Rural-Urban Disparity of Mental Health Symptoms Among Cancer Patients in Bangladesh: Results from a Multinomial Logistic Regression Model

Background Cancer can trigger distinct emotional reactions and difficulties for individuals, spanning from anxiety and depression to coping with treatment-related stressors. Geographic location can also influence access to mental health resources, cultural impacts on views, and available support systems for cancer patients. It is crucial to recognise these complexities when crafting mental health interventions and support approaches. Therefore, we investigated anxiety and depression prevalence among patients by cancer sites, stages, residence, and other associated factors. Methods This cross-sectional study was conducted at a leading cancer-specialised hospital in Bangladesh from April to June 2023. The Hospital Anxiety and Depression Scale (HADS) was used to assess depressive and anxious symptoms, and scores above 11 out of 21 were considered severe symptoms that need clinical concern. Subsequently, a multinomial regression model, adjusting for confounders, was applied to identify potential risk factors associated with different levels of anxiety and depression. Results Of 516 cancer patients, 63% were females, averaging 51.14 years (standard deviation 12.28). Of them, 10% reported severe anxiety, and 23% reported severe depression. Patients with head & neck cancer reported high levels of severe anxiety and depression. The level of severe anxiety increased with the cancer stage, being 3.18 times higher for advanced-stage patients compared to early-stage patients (relative risk ratio [RRR]: 3.18, 95% confidence interval [CI] = 1.57–6.42). Similarly, severe depression in advanced-stage patients was 8.25 times higher compared to early-stage patients (RRR: 8.25, 95% CI = 4.24–16.05). Despite similar anxiety levels, patients living in rural areas had 2.37 times more severe depression than those living in urban areas (RRR: 2.37, 95% CI = 1.37–4.11). Conclusions Cancer patients in rural areas are disproportionately affected by severe mental health issues. Patients with advanced-stage cancer and those with head & neck cancer are at particularly high risk of severe mental health symptoms. It is essential to ensure these patients receive the needed mental health support alongside a tailored treatment plan.