Depression and Loss to Follow-Up Among Patients treated for Premalignant Cervical Lesions at a Tertiary Hospital in Uganda: A Cross-Sectional study

Background Cervical cancer remains a leading cause of morbidity and mortality among women in sub-Saharan Africa. While treatment for premalignant cervical lesions is essential in prevention, loss to follow-up (LTFU) undermines treatment success. Depression is hypothesized to contribute to poor treatment adherence, yet its association with LTFU among women undergoing treatment for cervical lesions in Uganda remains underexplored. This study aimed to assess the prevalence of depression and its association with loss to follow-up among patients treated for premalignant cervical lesions at Mbarara Hospital, Uganda. Methods A cross-sectional study was conducted at the Cervical Cancer Clinic of Mbarara Regional Referral Hospital in southwestern Uganda. The study enrolled 112 women treated for premalignant cervical lesions between January 2017 and December 2022. Follow-up status was determined by clinic attendance within three months of the scheduled review. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores categorized as moderate/severe (≥ 10) or no/mild depression (< 10). Sociodemographic and clinical data were extracted from clinic registers and participant interviews. Logistic regression analysis was used to determine the association between depression and LTFU, adjusting for district of residence, marital status, education level, and employment status. Results Of the 112 participants, 75% were lost to follow-up. The mean age was 36.4 years (SD = 8.8), and 17.9% had moderate to severe depression. The mean PHQ-9 score was significantly higher among participants lost to follow-up (6.2 ± 5.2) than those retained in care (0.7 ± 3.1, p < 0.001). Depression was associated with a ninefold increased likelihood of LTFU (AOR = 9.697, 95% CI: 1.087–86.536, p = 0.042). Depression was more prevalent among participants who were unmarried, unemployed, had lower incomes, or required spousal permission to seek care. Functional impairment was also significantly associated with depression and LTFU. Alcohol use and greater distance to the facility appeared to exacerbate depression and attrition from care further. Conclusion This study found a high loss-to-follow-up rate among patients treated for premalignant cervical lesions, with depression being a major predictor. Socioeconomically disadvantaged individuals, especially single, divorced, unemployed, or with low income, were more prone to depression and subsequent attrition.