Prevalence and predictors of anxiety and depression in women with invasive ovarian cancer and their caregivers

Melanie A Price, Phyllis N Butow, Daniel S J Costa, Madeleine T King, Lynley J Aldridge, Joanna E Fardell, Anna DeFazio and Penelope M Webb, , the Australian Ovarian Cancer Study Group and the Australian Ovarian Cancer Study Group Quality of Life Study Investigators
Med J Aust 2010; 193 (5 Suppl): S52.


Objectives: To assess the prevalence and predictors of depression and anxiety in women with ovarian cancer and their caregivers, to compare levels of depression and anxiety with community norms, and to explore the relationship between patients and their nominated caregivers.

Design, setting and participants: Prospective cohort study of 798 women with invasive ovarian cancer recruited between 1 January 2002 and 30 June 2006 through the nationwide Australian Ovarian Cancer Study, and 373 of their caregivers.

Main outcome measures: Depression and anxiety as assessed with the Hospital Anxiety and Depression Scale, and the role of demographic variables, disease and treatment variables, psychosocial variables, and use of mental health and support services as potential predictors.

Results: Rates of anxiety and depression among patients were significantly lower than in previous reports, although clinical depression rates (5.9%) were significantly higher than community norms (3.0%; χ2 = 24.0; P < 0.001). Caregivers also reported higher levels of depression (χ2 = 21.1; P < 0.001) and anxiety (χ2 = 17.6; P < 0.001) compared with norms. There was no difference within patient–caregiver pairs for depression (P = 0.1), while caregivers reported significantly higher anxiety than patients (P < 0.01). In patients, higher symptom burden, lower optimism and current specialist mental health treatment all significantly predicted both depression and anxiety, while lower social support was a significant predictor of patient anxiety only. In caregivers, lower social support and lower optimism were significant predictors of depression and anxiety. Patients being treated for mental health was also a predictor of their caregiver’s depression.

Conclusions: While depression is significantly more common in women with ovarian cancer than in the general population, it is caregivers of such patients who report much higher levels of both subclinical and clinical depression and anxiety.

  • Melanie A Price1,2
  • Phyllis N Butow1
  • Daniel S J Costa2
  • Madeleine T King2
  • Lynley J Aldridge2
  • Joanna E Fardell1
  • Anna DeFazio3,4
  • Penelope M Webb5
  • , the Australian Ovarian Cancer Study Group and the Australian Ovarian Cancer Study Group Quality of Life Study Investigators

  • 1 Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, University of Sydney, Sydney, NSW.
  • 2 Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, NSW.
  • 3 Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW.
  • 4 Gynaecological Oncology Research Group, Westmead Institute for Cancer Research, Westmead Hospital, Sydney, NSW.
  • 5 Genetics and Population Health Division, Queensland Institute of Medical Research, Brisbane, QLD.


This study was funded by the Cancer Councils of New South Wales and Queensland (grant number RG 36/05 New South Wales). Financial support for the parent study was provided by the US Army Medical Research and Materiel Command (grant number DAMD17-01-1-0729), the National Health and Medical Research Council (NHMRC; grant numbers 400413, 400281) and the Cancer Councils of NSW, Queensland, South Australia, Tasmania, Victoria and Western Australia. Additional recruitment was conducted under the Australian Cancer Study (Ovarian Cancer), funded by the NHMRC (199600). Phyllis Butow is supported by an NHMRC Principal Research Fellowship (211199, 457093). Penelope Webb is supported by a Senior Research Fellowship from the NHMRC (496625). Full membership of the Australian Ovarian Cancer Study Group is listed at We gratefully acknowledge the contribution of all our clinical and scientific collaborators and the cooperation of the following institutions: New South Wales — John Hunter Hospital, North Shore Private Hospital, Royal Hospital for Women, Royal North Shore Hospital, Royal Prince Alfred Hospital, Westmead Hospital, NSW Cancer Registry; Queensland — Mater Misericordiae Hospital, Royal Brisbane and Women’s Hospital, Townsville Hospital, Wesley Hospital, Queensland Cancer Registry; South Australia — Flinders Medical Centre, Queen Elizabeth Hospital, Royal Adelaide Hospital, Burnside War Memorial Hospital, South Australian Cancer Registry; Tasmania — Royal Hobart Hospital; Victoria — Freemasons Hospital, Mercy Hospital for Women, Royal Women’s Hospital, Victorian Cancer Registry; Western Australia — King Edward Memorial Hospital, St John of God Hospital (Subiaco), Sir Charles Gairdner Hospital, Western Australia Research Tissue Network (WARTN), Western Australian Cancer Registry. We also acknowledge the contribution of the study nurses and research assistants and would like to thank all of the women and caregivers who participated in the study.

Competing interests:

None identified.

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