Supportive Care in Cancer

, Volume 12, Issue 3, pp 161–167 | Cite as

Psychiatric morbidity among cancer patients and awareness of illness

  • Figen Culha AtesciEmail author
  • Bahar Baltalarli
  • Nalan Kalkan Oguzhanoglu
  • Filiz Karadag
  • Osman Ozdel
  • Nursel Karagoz
Original Article


A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient’s environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.


Psychiatric morbidity Cancer Awareness 


  1. 1.
    Aass N, Fossa SD, Dahl AA, Moe TJ (1997) Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. Eur J Cancer 33:1597–1604PubMedGoogle Scholar
  2. 2.
    Alexander PJ, Dinesh N, Vidyasagar MS (1993) Psychiatric Morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome. Acta Oncol 32:623–626PubMedGoogle Scholar
  3. 3.
    American Psychiatric Association (1994) DSM-IV—diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DCGoogle Scholar
  4. 4.
    Angelino AF, Treisman GJ (2001) Major depression and demoralization in cancer patients: diagnostic and treatment considerations. Support Care Cancer 9:344–349CrossRefPubMedGoogle Scholar
  5. 5.
    Atesci FC, Oguzhanoglu NK, Baltalarlı B, Karadağ F, Özdel O, Karagöz N (2003) Psychiatric disorders in cancer patients and associated factor. Turk J Psychiatry 14:145–152Google Scholar
  6. 6.
    Aydemir O (1997) Validity and reliability of Turkish version of Hospital Anxiety and Depression Scale. Turk J Psychiatry 8:280–287Google Scholar
  7. 7.
    Baider L, Sarell M (1983) Perceptions and causal attributions of Israeli women with breast cancer concerning their illness: the effects of ethnicity and religiosity. Psychother Psychosom 39:136–143PubMedGoogle Scholar
  8. 8.
    Bloom JR, Spiegel D (1984) The relationship of two dimensions of social support to the psychological well-being and social functioning of women with breast cancer. Soc Sci Med 19:831–837CrossRefPubMedGoogle Scholar
  9. 9.
    Bottomley A (1998) Depression in cancer patients: a literature review. Eur J Cancer 7:181–191CrossRefGoogle Scholar
  10. 10.
    Bozcuk H, Erdoğan V, Eken C, et al (2002) Does awareness of diagnosis make any difference to quality of life? Determinants of emotional functioning in a group of cancer patients in Turkey. Support Care Cancer 10:51–57CrossRefPubMedGoogle Scholar
  11. 11.
    Breitbart W (1995) Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer 3:34–60Google Scholar
  12. 12.
    Caroll BT, Kathol RG, Noyes R, et al (1993) Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry 15:69–74PubMedGoogle Scholar
  13. 13.
    Chandra PS, Chaturvedi SK, Kumar A, et al (1998) Awareness of diagnosis and psychiatric morbidity among cancer patients—a study from South India. Psychosom Res 45:257–261CrossRefGoogle Scholar
  14. 14.
    Costantini M, Musso M, Viterboli P, et al (1999) Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale. Support Care Cancer 7:121–127CrossRefPubMedGoogle Scholar
  15. 15.
    Derogatis LR, Morrow GR, Fetting J (1983) The prevalence of psychiatric disorder among cancer patients. JAMA 297:751–757Google Scholar
  16. 16.
    Devrimci H, Unluglu G (1998) Psychiatric morbidity in cancer patients and their relatives. J Psychiatry Psychol Psychopharmacol 6:196–206Google Scholar
  17. 17.
    Elbi H (1998) Psycho-oncology. J Psychiatry Psychol Psychopharmacol 6:5–7Google Scholar
  18. 18.
    Elbi H, Ozaydemir G, Tamar M, Saygılı R, et al (1992) Psychosocial problems and approach in a group cancer patients. XVIIth Congress of the European Society for Medical Oncology. 7–10 November, LyonGoogle Scholar
  19. 19.
    Ell K, Nishimoto R, Morvay T, et al (1989) A longitudinal analysis of psychological adaptation among survivors of cancer. Cancer 63:406–413PubMedGoogle Scholar
  20. 20.
    Elwyn TS, Fetters MD, Gorenflo W, Tsuda T (1998) Cancer disclosure in Japan: historical comparisons, current practices. Soc Sci Med 46:1151–1163CrossRefPubMedGoogle Scholar
  21. 21.
    Ersoy MA (2000) Investigation of relationships between denial, relationships with the treatment team, being informed, knowing the diagnosis, resort to alternative treatment methods and diagnosis. J Psychiatry Psychol Psychopharmacol 8:17–26Google Scholar
  22. 22.
    Fawzy FI, Greenberg DB (1996) Oncology. In: Rundel JR, Wise MG (eds) Textbook of consultation-liaison psychiatry. American Psychiatric Press, Washington DC, pp 673–694Google Scholar
  23. 23.
    First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured clinical interview for DSM-IV clinical version (SCID-I/CV). American Psychiatric Press, Washington DCGoogle Scholar
