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DOI: 10.1177/0300060515616722
preoperative anxiety imr.sagepub.com
Abstract
Objectives: To investigate the prevalence rate and influencing factors of preoperative anxiety
and depression in patients with gastric cancer, in China.
Methods: Patients with gastric cancer who were diagnosed by gastroscopy and would accept
laparoscopic surgery were eligible for the study. Each participant completed self-administered
questionnaires, including the Hospital Anxiety and Depression Scale (HADS), Medical Coping
Modes Questionnaire (MCMQ), Social Support Rating Scale, and Type D personality scale before
surgery. Routine blood tests were undertaken within 7 days before surgery, to calculate the
neutrophil-to-lymphocyte ratio (NLR). Based on HADS, patients were divided into an anxiety/
depression group and a nonanxiety/depression group.
Results: Fifty-three patients with gastric cancer were included in the study. The prevalence of
preoperative anxiety and/or depression was 20.75% (11/53). Factors influencing preoperative
anxiety and depression were a resigned dimension of coping style, type D personality and NLR.
Logistic regression analysis showed that a higher score for the resigned dimension of coping style
on the MCMQ and a higher NLR were significantly associated with preoperative anxiety and
depression.
Conclusions: The prevalence of preoperative anxiety and depression in Chinese patients with
gastric cancer may be influenced by both the coping mode and NLR.
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122 Journal of International Medical Research 44(2)
Keywords
Gastric cancer, anxiety, depression, prevalence, influencing factors
insurance status; clinical staging; social dimensions that correspond to three disease-
support; coping styles; type D personality; related cognitive and behavioural coping
neutrophil-to-lymphocyte ratio (NLR). modes: confrontive, avoidant and resigned.
Ethical approval for the study was pro- Each item is scored on a four-point Likert
vided by the Ethics Committee of The scale (from 1 to 4, with each score indicating
Union Hospital of Fujian Medical a different frequency of each coping mode’s
University (reference no. 2015KY017). All use (e.g. never, sometimes, often, always);
patients provided verbal informed consent. this scale has good reliability and validity.
11
Table 3. Comparison of the levels of the Table 5. Comparison of the neutrophil- to-
different types of social support experienced by lymphocyte ratio (NLR) in patients with gastric
patients with gastric cancer (n ¼ 53) categorized cancer (n ¼ 53) categorized according to the
according to presence or absence of preoperative presence or absence of preoperative anxiety and
anxiety and depression. depression.
Objective 9.18 2.48 8.98 2.28 NLR 2.65 8.57 2.08 7.67*
Subjective 24.36 3.61 24.00 3.85
Utilization 7.64 2.36 7.02 2.17 Data presented as mean SD.
*P < 0.05 compared with anxiety/depression group;
Total score 41.18 5.89 40.00 5.71
Student’s t-test.
Data presented as mean SD.
20
considerable research. Gastric cancer is
Discussion
In people with cancer, psychological factors
play vital roles in not only tumourigenesis,
but also in tumour therapy, subsequent
rehabilitation and improvements in
18,19
HRQoL. Therefore, exploring the psy-
chological state of patients and its influence
on cancer patients has become the focus of
one of the most frequent cancers in the
world, with almost two-thirds of gastric
cancer cases and deaths occurring in less-
1,21
developed global regions.
Comprehensive therapy encompassing
surgery, chemotherapy and radiotherapy
has become the major treatment modality
22
for gastric cancer. Studies on anxiety and
depression in patients with gastric cancer
have mainly examined the diagnosis and
treatment of anxiety and depression follow-
20,23,24
ing chemotherapy or surgery. A study
in the Republic of Korea reported that,
before chemotherapy, the proportion of
anxiety-depressive disorders was as high as
63% in 43 patients demonstrated a provide edu- cation identify such
with advanced prevalence rate of on the prevention patients in a
gastric cancer.
23 preoperative and treatment of timely manner and
Another study anxiety and/ or tumours (such as perform effective
undertaken in the depression of gastric cancer), interventions, to
Republic of Korea 20.75% in 53 patients affected by con- trol their
reported that the patients with the disease (and psychological
preva- lence of gastric cancer, their family symptoms and
postoperative which was lower members) can fully improve outcomes.
depression was than that found in understand gastric When Japanese
44% in 391 the aforementioned cancer; thus we researchers
patients with studies. believer that they investigated the
gastric cancer.
24 These current, develop a more factors related to
In China, the preliminary, results positive attitude to depression in 1334
prevalence rates for dem- onstrate a low the disease. patients with lung
anxiety and prevalence rate of In this present cancer, depression
depression were preopera- tive study, 11 patients was not only
30.24% and anxiety and with gastric cancer correlated with
63.42%, depression in presented obvious biological factors
respectively, in 205 patients with preopera- tive such as cancer
patients with gastric cancer in symptoms of classification,
gastric cancer China, probably anxiety and stage and patient
among a total of owing to the depression. As the sex and age, but
1217 cancer following reasons. major purveyors was also signifi-
20
patients surveyed. First, China’s of cancer cantly correlated
Although economic prevention and with psychological
prevalence rates for development has treatment, factors (such as
preoperative brought an enor- healthcare coping mode and
anxiety and mous government personnel should neurotic person-
27
depression in investment in all ality). Coping
patients with fields of medical refers to one’s
gastric cancer insurance, which ability to change
have rarely been ensures the med- cognitive and
reported, such ical reimbursement behavioural efforts
rates were 44.7% of patients with constantly, to
and gastric cancer. manage specific
17.1%, respectively, Secondly, the external or internal
for patients with continuous rise in demands that are
25
lung cancer. In the level of appraised as
patients with breast medical care in taxing or exceeding
cancer, the China has made the resources of the
prevalence rates of comprehensive person; this
preoperative therapy accessible concept
anxiety and to most patients originated
depression reached with gastric cancer. from
70% and 37%, Finally, when theories of self-
26 28
respect- ively. healthcare defence. Anna
This present study personnel actively Freud pro- posed
the idea of the health. A positive
self-defence coping mode in
mechan- ism, cancer patients is
based on Sigmund correlated with
Freud’s theory of good psychological
defence adjust- ment,
29
mechanisms. whereas a negative
Self-defence is a coping mode is
method in which, correlated with
to adjust the psychological
33
relationship disorder.
between internal Moreover, a
conflict and negative coping
external real- ity, mode can, to some
the individual gets extent, result in
rid of anxiety and anxiety and
controls the depression in
emotional and cancer patients.
34
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