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Depression, anxiety, and suicidality in patients with prostate cancer: a systematic review and meta-analysis of observational studies

Abstract

Background

Psychiatric implications of prostate cancer are increasingly recognised, having important effects on oncological and functional outcomes. However, findings for co-occurring depression, anxiety, and suicidality remain variable. Therefore, this review of observational studies aimed to establish best estimates of the prevalence and rates of these outcomes in prostate cancer patients.

Methods

A systematic literature search was conducted using MEDLINE, Scopus, PsycInfo, and Cochrane Library databases from inception up to 26 May 2020. Observational studies using validated methods for evaluating prevalences of depression, anxiety and suicidal ideation, or suicide mortality rates post prostate cancer diagnosis were included. Random effect models were used to calculate pooled prevalences of depressive and anxiety symptoms or disorders, and suicidal ideation post diagnosis. Additionally, pooled crude suicide mortality rates per 100,000 person years were calculated. Heterogeneity was explored using a stratified analysis.

Results

Of 3537 articles screened, 117 were included. Pooled prevalence for depressive disorders was 5.81% (95% CI 4.36–7.46) in 11 studies, representing 655,149 patients. Significant depressive symptoms were identified in 17.07% (15.14–19.09) across 32,339 patients and 76 studies. In total, 16.86% (14.92–18.89) had significant anxiety symptoms in 56 studies combining 24,526 patients. In 6,173 patients and eight studies, recent suicidal ideation was present in 9.85% (7.31–12.70). Crude suicide mortality rate after diagnosis was 47.1 (39.85–54.96) per 100,000 person years in 12 studies. Significant heterogeneity was seen with potential sources identified through our sensitivity analysis including diagnostic method utilised, study size and location of study.

Conclusions

The mental health impact in patients with prostate cancer is significant. Depressive, anxiety, and suicidal symptoms were common. Additionally, a high suicide mortality rate was identified when compared to general population estimates. Screening of patients and integration of physical and mental health care should be evaluated further to improve quality of life and functional outcomes.

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Fig. 1: Study selection.
Fig. 2: Pooled prevalence of depressive disorders in prostate cancer.
Fig. 3: Pooled prevalence of significant depressive symptoms in prostate cancer.
Fig. 4: Pooled prevalence of significant anxiety symptoms in prostate cancer.

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Acknowledgements

OB, PD, and KA acknowledge research support from the Medical Research Council (MRC) Centre for Transplantation and funding from the King’s Medical Research Trust (KMRT). PD further acknowledges funding from the King’s College London-Vattikuti Institute of Robotic Surgery and the Guy’s and St. Thomas’ (GSTT) Charity. KA further acknowledges funding from the Royal College of Surgeons of England, The Urology Foundation, Coptcoat Charity and the Pelican Foundation. RS is part-funded by: (1) the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King’s College London; (2) a MRC Mental Health Data Pathfinder Award to King’s College London; (3) an NIHR Senior Investigator Award; (4) the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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OB, SH, and KA contributed to the study concept and design. OB, SH, and AM contributed to the literature search and data collection. OB, GG, MVH, RS, and KA contributed to the data analysis and interpretation of the data. OB contributed to the drafting of the paper. OB, PD, RS, and KA contributed to the critical revision of the paper All authors approved the final paper for submission.

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Correspondence to Oliver Brunckhorst.

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Brunckhorst, O., Hashemi, S., Martin, A. et al. Depression, anxiety, and suicidality in patients with prostate cancer: a systematic review and meta-analysis of observational studies. Prostate Cancer Prostatic Dis 24, 281–289 (2021). https://doi.org/10.1038/s41391-020-00286-0

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