Reply to C.E. Paiva et al
Authors: Anja Mehnert, Elmar Brähler, Hermann Faller, Martin Härter, Monika Keller, Holger Schulz, Karl Wegscheider, Joachim Weis, Hans-Ulrich Wittchen, Uwe Koch
Journal: Journal of Clinical Oncology (2015)

We very much appreciate the interest of Paiva et al in our study. We reported the 4-week prevalence of mental disorders in patients with cancer across major tumor entities using an epidemiologic crosssectional approach on the basis of the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for patients with cancer. Paiva et al noted that a categorization that only considered time after diagnosis would be overly simplified because, in addition to time, patients should be assessed with relation to stressful disease events. They therefore suggest a longitudinal approach to address the relationship between stressful events during different treatment phases and the occurrence of mental disorders. We agree with the authors’ statement that the prevalence of mental disorders depends at least to a certain degree on different disease phases and stressful events during the cancer trajectory. The causes of mental disorders are multifaceted, including cancerand treatment-related stressors as well as psychosocial stressors, individual and interpersonal factors that contribute to a variety of stress responses, emotional distress, and mental comorbidity. We would like to emphasize the authors’ suggestion that we further analyze our data to obtain a better understanding about the associations between cancerand treatment-related stressors and mental disorders—analyses that we are already planning. However, our primary study purpose was not to investigate the occurrence of mental disorders in relation to different treatments and disease phases, although our sample size is large enough to address this question in relevant study cohorts in detail. We used an epidemiologic and health services research perspective to assess reliable data on the 4-week prevalence of mental disorders in patients with cancer treated in any inpatient or outpatient cancer care facility to estimate the need for resources to provide appropriate psycho-oncologic and psychotherapeutic support. Epidemiologic data addressing mental health in cancer populations may be considered important for various reasons. National representative studies that describe patterns of prevalence for mental disorders are highly relevant for educating the scientific community, the public, health care policy makers, and politicians about the scope and psychological consequences of somatic disorders such as cancer. Therefore, epidemiologic data have significant value for health services utilization research, health care policy decisions, and planning purposes. Given the fact that major depressive disorder is among the leading causes of disability-adjusted life years, mental disorders might play an important role in both the manifestation and the maintenance of additional disorders and disabilities that can lead to further impairment in activities and participation in society. Anja Mehnert and Elmar Brahler University Medical Center Leipzig, Leipzig, Germany