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May 29, 2026Open Access

Risk Factors and Prognostic Impact of Depression and Anxiety in Gastric Cancer: A Systematic Review

Key Points

This systematic review aims to identify the risk factors and prognostic impacts of anxiety and depression in gastric cancer.
Systematic review of literature published by April 7, 2025, sourced from MEDLINE, EBSCOhost, and ProQuest databases.
Included studies focused specifically on risk factors and prognostic impact of anxiety and depression in gastric cancer.
Quality assessed using the Newcastle-Ottawa Scale, with meta-analysis for risk factors evaluated in at least three studies.
Fourteen studies included with a total of 31,660 patients.
Meta-analysis showed female sex (adjusted OR = 3.04; 95% CI 2.04–4.54) and diabetes mellitus (adjusted OR = 4.78; 95% CI 2.46–9.28) significantly associated with higher odds of depression.
Most studies indicated that anxiety and depression correlate with worse survival outcomes in gastric cancer patients.

Abstract

Background Gastric cancer is associated with a high mortality and morbidity rate. Patients often experience anxiety and depression, which are associated with a poor health-related quality of life. Furthermore, anxiety and depression have been associated with worse survival in patients with cancer. Therefore, this systematic review aims to identify the risk factors and prognostic impacts of anxiety and depression in gastric cancer. Methods We searched for relevant literature published up to April 7, 2025 from the MEDLINE, EBSCOhost, and ProQuest databases. We included studies that evaluated the risk factors and prognostic impact of anxiety and depression in gastric cancer. Studies that also included other types of cancers or only analyzed risk factors of psychological distress were excluded. Quality of studies was analyzed using the Newcastle-Ottawa Scale. Meta-analysis was performed if the adjusted odds ratio for a specific risk factor was evaluated in ≥ 3 studies. Otherwise, only qualitative analysis was performed. Results Fourteen studies were included in the review with a total number of 31,660 patients. From the included studies, we identified various risk factors that were significantly associated with anxiety or depression. We classified those risk factors based on Engel’s biopsychosocial model. Meta-analysis for eligible risk factors showed that female sex (adjusted OR = 3.04; 95% CI 2.04–4.54) and diabetes mellitus (adjusted OR = 4.78; 95% CI 2.46–9.28) were independently associated with higher odds of depression in gastric cancer. Furthermore, most studies showed that anxiety or depression was associated with worse survival in patients with gastric cancer. Conclusions We identified various risk factors for anxiety and depression in gastric cancer based on the available literature. It is important to screen for anxiety and depression in gastric cancer because of their negative prognostic impact on the patients.

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