institutional experience
Grover, S., Shankar, A., Dracham, C. B., & Ghoshal, S. (2016) · Indian Journal of Cancer · doi:10.4103/0019-509x.200651 · Cited by 42
Riblet, N., Larson, R., Watts, B. V., & Holtzheimer, P. (2014) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2014.05.010 · Cited by 41
Anxiety disorders in breast cancer: Prevalence, types, and determinants
Fatiregun, O., Olagunju, A. T., Erinfolami, A. R., Fatiregun, O. A. A., Arogunmati, O. A., & Adeyemi, J. D. (2016) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2016.1196805 · Cited by 41
Hamdan‐Mansour, A. M., Abeiat, D. D. A., Alzoghaibi, I., Ghannam, B. M., & Hanouneh, S. I. (2014) · Journal of Cancer Education · doi:10.1007/s13187-014-0678-y · Cited by 38
Prevalence of psychiatric morbidity among cancer patients – hospital-based, cross-sectional survey
Gopalan, M., Karunakaran, V., Prabhakaran, A., & Jayakumar, K. N. L. (2016) · Indian Journal of Psychiatry · doi:10.4103/0019-5545.191995 · Cited by 38
Psychological and physical effects of pain on cancer patients in Ibadan, Nigeria
Nuhu, F. T., Odejide, O. A., Adebayo, K., et al. (2009) · African Journal of Psychiatry · doi:10.4314/ajpsy.v12i1.30281 · Cited by 37
Quality of Life and Psychological Well-Being of Colorectal Cancer Survivors in Jordan
Abu-Helalah, M. A., Alshraideh, H. A., Al-Hanaqta, M. M., & Arqoub, K. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.18.7653 · Cited by 34
Screening of psychological distress in cancer patients during chemotherapy: A cross-sectional study
Singh, H., Singh, R. B., Singh, C., & Kaur, K. (2015) · Indian Journal of Palliative Care · doi:10.4103/0973-1075.164887 · Cited by 33
Bhattacharyya, S., Bhattacherjee, S., Mandal, T., & Das, D. (2017) · Indian Journal of Public Health · doi:10.4103/0019-557x.200252 · Cited by 33
Prevalence of depression among cancer patients in Jordan: a national survey
Mhaidat, N. M., Alzoubi, K. H., Al-Sweedan, S. A., & Al-Husein, B. A. (2009) · Supportive Care in Cancer · doi:10.1007/s00520-009-0600-z · Cited by 32
Anxiety and depressive features in chronic disease patients in Cambodia, Myanmar and Vietnam
Peltzer, K., & Pengpid, S. (2016) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v22i1.940 · Cited by 29
Fatiregun, O., Olagunju, A. T., Erinfolami, A. R., Arogunmati, O. A., Fatiregun, O. A. A., & Adeyemi, J. D. (2016) · The Breast · doi:10.1016/j.breast.2016.11.010 · Cited by 27
A study of depression and anxiety in cancer patients.
Thapa, P., Rawal, N. M., & Bista, Y. (2010) · PubMed · Cited by 24
Sexuality after breast cancer: cultural specificities of Tunisian population
Leila, M., Charfi, N., Kais, C., & Masmoudi, J. (2016) · Pan African Medical Journal · doi:10.11604/pamj.2016.25.17.10399 · Cited by 24
Psychosocial impact of cancer on adult patients.
