Anxiety and depression: risk and resilience factors in a population of cancer patients in active treatment

Background: Scientific literature recognizes unanimously that anxiety and depressive disorders can interfere significantly with the adherence to treatment and with the quality of life of cancer patients. To our knowledge, no studies have been conducted in Italy with high sample size, aiming to describe the presence of these psychological problems, in order to identify risk and resilience factors in a psychosocial and clinical perspective. Method: From 2004 to 2010, during 30 consecutive days each year, 765 patients attending the outpatient ward for anticancer therapy took part in the survey. Overall, the average age was 63.10 years (from 23 to 87). 59% were female and 41% male. The majority was born in Biella, with a low level of education (77.5% had an education of less than 9 years). Breast and gastrointestinal cancer are the most frequent in our sample (35.3% and 34.5% respectively). Almost one third of the patients (31.5%) are metastatic. All patients were administered a socio-demographic and clinical questionnaire along with the Hospital Anxiety and Depression Scale (HADS, Zigmond & Snait, 1983; Costantini et al. 1999). Results: 34.1% of our sample reported an anxious or a depressive symptomatology (8% only anxiety, 14.6% only depression and 10.5% both anxiety and depression). Participants with both anxiety and depression were more likely to be divorced and with a low level of education. Anxiety condition is associated with a younger age and with the family status, while female gender, widowhood and living alone seem to be risk factors in developing a depressive symptomatology. A higher degree of education and living only with a partner are resilience factors in developing significant clinical level of anxiety, depression or both. We found that patients with metastasis are overrepresented in the depression and anxiety-depression groups and patient undergoing further lines of therapy are at risk of developing both conditions. Discussion: Receiving a cancer diagnosis challenges our own vulnerability and mortality, facing also physically demanding therapies, often painful and debilitating. In order to ensure the patient a holistic care process, the early detection of cases at greater risk can help the multidisciplinary team in terms of identification and planning of an effective and personalized psychological support.