title: Depression in relation to survival among neurosurgical patients with a primary brain tumor: a 5-year follow-up study.
abstract: OBJECTIVE
  The adverse impact of depression in relation to survival among cancer patients is currently a subject of great interest in research. In a 5-year follow-up study, we investigated the association of depression with survival of patients with a primary brain tumor.
  
  
  METHODS
  The study population consisted of 75 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu University Hospital, in Northern Finland. The patients were interviewed during admission to the hospital for the tumor surgery. Assessment of depression was made using the Beck Depression Inventory and the Crown-Crisp Experiential Index. Information on all deaths within 60 months after tumor operation was collected from the Cause of Death Register, provided by Statistics Finland.
  
  
  RESULTS
  The patients with a high-grade glioma had a survival time of 22.5 months (standard deviation, 21.4 mo), whereas the corresponding time was 50.2 months (standard deviation, 19.9 mo) for patients with a low-grade glioma and 58.2 months (standard deviation, 9.4 mo) for the patients with a histologically benign tumor (P < 0.001, difference between groups, Kruskal-Wallis test). In the subgroup of patients with low-grade gliomas, depressive patients had a significantly shorter survival time compared with nondepressive subjects (P = 0.031, Kaplan-Meier survival analysis). A corresponding difference was not found in patients with high-grade gliomas or benign tumors. Tumor location in one hemisphere compared with bilateral location and wider extent of tumor surgery was associated with better survival in patients with low-grade gliomas and benign tumors but not in patients with high-grade gliomas.
  
  
  CONCLUSIONS
  Preoperative depression seemed to be a significant prognostic factor for worse survival in low-grade glioma patients. In clinical practice, an evaluation of depression among brain tumor patients by structured and standardized diagnostic methods is needed to distinguish the patients whose depression actually needs treatment. The effective treatment of clinical depression among brain tumor patients and the impact of treatment on the patients' chances of survival should be a focus of future research.
authors.affiliation: Department of Psychiatry, University of Oulu, and Oulu University Hospital, Oulu, Finland. arja.mainio@oulu.fi
authors.forename: Arja
authors.initials: A
authors.lastname: Mainio
authors.forename: Helinä
authors.initials: H
authors.lastname: Hakko
authors.forename: Markku
authors.initials: M
authors.lastname: Timonen
authors.forename: Asko
authors.initials: A
authors.lastname: Niemelä
authors.forename: John
authors.initials: J
authors.lastname: Koivukangas
authors.forename: Pirkko
authors.initials: P
authors.lastname: Räsänen
mesh_terms: D000328:Adult; D000367:Age Factors; D001932:Brain Neoplasms / Q000145:classification / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D003710:Demography; D003863:Depression / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D011183:Postoperative Complications; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D015996:Survival Rate