Rashid, Y. A., Ghafoor, Z. A., Masood, N., Mehmood, T., Awan, S., Ansar, T., Mirza, M., & Rashid, U. A. (2012) · PubMed · Cited by 23
Elnahas, W., El-Hadidy, Hegazy, Hafez, M. T., Refky, B., & Wahab, A. (2012) · Breast Cancer Targets and Therapy · doi:10.2147/bctt.s29890 · Cited by 20
Quality of life of people with cancers in Ibadan, Nigeria
Nuhu, F. T., Adebayo, K. O., & Adejumo, O. (2013) · Journal of Mental Health · doi:10.3109/09638237.2012.734644 · Cited by 20
Akin‐Odanye, E. O., Chioma, C., & Abiodun, O. (2011) · PubMed Central · Cited by 19
DEPRESSION AND ITS PREDICTORS AMONG BREAST CANCER PATIENTS IN NEPAL
Sharma, A., & Zhang, J. (2014) · ASEAN Journal of Psychiatry · Cited by 19
Que, J. C., Ortin, T. T. S., Anderson, K. O., Gonzalez-Suarez, C., Feeley, T. W., & Reyes‐Gibby, C. C. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0022 · Cited by 18
Caseness rates and risk factors for depression among Vietnamese cancer patients
Yen, N. T. K., Weiss, B., & Trung, L. T. (2016) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2016.07.020 · Cited by 16
A Controlled Study of Depression among Attendees of an Oncology Clinic in West Africa
Olagunju, A. T., & Aina, O. F. (2011) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.42.4.a · Cited by 15
Iqbal, A. (2004) · PubMed · Cited by 14
Nuhu, F. T., Odejide, O. A., Adebayo, K. O., & Adejumo, O. (2008) · Hong Kong journal of psychiatry · Cited by 9
Asuzu, C. C., Akin‐Odanye, E. O., & Philip, E. J. (2015) · Psycho-Oncology · doi:10.1002/pon.3950 · Cited by 8
Pathak, P., Mahal, R., Kohli, A., & Nimbran, V. (2013) · International Journal of Nursing Education · doi:10.5958/j.0974-9357.5.2.080 · Cited by 8
Walker, Z., Jones, M. P., & Ravindran, A. V. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017043 · Cited by 6
Self-citation
Flagged first, then by citations
Research works printed but not linked: 21
- The World Bank, 2020, World Bank Open Data
- Peltzer K, 2016, S Afr J Psychiatr, 22, 940
- Sharma A, 2015, ASEAN J Psychiatry, 16, 106
- Thapa P, 2010, Nepal Med Coll J, 12, 171
- Dogar IA, 2009, Pak J Med Sci, 25, 734
- Iqbal M, 2002, Pak J Med Sci, 18, 109
- Iqbal A, 2004, J Ayub Med Coll Abbottabad, 16, 65
- Rashid YA, 2012, J Pak Med Assoc, 62, 905
- Gaballa H, 2009, Egypt J Psychiatry, 29, 71
- El Missiry A, 2011, Arab J Psychiatry, 22, 36
- El-Hadidy MA, 2012, Breast Cancer (Dove Med Press), 4, 25
- Elsheshtawy EA, 2014, Breast Cancer (Auckl), 8, 97
- Alkhyatt MK, 2012, Jordan Med J, 46, 315
- Akin-Odanye EO, 2011, Afr Health Sci, 11, 341
- Nuhu FT, 2008, Hong Kong J Psychiatry, 18, 107
- Nuhu FT, 2009, Afr J Psychiatry (Johannesbg), 12, 64
- Institute for Health Metrics and Evaluation, 2018, Global Health Data Exchange. Global Burden of Disease Results Tool
- Ostuzzi G, 2015, Cochrane Database Syst Rev, 2015, CD011006
- Ostuzzi G, 2018, Cochrane Database Syst Rev, 4, CD011006
- Cramer H, 2017, Cochrane Database Syst Rev, 1, CD010802
- International Psycho-Oncology Society, 2021, IPSO International Standard of Quality Cancer Care
Cited by
Sorted by citations
Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline
Grassi, L., Caruso, R., Riba, M. B., Lloyd-Williams, M., Kissane, D., Rodin, G., McFarland, D., Campos-Ródenas, R., Zachariae, R., Santini, D., et al. (2023) · ESMO Open · doi:10.1016/j.esmoop.2023.101155 · Cited by 316
Carlson, L. E., Ismaila, N., Addington, E. L., Asher, G. N., Atreya, C. E., Balneaves, L. G., Bradt, J., Fuller-Shavel, N., Goodman, J., Hoffman, C. J., et al. (2023) · Journal of Clinical Oncology · doi:10.1200/jco.23.00857 · Cited by 331
Getie, A., Ayalneh, M., & Bimerew, M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06599-5 · Cited by 117
Global unmet psychosocial needs in cancer care: health policy
Bergerot, C. D., Jacobsen, P. B., Rosa, W. E., Lam, W., Dunn, J. C., Gonzalez, L. F., Mehnert, A., Veeraiah, S., & Li, M. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2024.102942 · Cited by 102
Goerling, U., Hinz, A., Koch, U., Hufeld, J. M., Esser, P., & Mehnert, A. (2023) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-023-04600-w · Cited by 65
Metadata
- 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.
- Venue
- JCO Global Oncology
- Published
- 2021-12
- Volume
- 7
- Issue
- 7
- Pages
- 1233-1250
- ISSN
- 2687-8941 (ISSN-L)
- 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
- gold
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
