Depressive symptoms among patients with cancer receiving palliative care: a cross-sectional study

Background Depressive symptoms are clinically important in palliative oncology, but interpretation is complicated by overlap between cancer-related somatic symptoms and depression-screening items. Saudi studies report psychological distress in advanced cancer, but PHQ-9 severity and symptom patterns in palliative oncology remain less characterized. Objective To characterize the frequency and severity of depressive symptoms using the Arabic PHQ-9, describe individual symptom patterns including thoughts of death or self-harm, and explore selected demographic and clinical characteristics associated with a PHQ-9 score ≥10. Methods This single-center cross-sectional study recruited adults with cancer receiving palliative care over 12 months. Data were collected through interviews and medical-record review. PHQ-9 severity categories and screening thresholds were summarized descriptively. Exploratory comparisons of PHQ-9 < 10 versus ≥10 used Fisher’s exact tests, unadjusted odds ratios (ORs) with 95% confidence intervals (CIs), and the Mann–Whitney U test for age. Individual cancer types and individual comorbidities were descriptive only. Results Of 150 patients approached, 90 consented, were assessed as eligible and participated (60.0%); eligibility was unknown for the 60 who declined. PHQ-9 scores were none/minimal in 43 (47.8%), mild in 22 (24.4%), moderate in 6 (6.7%), moderately severe in 9 (10.0%) and severe in 10 (11.1%). Scores ≥5, ≥10 and ≥15 occurred in 47 (52.2%; 95% CI 42.0–62.2%), 25 (27.8%; 19.6–37.8%) and 19 (21.1%; 14.0–30.6%), respectively. All 13 participants endorsing thoughts of death or self-harm (14.4%; 8.6–23.2%) received same-day psychiatric assessment. Exploratory associations were imprecise, with all categorical OR confidence intervals including 1. Conclusion Approximately half of participants reported at least mild depressive symptoms, while more than one-quarter met the conventional moderate-or-greater PHQ-9 screening threshold. Item-level assessment identified clinically important symptom burden, including thoughts of death or self-harm. These findings support careful early recognition and individualized assessment rather than diagnostic interpretation of screening scores.