Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6 months after diagnosis

Abstract Objective To describe the prevalence of anxiety, depression and comorbid anxiety–depression among adult cancer survivors six months following diagnosis, and identify the individual, disease, health behaviour, psychological and social factors associated with psychological morbidity. Methods A population-based sample of adult cancer survivors was recruited from two state-based cancer registries in Australia. Data for 1323 survivors were obtained by self-report questionnaire and linkage with registry data. Anxiety and depression were assessed by the 14-item Hospital Anxiety and Depression Scale (HADS). Results The prevalence of psychological morbidity was 28% (95% CI: 23%–33%). Specifically, 24% (95% CI: 19%–29%) of survivors were identified as cases on anxiety (irrespective of depression), 14% (95% CI: 9%–19%) as cases on depression (irrespective of anxiety) and 10% (95% CI: 5%–15%) as cases on comorbid anxiety–depression. In addition to mental health history prior to cancer, modifiable health behaviours (physical activity, smoking status), psychological (helplessness–hopelessness, anxious preoccupation coping) and social (low positive social interaction) characteristics were stronger indicators of psychological morbidity than survivors' individual or disease characteristics. Limitations Psychological morbidity was assessed by self-report screening instrument rather than clinical interview. The extent to which psychological morbidity is age-related versus cancer-related cannot be determined without a gender- and age-matched control group. Conclusion Although lower than previously reported, psychological morbidity is prevalent six months after a cancer diagnosis and emphasises the need for routine psychosocial assessment throughout the cancer trajectory to identify those at increased risk or in need of immediate intervention. Physical activity, smoking cessation and coping skills training interventions warrant further exploration.