Depression, anxiety and associated factors among cancer patients in Africa; a systematic review and meta-analysis study

BACKGROUND: Depression and anxiety are the most common types of mental disorders among cancer patients. Many research studies carried out in African countries indicate that anxiety and depression are highly prevalent, but the results vary across regions. Thus, this study aimed to estimate the pooled prevalence and associated factors of depression and anxiety among cancer patients in Africa. METHODS: The databases EMBASE, PubMed, African Journals Online, and Google Scholar were used to identify articles. This systematic review and meta-analysis included 32 (31 for depression and 25 for anxiety) original articles from 11 African countries. To detect publication bias, Egger regression tests and funnel plot analysis were employed. A sensitivity analysis and a subgroup analysis were carried out. RESULTS: The pooled prevalence of depression and anxiety among cancer patients was found to be 53.21% (95% CI: 47.47-58.94) and 53.32% (95% CI: 46.85, 59.80) respectively. Across regions, the prevalence of depression among cancer patients was 60.03 (95% CI: 55.85-64.21), 53.59 (95% CI: 45.31-61.87), and 43.92 (95% CI: 36.17-51.67) in North, East, and West Africa, respectively. The pooled prevalence of anxiety among cancer patients was 64.85 (95% CI: 54.81-74.88) in North Africa, 49.53 (95% CI: 40.72-58.33) in East Africa, and 46.23 (95% CI: 38.98-53.48) in West Africa. Advanced stages of cancer (AOR = 3.8; 95% CI: 1.73, 8.42), less educated (AOR = 2.57; 95% CI: 1.28-5.14), and having no financial support (AOR = 2.03; 95% CI: 1.12, 3.67) were factors associated with depression. Advanced stages of cancer (AOR = 5.44; 95% CI: 1.95, 15.18) and no financial assistance (AOR = 2.88; 95% CI: 1.79, 4.63) were factors associated with anxiety. CONCLUSION: Depression and anxiety among cancer patients are highly prevalent in Africa. Being at an advanced stage of cancer, low educational attainment, and not having financial support were all associated with depression symptoms; in addition, having advanced cancer and not having financial support were also associated with anxiety symptoms. Therefore, it is critical to screen cancer patients for anxiety and depression and provide them with appropriate interventions when these conditions arise.