Proportion and Correlates of Psychiatric Morbidity Among Psychiatry-Assessed Oncology Inpatients

TL;DR

A study finds high rates of anxiety and depression among cancer patients in a hospital, especially those with urogenital cancers, and links these issues to worse health outcomes.

Contribution

The study provides real-world data on psychiatric morbidity in oncology inpatients, focusing on urogenital cancers and their unique psychosocial stressors.

Findings

Urogenital cancer patients had significantly higher rates of anxiety and depression compared to non-urogenital cancer patients.

Mixed anxiety–depressive disorder was most common in cervical, bladder, and prostate cancers.

Poorer functional status (ECOG) independently predicted severe depressive symptoms.

Abstract

Background/Objectives: Psychiatric morbidity is frequent in oncology, yet prevalence and correlates differ across tumour sites. Urogenital cancers, in particular, involve psychosocial stressors related to sexuality, fertility, continence, and body image, which may intensify anxiety and depression. This study aimed to estimate the proportion of psychiatric morbidity among psychiatry-assessed oncology inpatients in a real-world hospital setting to compare urogenital with non-urogenital malignancies and to examine clinical correlates and hospitalisation outcomes. Methods: We conducted a retrospective analysis of 174 oncology inpatients who were evaluated by liaison psychiatry and completed the Hospital Anxiety and Depression Scale (HADS) during admission to a tertiary hospital in Galați, Romania, between 2019 and 2022. All patients completed the Hospital Anxiety and Depression Scale (HADS) and underwent liaison psychiatry evaluation. Mixed anxiety–depressive disorder (ICD-10 F41.2) was the primary psychiatric outcome. Demographic, clinical, and functional data—including Eastern Cooperative Oncology Group (ECOG) performance status—were extracted from medical records. Comparative and multivariable analyses were performed to identify predictors of severe depressive symptoms (primary outcome, HADS-D ≥ 11) and to explore associations with length of stay and costs. Results: Overall, 59% of patients had elevated HADS-Anxiety and 62% elevated HADS-Depression, while 40% received a psychiatric diagnosis. Mixed anxiety–depressive disorder predominated, especially in cervical (95%), bladder (100%), and prostate (≈70–75%) cancers. Urogenital cancers showed significantly higher rates of anxiety/depression than non-urogenital cancers (85% vs. 46%, p < 0.01). Poorer ECOG status independently predicted severe depressive symptoms (OR 3.6, 95% CI 2.1–6.2, p < 0.001). Psychiatric morbidity was associated with a trend toward longer LOS (median 12 vs. 9 days, p ≈ 0.08) and ≈10% higher hospital costs. Conclusions: Anxiety and depression were highly frequent among psychiatry-assessed oncology inpatients, particularly in urogenital malignancies. Functional impairment strongly correlates with psychiatric morbidity. These findings underscore the need for systematic screening and risk-stratified psycho-oncologic interventions to improve patient outcomes and resource utilisation.

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