Depression and Psychological Distress in Patients with Lower Extremity Lymphedema: A Mixed-Method Study

Background: Lower extremity lymphedema is a chronic and incurable condition. Treatment options for lymphedema have continued to advance and prognosis has improved; however, the condition still poses a substantial negative impact on patients' mental health. Therefore, the key questions raised in this study are "How many patients with lower limb lymph have depression symptoms?" and "Are there any differences in the symptoms and distress factors of patients with lower extremity lymphedema, and how do they experience distress?" Methods and Results: A total of 112 lower extremity lymphedema patients from June 2021 to December 2023 were enrolled in the study. Quantitative and qualitative data of patients were collected and analyzed. Participants completed the Patient Health Questionnaire (PHQ-9), and we interviewed participants with moderate/severe depressive symptoms with score ≥10. A total of 83 participants completed this study. Overall, 39.76% of the participants had a PHQ-9 score ≥5, indicating that they had mild depressive symptoms; 13.25% of the participants had a PHQ-9 score ≥10, indicating that they had moderate or severe depressive symptoms. Compared with participants who had received treatment before the study, participants who did not receive any treatment before the study had a higher risk of depression (χ² = 6.705, p = 0.031). There was no significant difference in the degree of depression in patients with different stages of lymphedema (χ² = 8.430, p = 0.077). From the qualitative interview data, we extracted five common themes: "loss of self," "isolation from surroundings," "discomfort caused by symptoms and complications," "concern about the progression or deterioration of the original malignant tumor," and "fear that surgical treatment may be ineffective." Conclusions: This study found that patients with lower extremity lymphedema are prone to psychological symptoms of depression. To clarify the reason that affect psychological distress is important information to improve the psychological health support for patients with lower extremity lymphedema.