Prevalence of Anxiety & Depression in Adult Patients with Lymphoid Malignancies at Diagnosis: What Are Its Implications?.

Background: Patients undergoing treatment for hematological malignancies suffer from high levels of undetected anxiety and depression. Psychological adaptation to the intensive treatments is highly individual, but a proportion of patients will experience a marked deterioration in quality of life (QOL) and/or may develop clinical depression. In adult patients with lymphoid malignancies, there are no guidelines for use of antidepressants because data on the prevalence at diagnosis is scarce. In addition, a qualified psychiatrist referral is recommended before putting these patients on anti depressants or anxiolytic agents. There are several tools available in the market to objectively assess depression & anxiety. We therefore studied the prevalence of anxiety and depression and their severity in patients with lymphoid malignancies at the time of presentation.

Methods: The Hospital Anxiety and Depression Scale (HADS) were used for screening and the Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used to assess the severity of anxiety and depression in our patients with leukemia. The questionnaire was administered by a qualified psychiatrist and data so collected was compiled.

Results: A total of 27 patients (age: 18–54 years) with acute lymphoid malignancies (23 ALL, 4 Lymphoblastic lymphoma) were evaluated and administered the questionnaire at the time of diagnosis. HADS score indicated that 11 (40%) patients were normal, 2 (7 %) had borderline and 14 (52 %) had definite anxiety and/or depression. All these patientswere also evaluated using the HDRS and the HARS. On HDRS, 13 patients were normal, 6 patients had borderline depression and 8 patients had definite depression (table 1&2). All of these 14 patients are put on medications under the supervision of the psychiatrist.

Conclusion: A significant proportion of patients with acute lymphoid malignancy suffer from clinically significant depression/anxiety which may affect the quality of life of these patients while on treatment. Whether these responses are normal reactions to the diagnosis of cancer or has some inherent pharmacological/pathological correlation needs to be studied further. HADS, a screening tool, has good corelation with HDRS and HARS and can be applied on OPD basis.