Depression and psycho-existential correlates in cancer outpatients: A longitudinal real-life study

Depression is prevalent and clinically significant among cancer patients, being associated with poorer quality of life, treatment non-adherence, and increased mortality. However, few studies have investigated major depression and its relationship with psycho-existential dimensions using structured diagnostic tools and longitudinal designs in real-world psycho-oncology settings.

This study aimed to assess the prevalence of major depression in cancer outpatients receiving integrated psycho-oncology care and to examine longitudinal changes in psychological and existential variables over six months, with a focus on baseline depression status. A total of 221 outpatients were assessed at baseline using the Patient Health Questionnaire-9. Measures included distress, anxiety, somatization, embitterment, loss of dignity, demoralization, post-traumatic growth, and traumatic stress. At six months, 156 patients completed follow-up assessments. All participants received supportive-expressive psychotherapy with elements of meaning-centered therapy and pharmacological treatment when indicated. Data were analyzed using paired t-tests and mixed models for repeated measures..

At baseline, 35.3% of patients met criteria for major depression. Depressed patients showed higher levels across all psychological and existential measures and lower post-traumatic growth. Longitudinal analyses revealed significant improvements across multiple domains, particularly among depressed patients, including embitterment and loss of dignity. Mixed-model analyses indicated significant group-by-time interactions in most variables.

These findings confirm the high prevalence of major depression in cancer outpatients and its association with emotional and existential distress. Integrated psycho-oncological care was associated with meaningful psychological improvements over time, especially in patients with baseline depression, supporting the need for structured screening and tailored interventions.