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Prevalence and Predictors of Anxiety and Depression Among Cervical Cancer Survivors in Korea

Kim, Soo Hyun RN, PhD*†; Kang, Sokbom MD, PhD‡; Kim, Yong-Man MD, PhD§; Kim, Byoung-Gie MD, PhD∥; Seong, Seok Ju MD, PhD¶; Cha, Soon Do MD, PhD**; Park, Chan-Yong MD, PhD††; Yun, Young Ho MD, PhD*

International Journal of Gynecological Cancer: August 2010 - Volume 20 - Issue 6 - pp 1017-1024
doi: 10.1111/IGC.0b013e3181e4a704
Cervical Cancer

Purpose: With increasing survival rates of women with cervical cancer, quality of life of the survivors becomes a more important issue. However, little is known about the mental health of cervical cancer survivors (CCSs). This study investigated the prevalence of anxiety and depression in CCSs compared with healthy controls and identified factors associated with multidimensional model including sociodemographic, clinical, functioning and well-being, and symptom variables.

Methods: The participants included 828 CCSs (mean time since treatment, 6.9 years) enrolled at 6 tertiary hospitals from 1983 to 2004 and 500 control subjects selected randomly from a representative sample of Korean women. Subjects completed the following questionnaires: the Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire-C30, its Cervical Cancer module, and the McGill Quality of Life Questionnaire.

Results: Hospital Anxiety and Depression Scale-defined anxiety in CCSs did not differ from that in healthy controls (39.5% and 32.2%, respectively; P = 0.218). Anxiety was significantly more prevalent in younger CCSs (≤50 years) than in controls (40% vs 26.4%, respectively; P < 0.001). Hospital Anxiety and Depression Scale-defined depression was even lower in CCSs than in controls (34.6% vs 48.0%, respectively; P < 0.001). In multivariate analyses, the Hospital Anxiety and Depression Scale-defined anxiety and depression in CCSs were commonly associated with financial difficulty, poor body image, sexual inactivity, and low existential well-being. Low support and insomnia were uniquely related to anxiety, with older age and decrement role function uniquely related to depression. However, disease-related clinical factors were not related to either anxiety or depression.

Conclusions: Cervical cancer survivors showed relatively good mental health compared with healthy controls; however, women who have low functioning and well-being could be at high risk of anxiety or depression or both.

*Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi; †Department of Nursing, Inha University, Incheon; ‡Center for Uterine Cancer, National Cancer Center, Goyang, Gyeonggi; §Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine; ∥Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine; ¶Department of Obstetrics and Gynecology, Kangnam Cha Hospital, College of Medicine, CHA University, Seoul; **Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu; and ††Department of Obstetrics and Gynecology, Gachon University, Gil Hospital, Incheon, Korea.

Received January 22, 2010, and in revised form March 25, 2010.

Accepted for publication April 24, 2010.

Address correspondence and reprint requests to Young Ho Yun, MD, PhD, Research Institute and Hospital, National Cancer Center, 809 Madu-dong, Ilsandong-gu, Goyang, Gyeonggi, Republic of Korea, 410-769. E-mail:

This work was supported by National Cancer Center grants 04101502 and 07104213.

There were no potential financial conflicts of interest.

Copyright © 2010 by IGCS and ESGO