title: Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis.
abstract: BACKGROUND
  Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls.
  
  
  METHODS
  We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls.
  
  
  RESULTS
  Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7-16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0-12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96-1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8-23·6) in 48 964 cancer survivors and 13·9% (9·8-18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08-1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86-1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44-1·14; p=0·16) differed significantly between cancer patients and their spouses.
  
  
  CONCLUSIONS
  Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Psycho-oncology, Leicester Partnership Trust, Leicester, UK. ajm80@le.ac.uk
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: David W
authors.initials: DW
authors.lastname: Ferguson
authors.forename: John
authors.initials: J
authors.lastname: Gill
authors.forename: Jim
authors.initials: J
authors.lastname: Paul
authors.forename: Paul
authors.initials: P
authors.lastname: Symonds
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D018454:Spouses / Q000523:psychology*; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology*; D013997:Time Factors