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

Journal article extract: Prostate Cancer and Prostatic Diseases Volume 24 2021

Oliver Brunckhorst, Safiya Hashemi, Anastasia Martin, Gincy George, Mieke Van Hemelrijck, Prokar Dasgupta, Robert Stewart & Kamran Ahmed

DOI 10.1038/s41391-020-00286-0

“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.

A systematic literature search was conducted using MEDLINE, Scopus, PsycInfo, and Cochrane Library databases from inception up to 26 May 2020. The review sought to provide best estimates for depression, anxiety, and suicidality after a diagnosis of prostate cancer. Our identified prevalence of clinical diagnoses of depressive disorders were consistent with global estimates in the general population of 4.4%, particularly when considering estimates of 5.5% for males aged between 55 and 74. These results are also in keeping with estimates in a cancer specific population of between 4 and 11%. Significant depressive and anxiety symptoms were common in our analysis, with these figures also largely consistent with the high prevalences of these symptoms in cancer populations as a whole. Similarly, recent suicidal ideation was common; present in 9.85%, and considerably higher than 2% 1-year general population estimates. Subsequently, the suicide mortality rate seen was high, with our identified rate considerably higher than quoted rates in the United States of 16.7 and 31.4 per 100,000 person years for both general and cancer specific populations respectively. This remains the case even when considering the higher risk groups of elderly and male patients. These results therefore demonstrate the high psychiatric morbidity and mortality experienced by men post prostate cancer diagnosis.

The findings in this meta-analysis have important clinical implications. Increased awareness of the psychiatric impact of prostate cancer and is needed. We demonstrate this to be frequent, thereby requiring a central role during follow-up. Integration of psychosocial services into current pathways is vital for improving current care Psychiatric complications of prostate cancer are common. A high prevalence of depressive and anxiety symptoms is seen in this cohort. Additionally, recent suicidal ideation and suicide mortality are high when compared to general population estimates. This highlights the importance of integrating mental health care within urological and oncological follow-up. Regular screening of patients and at-risk groups is vital for early identification and treatment and should be evaluated for improving overall quality of life and functional outcomes in prostate cancer patients.”

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