Development of anxiety and depression in patients with benign intracranial meningiomas: a prospective long-term study



The aim of this study was to provide the first prospective longitudinal assessment of anxiety and depression in patients with a benign intracranial meningioma (WHO° I).


The Hospital Anxiety and Depression Scale was applied prior to (t1) and directly after (t2) neurosurgery as well as 6 months after surgery (t3). The research was conducted in a single treatment centre in Germany. Numerous sociodemographic, medical, psychological and cognitive accompanying measures were assessed. The study population consisted of 52 meningioma patients. Additionally, a control group of 24 patients with malignant brain tumours (astrocytoma WHO° III) was assessed.


In meningioma patients, anxiety was high prior to surgery but declined significantly after successful neurosurgical treatment. Low levels of depression were observed at all times. In contrast, astrocytoma patients showed constantly high levels of anxiety whilst depression increased over the course of the disease. Numerous medical, psychosocial and psychological factors were associated with psychiatric morbidity in meningioma patients.


In conclusion, psychiatric morbidity of patients with benign intracranial meningiomas was comparable to that of the general population after successful neurosurgical treatment. Numerous associated factors suggest complex relationships within a biopsychosocial model. However, due to the small sample size and recruitment in a single institution, our results are of limited generalisability and need cross-validation in future studies.

This is a preview of subscription content, access via your institution.

Fig. 1



World Health Organization


Hospital Anxiety and Depression Scale


Karnofsky Performance Status. The KPS allows patients to be classified as to their functional impairment ranging from 100 (“normal, no complaints, no signs of disease” to 0 (“death”)


Health-Related Quality of Life


European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire


Posttraumatic Stress Diagnostic Scale


Fragebogen zur Sozialen Unterstützung; one of the most frequently used measures of social support in Germany


Trail making test


  1. 1.

    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109

    PubMed  Article  Google Scholar 

  2. 2.

    Kleihues P, Burger PC, Scheithauer BW (1993) Histological typing of tumours of the central nervous system: international histological classification of tumours, 2nd edn. Springer, Berlin

    Google Scholar 

  3. 3.

    Lee JH (2009) Meningiomas: diagnosis, treatment, and outcome, 1st edn. Springer, London

    Google Scholar 

  4. 4.

    Pace A, Di Lorenzo C, Lorenzo CD, Guariglia L, Jandolo B, Carapella CM, Pompili A (2009) End of life issues in brain tumor patients. J Neuro-Oncol 91(1):39–43

    Article  Google Scholar 

  5. 5.

    Pringle A-A, Taylor R, Whittle IR (1999) Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. Br J Neurosurg 13:46–51

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Chochinov HM (2001) Depression in cancer patients. Lancet Oncol 2:499–505

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Zabora JR, BrintzenhofeSzoc KM, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncol 10:19–28

    Article  CAS  Google Scholar 

  8. 8.

    Goebel S, Stark A, Kaup L, von Harscher M, Mehdorn HM (2011) Distress in patients with newly diagnosed brain tumours. Psycho Oncol 20(6):623–630

    Article  CAS  Google Scholar 

  9. 9.

    Giovagnoli AR, Boiardi A (1994) Cognitive impairment and quality of life in long-term survivors of malignant brain tumors. Ital J Neurol Sci 15(9):481–488

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Tsay SL, Chang JY, Yates P, Lin KC, Liang SY (2012) Factors influencing quality of life in patients with benign primary brain tumors: prior to and following surgery. Support Care Cancer 20:57–64

    PubMed  Article  Google Scholar 

  11. 11.

    Arnold SD, Forman LM, Brigidi BD, Carter KE, Schweitzer HA, Qiunn HE, Bebe Guill A, Herndon JE, Raynor RH (2008) Evaluation and characterization of generalized anxiety and depression in patients with primary brain tumors. J Neuro-Oncol 10:171–181

    Article  Google Scholar 

  12. 12.

    Goebel S, Strenge H, Mehdorn HM (2011) Acute stress in patients with brain cancer during primary care. Support Care Cancer 20(7):1425–1434

    Google Scholar 

  13. 13.

    Pace A, Metro G, Fabi A (2010) Supportive care in neurooncology. Curr Opin Oncol 22(6):621–626

    PubMed  Article  Google Scholar 

  14. 14.

    Rooney AG, Carson A, Grant R (2011) Depression in cerebral glioma patients: a systematic review of observational studies. J Natl Cancer Inst 103(1):61–76

    PubMed  Article  Google Scholar 

  15. 15.

    D'Angelo C, Mirijello A, Leggio L, Ferrulli A, Carotenuto V, Icolaro N, Miceli A, D'Angelo V, Gasbarrini G, Addolorato G (2008) State and trait anxiety and depression in patients with primary brain tumors before and after surgery: 1-year longitudinal study. J Neurosurg 108(2):281–286

    PubMed  Article  Google Scholar 

  16. 16.

    Litofsky NS, Farace E, Anderson F, Meyers CA, Huang W, LE R (2004) Depression in patients with high-grade glioma: results of the glioma outcome project. Neurosurgery 54:358–366

    PubMed  Article  Google Scholar 

  17. 17.

    Mainio A, Hakko H, Niemela A, Koivukangas J, Rasanen P (2005) Depression and functional outcome in patients with brain tumours: a population based 1-year follow-up study. J Neurosurg 103:841–847

    PubMed  Article  Google Scholar 

  18. 18.

    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale—an updated literature review. J Psychosom Res 52:69–77

    PubMed  Article  Google Scholar 

  20. 20.

    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia Universitiy Press, New York, pp 191–205

    Google Scholar 

  21. 21.

