Prevalence of Depression

Among Cancer Patients

at the National Oncology Center,
Sana’a, 2024
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 Research Team
• Ahmed Abdalwali Ghalib • Hassan Ali Modhesh
• Ahmed Muaadh Al- Absi • Marwa Nabil Al-Begairy
• Ahmed Yaseen Mohammed • Mohammed Gobran Nasher
• Aisha Hammod Al-Waely • Nadia Mohammed Al-Namer
• Ammar Mohammed Maodah • Safaa Abdu Al-Hazmi
• Ebrahim Ahmed Al-Abasi • Shaima Qahtan Jaber

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 Supervisors

Ass. prof. Muneera Shaher Prof. Fekry AL-Naib

Head of Public Health The Head of the Psychiatric Dept.
& Community Medicine Dept. 21 September University
21 September University
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Introduction
 CANCER
Group of diseases associated with
abnormal growth of cells.

Leads to a swelling commonly known as a

tumor.
The type of tumor associated with cancer
is a malignant tumor.
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 Depression

Common mental disorder.

Depressed mood
Loss of pleasure For a long period of
Loss of interest in time
activities
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 Depression
•It is different from regular mood changes and
feelings about everyday life.
•It can affect all aspects of life, including family,
friends, and community relationships.
•It can happen to anyone.
•People who have lived through abuse, severe
losses, or stressful events are more likely to develop
depression.
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 Epidemiology of Depression
Globally
322 million (4.4%)
6% of Females / 2.6% of
Males

In Yemen
915 thousands (3.6%)
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 Treatment

Medications Psychotherapy
MAOs,
tricyclics,
SSRIs,
…etc.

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 Problem Statement
• Cancer is a life-threatening disease with a significant global
burden, affecting millions worldwide.
• Beyond physical suffering, cancer causes severe psychological
distress, including high rates of depression among patients.
• Depression in cancer patients is linked to poorer quality of life,
decreased treatment adherence, longer hospital stays, and
higher mortality rates.
• Despite this, mental health in cancer care is often neglected,
especially in low- and middle-income countries like Yemen.

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 Justification
• Lack of comprehensive published studies on depression
among cancer patients in Sanaa, Yemen.
• Understanding the impact of depression is crucial to
improving overall health outcomes and quality of life for
cancer patients.
• Findings will help optimize resource allocation and guide
the development of targeted mental health interventions
for cancer patients in Sana'a.

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 General Objective
To determine the prevalence of
depression among cancer patients at the
National Oncology Center, Sana’a, Yemen.
.

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 Specific Objectives
1. Determine the prevalence of depression among cancer patients in
Sana'a, Yemen.
2. Assess the association between depression and
sociodemographic factors, including age, gender, residence,
marital status, education level, and smoking.
3. Evaluate the association between depression and clinical factors,
such as type and duration of cancer, and treatment modalities.
4. Identify predictors of depression among cancer patients.

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Methodology
 Study Design

Retrospective, analytical cross-sectional.

National Oncology Center, Sana’a, Yemen.

Jan – Dec,
2024
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 Study Sample
• 360 patients.
• Age > 18 years, with confirmed diagnosis,
and receiving treatment and follow-up at
the center.
• We excluded patients with:
• Cognitive impairment or inability to
consent.
• Depression started before cancer.
• Refused to participate in the study.
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 Data Collection
• Face-to-face interviews with the participants.
• Patient information.
• Cancer information.
• Patient Health Questionnaire (PHQ-9) and
BDI.
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Statistical Analysis
• Descriptive statistics (frequency and
proportions)

• Association → Chi-square test.

• P-values → Significant at < 0.05.
• IBM SPSS.
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Results
Prevalence of Depression Among Cancer
Patients

Figure 4.1 Prevalence of Depression among Cancer 20

 Level of Depression

Figure 4.2 Level of Depression among Depressed Cancer Patients (According

to BDI) 21
 Patients Characteristics and
Depression
Table 4.3 Association Between Socio-demographics and Depression
Among Cancer Patients
Characteristic Total Depression n(%) p
n (%) Yes No
Age Group
18y - 28y 37 (10.3) 17 (46) 20 (54)
29y - 38y 68 (18.9) 33 (48.5) 35 (51.5) 0.132
39y - 50y 255 (70.8) 144 (56.5) 111 (43.5)
Gender
Male 162 (45.0) 82 (50.6) 80 (49.4)
0.261
Female 198 (55.0) 112 (56.6) 86 (43.4)
Having job
Yes 202 (56.1) 114 (56.4) 88 (43.6)
0.274
No 158 (43.9) 80 (50.6) 78 (49.4)

