title: A quantitative analysis of the prevalence of clinical depression and anxiety in patients with prostate cancer undergoing active surveillance.
abstract: OBJECTIVE
  To quantitatively determine the prevalence of anxiety and depression in men on active surveillance (AS).
  
  
  METHODS
  Cross-sectional questionnaire survey.
  
  
  METHODS
  Secondary care prostate cancer (PCa) clinics across South, Central and Western England.
  
  
  METHODS
  313 men from a total sample of 426 with a histological diagnosis of PCa currently managed with AS were identified from seven UK urology departments. The mean age of respondents was 70 (51-86) years with the majority (76%) being married or in civil partnerships. 94% of responders were of white British ethnicity.
  
  
  METHODS
  The prevalence of clinically meaningful depression and anxiety as assessed by the Hospital Anxiety and Depression Scale (HADS; score ≥8/21).
  
  
  METHODS
  Patient demographic data (age, employment, relationship, ethnic and educational status). Each demographic variable was cross-tabulated against patients identified as depressed or anxious to allow for the identification of variables that were significantly associated with depression and anxiety. In order to determine predictors for depression and anxiety among the demographic variables, logistic regression analyses were conducted, with p<0.05 considered as indicating statistical significance.
  
  
  RESULTS
  The prevalence of clinical anxiety and depression as determined via the HADS (HADS ≥8) was 23% (n=73) and 12.5% (n=39), respectively. Published data from men in the general population of similar age has shown prevalence rates of 8% and 6%, respectively, indicating a twofold increase in depression and a threefold increase in anxiety among AS patients. Our findings also suggest that AS patients experience substantially greater levels of anxiety than patients with PCa treated radically. The only demographic predictor for anxiety or depression was divorce.
  
  
  CONCLUSIONS
  Patients with PCa managed with AS experienced substantially higher rates of anxiety and depression than that expected in the general population. Strategies to address this are needed to improve the management of this population and their quality of life.
authors.affiliation: Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Watts
authors.affiliation: Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Leydon
authors.affiliation: Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Eyles
authors.affiliation: Division of Surgery and Interventional Science, University College London & Department of Urology, UCLH NHS Foundation Trust, London, UK.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Moore
authors.affiliation: Faculty of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Richardson
authors.affiliation: Department of Urology, Southampton University Hospitals NHS Trust, Southampton, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Birch
authors.affiliation: Department of Mathematics, University of Southampton, Southampton, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Prescott
authors.affiliation: Department of Urology, Hampshire Hospitals NHS Trust, Winchester, UK.
authors.forename: Catrin
authors.initials: C
authors.lastname: Powell
authors.affiliation: Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: George
authors.initials: G
authors.lastname: Lewith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D063127:Secondary Health Care; D011795:Surveys and Questionnaires; D057832:Watchful Waiting
keywords: MENTAL HEALTH