Impact of anxiety and depression on quality of life in gastric cancer patients receiving SOX neoadjuvant chemotherapy

Table 1 Detection rates and severity of anxiety and depression symptoms, n (%)

	Total	Negative	Mild	Moderate	Severe	Prevalence (%)
Anxiety1	153	95 (62.09)	54 (35.29)	4 (2.61)	0 (0.00)	37.91
Depression2	153	92 (60.13)	49 (32.03)	12 (7.84)	0 (0.00)	39.87

¹For anxiety, a Self-Rating Anxiety value of less than 50 is negative, 50 to 60 is mild, 61 to 70 is moderate, and over 70 is severe.

²For depression, a Self-Rating Anxiety value of less than 53 is negative, 53 to 62 is mild, 63 to 72 is moderate, and more than 72 is severe.

Table 2 Intergroup comparison of factors related to anxiety/depression, n (%)

Variables	Total (n = 153)	Normal group (n = 80)	Anxiety-depression group (n = 73)	Statistic	P value
Age	55.00 (40.00, 71.00)	54.50 (37.00, 72.25)	55.00 (41.00, 71.00)	Z = -0.43	0.665
Gender				χ² = 5.19	0.023
Male	94 (61.44)	56 (70.00)	38 (52.05)
Female	59 (38.56)	24 (30.00)	35 (47.95)
BMI, kg/m2	25.60 (21.00, 30.40)	26.45 (19.00, 30.40)	25.50 (21.40, 30.40)	Z = -0.11	0.914
Marital status				χ² = 6.25	0.012
Married	122 (79.74)	70 (87.50)	52 (71.23)
Unmarried/divorced/widowed	31 (20.26)	10 (12.50)	21 (28.77)
Educational level				χ² = 7.18	0.028
High school or above	33 (21.57)	23 (28.75)	10 (13.70)
Junior and senior high school	57 (37.25)	31 (38.75)	26 (35.62)
Primary school and below	63 (41.18)	26 (32.50)	37 (50.68)
Tumor size, cm	5.30 (2.90, 7.70)	4.70 (2.82, 8.03)	5.70 (3.50, 7.60)	Z = -0.50	0.621
Number of lymph node metastases	3.00 (2.00, 4.00)	3.00 (2.00, 4.00)	3.00 (2.00, 4.00)	Z = -0.25	0.799
Pathological type				χ² = 1.50	0.472
Others	24 (15.69)	12 (15.00)	12 (16.44)
Adenocarcinoma	105 (68.63)	58 (72.50)	47 (64.38)
Signet ring cell carcinoma	24 (15.69)	10 (12.50)	14 (19.18)
Differentiation grade				χ² = 3.79	0.285
Low differentiation	53 (34.64)	24 (30.00)	29 (39.73)
Highly differentiated	37 (24.18)	19 (23.75)	18 (24.66)
Undifferentiated	15 (9.80)	11 (13.75)	4 (5.48)
Moderate differentiation	48 (31.37)	26 (32.50)	22 (30.14)
HER2 status				χ² = 0.02	0.884
Positive	39 (25.49)	20 (25.00)	19 (26.03)
Negative	114 (74.51)	60 (75.00)	54 (73.97)
Clinical stage				χ² = 9.09	0.003
I/II	74 (48.37)	48 (60.00)	26 (35.62)
III	79 (51.63)	32 (40.00)	47 (64.38)

BMI: Body mass index; HER2: Human epidermal growth factor receptor 2.

Table 3 Multivariate regression model of independent risk factors for anxiety/depression

Variables	β	SE	OR	95%CI	P value
Intercept	-1.92	0.50	0.15	0.06-0.39	< 0.001
Gender
Male			1.00	Reference
Female	0.76	0.37	2.13	1.03-4.40	0.040
Marital status
Married			1.00	Reference
Unmarried/divorced/widowed	1.15	0.46	3.17	1.28-7.85	0.013
Educational level
High school or above			1.00	Reference
Junior and senior high school	0.70	0.50	2.02	0.76-5.38	0.158
Primary school and below	1.25	0.49	3.50	1.33-9.21	0.011
Clinical stage
I/II			1.00	Reference
III	0.99	0.36	2.69	1.32-5.46	0.006

OR: Odds ratio; CI: Confidence interval.

Table 4 Association between anxiety and depression and adverse reactions during chemotherapy, n (%)

Symptoms	Group	Normal group (n = 80)	Anxiety-depression group (n = 73)	Statistic	P value
Gastrointestinal reactions	0	13 (16.25)	4 (5.48)	7.69	0.021
	I/II	60 (75.00)	54 (73.97)
	III-IV	7 (8.75)	15 (20.55)
Myelosuppression	0	14 (17.50)	7 (9.59)	3.49	0.175
	I/II	62 (77.50)	58 (79.45)
	III-IV	4 (5.00)	8 (10.96)
Hematological toxicity	0	16 (20.00)	11 (15.07)	1.94	0.380
	I/II	58 (72.50)	52 (71.23)
	III-IV	6 (7.50)	10 (13.70)
Neurotoxicity	0	19 (23.75)	9 (12.33)	4.49	0.106
	I/II	53 (66.25)	51 (69.86)
	III-IV	8 (10.00)	13 (17.81)

Table 5 Multi-dimensional correlation between anxiety, depression and quality of life

	Emotional	Cognitive	Social	Physical	Role	Global QoL
Anxiety (SAS)	-0.552a	-0.051	-0.403a	-0.369a	-0.158	-0.539a
Depression (SDS)	-0.599a	-0.001	-0.471a	-0.404a	-0.148	-0.574a

^aP < 0.001.

QoL: Quality of life; SDS: Self-Rating Depression; SAS: Self-Rating Anxiety.

Table 6 Multiple linear regression analysis of the impact of anxiety/depression on quality of life

Variables	β (95%CI)	t	Crude P	β (95%CI)	t	Adjusted P1
Anxiety (SAS)	-0.25 (-0.31 to -0.19)	-7.87	< 0.001	-0.12 (-0.21 to -0.03)	-2.53	0.013
Depression (SDS)	-0.20 (-0.25 to -0.16)	-8.61	< 0.001	-0.14 (-0.21 to -0.07)	-3.88	< 0.001

¹Adjust for gender, marital status, educational attainment, clinical stage, and adverse reactions.

SAS: Self-Rating Anxiety; SDS: Self-Rating Depression; OR: Odds ratio; CI: Confidence interval.