Psychiatric disorders and associated and predictive factors in patients with unresectable nonsmall cell lung carcinoma - A longitudinal study

BACKGROUND. Few longitudinal studies have investigated psychiatric disorder s in patients with unresectable nonsmall cell lung carcinoma (NSCLC). This study addressed three questions: 1) Which psychiatric disorders are prevale nt among patients with unresectable NSCLC? 2) What is the clinical course o f psychological distress? 3) Which factors are associated with this distres s, and do any antecedent variables predict subsequent psychological distres s? METHODS. A series of 129 consecutive patients with newly diagnosed, unresec table NSCLC participated. Psychiatric assessments were conducted by using t he Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised between the time of diagnosis and initial treatment for NSCLC (baseline) and 6 months after diagnosis (follow -up). Potential associated and predictive variables, including sociodemogra phic, biomedical, and psychosocial factors, were explored. RESULTS. The most common psychiatric disorder at baseline was nicotine depe ndence (67%), followed by adjustment disorders (14%), alcohol dependence (1 3%), and major depression (5%). At follow-up, adjustment disorders were dia gnosed in 16% of patients, and major depression was diagnosed in 3% of pati ents. Thirty-five percent of patients who experienced depressive disorders (adjustment disorders and/or major depression) at baseline continued to exp erience the same disorders at follow-up. Multivariate analysis revealed tha t relatively younger age and pain were associated significantly with psycho logical distress at baseline. Only self-reported anxiety and depression at baseline could predict subsequent psychological distress. CONCLUSIONS. Substance dependence and depressive disorders are common psych iatric disorders in patients with unresectable NSCLC. Although this form of malignant disease often is progressive, depressive disorders do not seem t o increase during its clinical course. Pain management is essential for all eviating patients' depressive disorders, and self-rating depression and anx iety seems to be an indicator of subsequent depressive disorders. (C) 2001 American Cancer Society.