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 Patients Characteristics and
Depression
Figure 4.3 Distribution of Residence Among the Sample n=(360)

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 Patients Characteristics and
Depression
Table 4.4 Association Between Living Area and Marital Status and
Depression Among Cancer Patients
Characteristic Total Depression n(%) p
n (%) Yes No
Living Area
Rural 166 (46.1) 88 (53.0) 78 (47.0)
0.758
Urban 194 (53.9) 106 (54.6) 88 (45.4)
Marital Status
Divorced 25 (6.9) 11 (44.0) 14 (56.0)
Married 308 (85.6) 168 (54.6) 140 (45.5) 0.724
Single 14 (3.9) 7 (50.0) 7 (50.0)
Widowed 13 (3.6) 8 (61.5) 5 (38.5)

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 Patients Characteristics and
Depression
Table 4.4 Association Between Education and Depression Among
Cancer Patients
Total Depression n(%)
Characteristic p
n (%) Yes No
Education
Yes 317 (88.1) 177 (55.8) 140 (44.2)
0.044
No 43 (11.9) 17 (39.5) 26 (60.5)
Education Level
High school 93 (29.2) 49 (52.7) 44 (47.3)
Middle Preparatory School 54 (17.0) 33 (61.1) 21 (38.9)
0.165
Primary School 103 (32.4) 61 (59.2) 42 (40.8)
University 68 (21.4) 34 (50.0) 34 (50.0)

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 Patients Characteristics and
Depression
Table 4.4 Association Between Medical Habits and Depression Among
Cancer Patients
Depression n(%)
Characteristic Total n (%) p
Yes No
Smoking
Yes 149 (41.4) 79 (53.0) 70 (47.0)
0.782
No 211 (58.6) 115 (54.5) 96 (45.5)
Chewing Qat
Yes 246 (68.3) 134 (54.5) 112 (45.5)
0.745
No 114 (31.7) 60 (52.6) 54 (47.4)

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 Cancer Characteristics and
Depression
Table 4.13 Association Between Duration of Cancer and Depression
Among Cancer Patients
Total Depression n(%)
Characteristic p
n (%) Yes No
Duration of Symptoms
Less than 6 m 63 (17.5) 9 (14.3) 54 (85.7)
6 m – 11 m 110 (30.6) 41 (37.3) 69 (62.7)
12 m – 2 y 101 (28.1) 71 (70.3) 30 (29.7)
<0.001
2y–3y 51 (14.2) 43 (84.3) 8 (15.7)
More than 3 y 32 (8.9) 30 (93.8) 2 (6.3)
Not known 3 (0.8) 0 (0.0) 3 (100.0)

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 Cancer Characteristics and
Depression
Table 4.14 Association between Type of Treatment Used for Treating
Cancer and Depression

Total Depression n(%)

Characteristic p
n (%) Yes No
Type of Treatment
Chemotherapy 136 (37.8) 31 (22.8) 105 (77.2)
Chemotherapy and radiation 68 (18.9) 42 (61.8) 26 (38.2)
Chemotherapy and surgical 97 (26.9) 67 (69.1) 30 (30.9) <0.001
Chemotherapy, radiation, and
59 (16.4) 54 (91.5) 5 (8.5)
surgical

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 Cancer Characteristics and
Depression
Table 4.15 Association between Type of Cancer and Depression
Total Depression n(%)
Characteristic p
n (%) Yes No
Type of Cancer
Breast 75 (20.8) 53 (70.7) 22 (29.3)
GIT 54 (15.0) 28 (51.9) 26 (48.1)
Gynecological 29 (8.1) 14 (48.3) 15 (51.7)
Leukemia 26 (7.2) 11 (42.3) 15 (57.7)
Lung 70 (19.4) 35 (50.0) 35 (50.0)
0.032
Lymphoma 32 (8.9) 11 (34.4) 21 (65.6)
Mouth 6 (1.7) 3 (50.0) 3 (50.0)
Other 31 (8.6) 18 (58.1) 13 (41.9)
Prostate 24 (6.7) 11 (45.8) 13 (54.2)
Sarcoma 13 (3.6) 10 (76.9) 3 (23.1)
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 Cancer Characteristics and
Depression
Table 4.16 Association Between Levels of Depression and Types of
Treatment
Very
Mild Moderate Severe
Characteristic Total Severe p
(10–15) (16–23) (24–36)
(37–63)
Type of Treatment
Chemotherapy 31 (16.0) 30 (96.8) 1 (3.2) 0 (0.0) 0 (0.0)

