A new study conducted at Princess Marina Hospital has revealed a troubling reality as more than a third of cancer patients receiving treatment at he nation’s main referral hospital are battling depression.
The study, titled ‘Prevalence of depression and association with quality-of-life among oncology patients at Princess Marina Hospital, Botswana: A cross-sectional study,’ shows that this compounds the already heavy burden of disease.
It also found that 35.8 percent of oncology patients screened positive for depression. The research involved 302 patients, 28 percent of them in-patients and 72 percent out-patients.
Researchers reported that the median age of participants was 55 years with women making up 71 percent of the sample. A majority of patients which translated to 70 percent, were unemployed and had no personal income. Among those who reported earning, the average monthly income was just 29 US dollars (about P390).
‘This study reveals a high prevalence of depression among oncology patients at Princess Marina Hospital,’ the authors state. They added that; ‘Depression may greatly affect not only overall quality of life but also ultimately survival.’
The findings point to a web of hardship. Participants reported a mean pain score of four out of 10. However, those with depression experienced significantly higher pain levels, averaging six compared to four among non-depressed patients which is a statistically significant difference.
‘Pain was identified as a major factor associated with depression, affecting multiple aspects of quality of life,’ the researchers noted. They found a clear positive correlation between higher pain levels and increased depression scores.
Beyond physical discomfort, depression was shown to erode quality of life across every measured domain: physical health, psychological health, social relationships and environmental well-being. Researchers found a negative correlation between depression and quality-of-life scores, meaning that as depressive symptoms increased, quality of life declined sharply.
‘Addressing the dual challenges of cancer and depression is crucial for enhancing the quality of life of oncology patients in Botswana,’ the study says. It also states that ‘By recognising and treating depression as a critical component of cancer care, healthcare providers can mitigate its detrimental effects.’
The study also revealed surprising trends. While previous research in Botswana has shown high depression rates among people with diabetes, this study found that cancer patients with type 2 diabetes were less likely to have depression.
Similarly, no increased risk of depression was found among cancer patients living with HIV, another result that diverges from prior global research. Only one percent of participants reported a prior mental illness diagnosis, a figure the researchers suggest may reflect underdiagnosis and poor mental health screening in general care.
Importantly, being newly diagnosed with cancer emerged as a key factor linked to depression, underscoring the emotional shock and uncertainty patients face at the onset of treatment.
The prevalence rate of 35.8 percent aligns closely with the African average and mirrors findings in other countries. For example, a comparable depression rate of 39.5 percent was observed among cervical cancer patients in Korea which is a relevant comparison given that cervical cancer remains the leading cause of cancer among women in Botswana.
The researchers argue that routine mental health screening must become standard practice in oncology settings. They recommended that ‘In Botswana, PHQ-9 screening should be a routine, standard part of oncology care.’
The study also recommended that treatment must go beyond chemotherapy and surgery. It also warned that without integrating mental health care into oncology, many patients at Princess Marina Hospital will continue fighting two battles at once; one against cancer and another within themselves.