    Krannich JH, Weyers P, Lueger S, Herzog M, Bohrer T, Elert O (2007) Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry 7:47

    PubMed  Article  Google Scholar 

  22. 22.

    Hinz A, Zweynert U, Kittel J, Igl W, Schwarz R (2009) Measurement of change with the Hospital Anxiety and Depression Scale (HADS): sensitivity and reliability of change. Psychother Psychosom Med Psychol 59:394–400

    PubMed  Article  Google Scholar 

  23. 23.

    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Schumacher J, Klaiberg A, Brähler E (2003) Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Hogrefe, Göttingen

    Google Scholar 

  25. 25.

    Foa EB (1997) Posttraumatic Stress Diagnostic Scale (PDS®). Pearson, San Antonio

    Google Scholar 

  26. 26.

    Fydrich T, Sommer G, Brähler E (2007) F-SozU-Fragebogen zur Sozialen Unterstützung. Hogrefe, Göttingen

    Google Scholar 

  27. 27.

    Lezak MD, Howieson DB, Loring DW (2004) Neuropsychological assessment, 4th edn. Oxford University Press, New York

    Google Scholar 

  28. 28.

    Warrington EK, James M (1992) Testbatterie für visuelle Objekt-und Raumwahrnehmung (VOSP). Thames Valley Test Company, Bury St Edmunds

    Google Scholar 

  29. 29.

    Wechsler D (1987) Wechsler Memory Scale-Revised. The Psychological Corporation, San Antonio

    Google Scholar 

  30. 30.

    Benton AL, Kd H (1989) Multilingual aphasia examination. AJA Associates, Iowa City

    Google Scholar 

  31. 31.

    Huber W, Poeck K, Weninger D, Willmes K (1983) Der Aachener Aphasie Test (AAT). Hogrefe, Göttingen

    Google Scholar 

  32. 32.

    Leonhart R (2004) Effektgrößenberechnung bei Interventionsstudien. Die Rehabil 43:241–246

    Article  CAS  Google Scholar 

  33. 33.

    Leplow B, Friege L (1998) Eine Sozialformel zur Schätzung der prämorbiden Intelligenz. Z Klin Psychol 27:1–8

    Google Scholar 

  34. 34.

    Hinz A, Krauss O, Hauss JP, Höckel M, Kortmann RD, Stolzenburg JU, Schwarz R (2009) Anxiety and depression in cancer patients compared with the general population. Eur J Cancer Care 19:522–529

    Article  Google Scholar 

  35. 35.

    Mainio A, Hakko H, Timonen M, Niemelä A, Koivukangas J, Räsänen P (2005) Depression in relation to survival among neurosurgical patients with primary brain tumor: a 5-year follow-up study. Neurosurgery 56:1234–1242

    PubMed  Article  Google Scholar 

  36. 36.

    Ownsworth T, Hawkes A, Steginga S, Walker D, Shum D (2009) A biopsychosocial perspective on adjustment and quality of life following brain tumor: a systematic evaluation of the literature. Disabil Rehabil 31:1038–1055

    PubMed  Article  Google Scholar 

  37. 37.

    Kilbride L, Smith G, Grant R (2007) The frequency and cause of anxiety and depression amongst patients with malignant brain tumours between surgery and radiotherapy. J Neuro Oncol 84(3):297–304

    Article  Google Scholar 

  38. 38.

    Goebel S, Kaup L, Mehdorn HM (2011) Measuring preoperative anxiety in patients with intracranial tumours: the Amsterdam Preoperative Anxiety and Information Scale (APAIS). J Neurosurg Anesthesiol 23(4):297–303

    PubMed  Article  Google Scholar 

  39. 39.

    Gupta DK, Chandra PS, Ojha BK, Sharma BS, Mahapatra AK, Mehta VS (2007) Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex—a prospective randomised study. Clin Neurol Neurosurg 109:335–343

    PubMed  Article  Google Scholar 

  40. 40.

    Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E (2007) Quality of life among patients with a brain tumour and their carers. J Psychosom Res 63:617–623

    PubMed  Article  Google Scholar 

  41. 41.

    Armstrong C, Goldstein B, Cohen B, Jo M, Tallent E (2002) Clinical predictors of depression in patients with low-grade brain tumors: consideration of a neurologic versus a psychogenic model. J Clin Psychol Med Settings 9(2):97–107

    Article  Google Scholar 

  42. 42.

    Wellisch DK, Kaleita TA, Freeman D, Cloughesy T, Goldman J (2002) Predicting major depression in brain tumor patients. Psycho-Oncology 11:230–238

    PubMed  Article  Google Scholar 

  43. 43.

    Salander P, Bergenheim T, Henriksson R (1996) The creation of protection and hope in patients with malignant brain tumours. Soc Sci Med 42(7):985–996

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Pelletier G, Verhoef MJ, Khatri N, Hagen N (2002) Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. J Neuro Oncol 57:41–49

    Article  Google Scholar 

  45. 45.

    Molassiotis A, Wilson B, Brunton L, Chaudhary H, Gattamaneni R, McBain C (2010) Symptom experience in patients with primary brain tumours: a longitudinal exploratory study. Eur J Oncol Nurs 14:410–416

    PubMed  Article  Google Scholar 

Download references

Conflicts of interests

None. We have full control of all primary data and agree to let the journal review the data if requested.

Author information



Corresponding author

Correspondence to Simone Goebel.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Goebel, S., Mehdorn, H.M. Development of anxiety and depression in patients with benign intracranial meningiomas: a prospective long-term study. Support Care Cancer 21, 1365–1372 (2013).

Download citation


  • Meningioma
  • Intracranial tumour
  • Anxiety
  • Depression
  • Neuro-oncology
  • Psycho-oncology