Chemo + radiation 42 (21.6) 16 (38.1) 17 (40.5) 8 (19.0) 1 (2.4)

<0.00
1
Chemo + surgical 67 (34.5) 23 (34.3) 22 (32.8) 11 (16.4) 11 (16.4)
Chemo + radiation
54 (27.8) 7 (13.0) 17 (31.5) 22 (40.7) 8 (14.8)
+surgical

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 Cancer Characteristics and
Depression
Table 4.17 Association Between Levels of Depression and Cancer Types
Severe Very Severe
Characteristic Total Mild (10–15)Moderate (16–23) p
(24–36) (37–63)
Type of Cancer
Breast 53 (27.3) 20 (37.7) 15 (28.3) 10 (18.9) 8 (15.1)
GIT 28 (14.4) 12 (42.9) 6 (21.4) 6 (21.4) 4 (14.3)
Gynecologica
14 (7.2) 5 (35.7) 4 (28.6) 4 (28.6) 1 (7.1)
l
Leukemia 11 (5.7) 5 (45.5) 2 (18.2) 4 (36.4) 0 (0.0)
0.6
Lung 35 (18.0) 14 (40.0) 10 (28.6) 7 (20.0) 4 (11.4)
Lymphoma 11 (5.7) 4 (36.4) 4 (36.4) 2 (18.2) 1 (9.1)
Mouth 3 (1.5) 1 (33.3) 1 (33.3) 1 (33.3) 0 (0.0)
Sarcoma 10 (5.2) 3 (30.0) 5 (50.0) 2 (20.0) 0 (0.0)
Prostate 11 (5.7) 5 (45.5) 3 (27.3) 2 (18.2) 1 (9.1)
Other 18 (9.3) 7 (38.9) 7 (38.9) 3 (16.7) 1 (5.6)
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 Cancer Characteristics and
Depression
Table 4.18 Association Between Depression Levels and Cancer Duration
Very
Mild Moderate Severe
Characteristic Total Severe p
(10–15) (16–23) (24–36)
(37–63)
Duration of
Symptoms
12 m – 2 y 71 (36.6) 34 (47.9) 20 (28.2) 10 (14.1) 7 (9.9)
2y–3y 43 (22.2) 2 (4.7) 18 (41.9) 17 (39.5) 6 (14.0)
6 m – 11 m 41 (21.1) 29 (70.7) 11 (26.8) 1 (2.4) 0 (0.0) <0.00
1
Less than 6 m 9 (4.6) 9 (100.0) 0 (0.0) 0 (0.0) 0 (0.0)
More than 3 y 30 (15.5) 2 (6.7) 8 (26.7) 13 (43.3) 7 (23.3)
Not known 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
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Conclusion
 Conclusion
• Depression is highly prevalent among cancer patients 54%.
• Significant factors associated with depression:
• Educational level
• Duration of disease
• Type of treatment
• Type of cancer
• Higher depression rates were observed in:
• Patients with longer disease duration
• Those receiving multimodal or aggressive treatments
• Patients with certain cancer types (e.g., breast cancer, sarcoma)

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 Recommendations
• Increase awareness on depression in cancer patients.
• Provide psychological support and counseling services in
oncology centers.
• Educate patients on treatment options and medication
adherence (especially SSRIs).
• Encourage healthy lifestyle changes (sleep, nutrition, exercise,
stress management).
• Support and fund further research on cancer-related depression.

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 Limitations
• Financial and time constraints affected data
collection and site visits.
• Transportation difficulties limited access to
some research sites.
• Some participants refused to complete the
questionnaire, affecting sample size and
response rate.

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Thanks!
Do you have any questions?