  24. 24.
    Ford S, Lewis S, Fallowfield L (1995) Psychological morbidity in newly referred patients with cancer. J Psychosom Res 39:193–202PubMedGoogle Scholar
  25. 25.
    Gordon DR, Paci E (1997) Disclosure practices and cultural narratives: understanding concealment and silence around cancer in Tuscany, Italy. Soc Sci Med 44:1433–1452CrossRefPubMedGoogle Scholar
  26. 26.
    Hardman A, Maguire P, Crowther D (1989) The recognition of psychiatric morbidity on a medical oncology ward. J Psychosom Res 33:235–239CrossRefPubMedGoogle Scholar
  27. 27.
    Holland JC, Geary N, Marchini A, et al (1987) An international survey of physician attitudes and practice in regard to revealing the diagnosis of cancer. Cancer Invest 5:151–154PubMedGoogle Scholar
  28. 28.
    Hosaka T, Awazu H, Fukunishi I, Okuyama T, Wogan J (1999) Disclosure of true diagnosis in Japanese cancer patients. Gen Hosp Psychiatry 21:209–213CrossRefPubMedGoogle Scholar
  29. 29.
    Kılıc C (1996) General health questionnaire: a validity and reliability study. Turk J Psychiatry 7:3–9Google Scholar
  30. 30.
    Lancee WJ, Wachon MLS, Ghadirian P, et al (1994) The impact of pain and impaired role performance on distress in persons with cancer. Can J Psychiatry 39:617–622PubMedGoogle Scholar
  31. 31.
    Le Fevre P, Devereux J (1999) Screening for psychiatric illness in the palliative care inpatient setting: a comparison between the Hospital Anxiety and Depression Scale and the General Health Questionnaire-12. Palliat Med 13:399–409CrossRefPubMedGoogle Scholar
  32. 32.
    Levy NB (1988) Fatal illness: what should the patient be told? In: Klagsbrun SC, Goldberg IK, Rawnsley MM (eds) Psychiatric aspects of terminal patients. Charles Press, Philadelphia, pp 42–46Google Scholar
  33. 33.
    Massie M, Holland J (1990) Depression and the cancer patient. J Clin Psychiatry 51:12–17Google Scholar
  34. 34.
    Minagawa H, Uchitomi Y, Yamawaki S, Ishitani K (1996) Psychiatric Morbidity in terminally ill cancer patients. Cancer 78:1131–1137CrossRefPubMedGoogle Scholar
  35. 35.
    Montgomery C, Lydon A, Lloyd K (1999) Psychological distress among cancer patients and informed consent. J Psychosom Res 46:241–245PubMedGoogle Scholar
  36. 36.
    Nordin K, Berglung G, Glimelius B, Sjöden PO (2001) Predicting anxiety and depression among cancer patients: a clinical model. Eur J Cancer 37:376–384CrossRefPubMedGoogle Scholar
  37. 37.
    Ozkan S, Turgay M (1992) Psychiatric morbidity and psychosocial adjustment in mastectomy and the relationship between cancer-organ loss and psychopathology. Arch Neuropsychiatry 29:207–215Google Scholar
  38. 38.
    Ozkurkcugil A, Aydemir O, Yildiz M, Esen Danaci A, Koroglu E (1999) Adaptation to Turkish and reliability study of Structured Clinical Interview for Axial I disorders. J Drug Treat 2:233–236Google Scholar
  39. 39.
    Pirl FW, Roth JA (1999) Diagnosis and treatment of depression in cancer patients. Oncology 13:1293–1306PubMedGoogle Scholar
  40. 40.
    Roth AJ, Holland JC (1994) Treatment of depression in cancer patients. Primary Care Cancer 14:23–29Google Scholar
  41. 41.
    Sen M (1997) Communication with cancer patients. The influence of age, gender, education, and health insurance status. Ann N Y Acad Sci 809:514–524PubMedGoogle Scholar
  42. 42.
    Surbone A (1992) Truth telling to the patients. JAMA 268:1661–1662CrossRefPubMedGoogle Scholar
  43. 43.
    Turhal NS, Efe B, Gumus M, et al (2002) Patient satisfaction in the outpatients’ chemotherapy unit of Marmara University, Istanbul, Turkey: a staff survey. BMC Cancer 2:30–35CrossRefPubMedGoogle Scholar
  44. 44.
    Valente SM, Saunders F (1997) Diagnosis and treatment of major depression among people with cancer. Cancer Nurs 20:168–177CrossRefPubMedGoogle Scholar
  45. 45.
    Younge D, Moreau P, Ezzat A, Gray A (1997) Communicating with cancer patients in Saudi Arabia. Ann N Y Acad Sci 809:309–316PubMedGoogle Scholar
  46. 46.
    Zigmond AS, Snaith PR (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–337PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Figen Culha Atesci
    • 1
    • 3
    Email author
  • Bahar Baltalarli
    • 2
  • Nalan Kalkan Oguzhanoglu
    • 1
  • Filiz Karadag
    • 1
  • Osman Ozdel
    • 1
  • Nursel Karagoz
    • 1
  1. 1.Psychiatry Department, Faculty of MedicinePamukkale UniversityDenizliTurkey
  2. 2.Oncology Department, Division of Radiation, Faculty of MedicinePamukkale UniversityDenizliTurkey
  3. 3.Kınıklı-DenizliTurkey

Personalised recommendations