Depression and Anxiety in Patients with Hematological Malignancies in a Tertiary Center in Saudi Arabia, Prevalence and Associated Factors
Authors: Abuelgasim Khadega A , Ahmed Gasmelseed Y , Alqahtani Jamilah A , Alayed Aseel , Alaskar Ahmed S. , Malik Mansoor A 
Published: October 2019

Abstract
Introduction:
Cancer is a serious condition that has an affect not only on patients' physical but also on their emotional well-being.Adults with hematological cancers (HC) have high prevalence rates of depression and anxiety.No reports are yet available about their prevalence in such patients' population in the Arab world. We aimed in this study to determine the prevalence of depression and GAD in HC patients seen at our facility.
Methods:
A cross-sectional study was conducted and recruited 211 participants. Institutional Review Board approval was obtained prior to conducting the study. All patients 14 years or older, with confirmed HC in the period of March 2014 -March 2015 were asked to participate in the study. Patients known to have a mental disorder were excluded. After obtaining the informed consent, a structured face to face interview was conducted using an internally developed and validated questionnaire.
Generalized Anxiety Disorder-7 (GAD-7) standardized questionnaire, translated into Arabic language was used to screen participants for GAD.It is 7-item scale that provides a 0-21 severity score. A score 5 to 9 is indicative of mild GAD, a score of 10 indicates moderate GAD, while a score of 15 indicates severe GAD. We only report cases of moderate and severe GAD.
Patient Health Questionaire-9 (PHQ-9) standardized, translated into Arabic language was used to screen participants for depression.It includes 9 items; with severity score of 0-27. Scores of 5, 10, 15 and 20 represents cut off points for mild, moderate, moderately severe and severe depression respectively. A cut-off point of 10 is used to identify depression in our study.
Results:
The median age was 46 (27 - 64) years and 121 (57.35%) were males. GAD was detected in 47 (22.3%) and depression was detected in 98 (46.5%) participants; while concurrent GAD and depression were detected in 38 (18.01%). Multivariate analyses revealed that the presence of multiple co-morbidities and tense home atmosphere are significant predictors for GAD and depression, while lower or no education is only associated with depression. We found no association between gender, smoking, family income or being on active therapy and the presence of depression or GAD.
Conclusion:
The prevalence of GAD and depression in HC in KAMC seems to be in the same range compared to what is reported by the international studies. Health care providers in the region ought to screen HC patients for depression and GAD as early referral and intervention may improve their emotional well being and possibly their disease outcome.
Table 1. Multivariate analysis for patients with anxiety (n=211) Variable (anxiety) OR 95% CI P-value Gender Female vs. male 1.499 (0.687 - 3.271) 0.3092 Education College graduate vs. not educatedElementary/middle/high vs. not educated 1.849 2.295 (0.522 - 6.192) (0.874 - 6.030) 0.6910 0.1749 Employment Employed vs. unemployed 1.242 (0.484 - 3.186) 0.6520 Marital status Unmarried vs. married 1.914 (0.867 - 4.225) 0.1080 Support Socially supported vs. poorly supported 2.107 (0.707 - 6.276) 0.1810 Home atmosphere Tense vs. relaxed home atmosphere 4.494 (1.686 - 11.979) 0.0027 Income Low income vs. high income 1.043 (0.426 - 2.549) 0.9272 Comorbidities Comorbidity vs. no comorbidity 7.673 (3.136 - 18.777) 0.0001 Actively receiving treatment Yes vs. no 1.053 (0.424 - 2.615) 0.9120
Table 2. Multivariate analysis for patients with depression (n=211) Variable (depression) OR 95% CI P-Value Gender Females vs. males 1.352 (0.682 - 2.680) 0.3874 Education College/graduate vs. elementary/middle/highN ot educated vs. elementary/middle/high 1.365 2.541 (0.584 - 3.190) (1.106 - 5.833) 0.7309 0.0803 Employment Employed vs. unemployed 2.270 (1.000 - 5.149) 0.0499 Marital status Unmarried vs. married 1.806 (0.901 - 3.621) 0.0960 Family support Supported vs. poorly supported 1.854 (0.728 - 4.725) 0.1957 Home atmosphere Tense vs. relaxed 2.591 (1.199 - 5.599) 0.0154 Income Low vs. high 1.816 (0.779 - 4.235) 0.1670 Comorbidities Comorbidity vs. no comorbidity 6.578 (3.315 - 13.055) 0.0001 Actively receiving treatment Yes vs. no 1.627 (0.744 - 3.562) 0.2230

Disclosures
No relevant conflicts of interest to declare.