Rural–urban disparity in anxiety and depression among cancer patients in Bangladesh

In Bangladesh, where psychological issues are highly stigmatized, cancer patients face significant mental health challenges. Disparities in care between rural and urban areas may worsen this burden, yet this issue remains understudied. This study aimed to investigate the prevalence of anxiety and depression and identify associated risk factors, with a focus on rural–urban differences. This cross-sectional study was conducted at the National Institute of Cancer Research and 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. Among 516 cancer patients, the prevalence of depression was 73% (23% severe) and anxiety was 38% (10% severe). Patients with head and neck cancer reported the highest rates of severe anxiety (14%) and depression (32%) symptoms. Multivariable analysis showed that patients from rural areas had a 2.37 times higher risk of severe depression than urban patients (Relative Risk Ratio [RRR]: 2.37, 95% CI = 1.37–4.11). The risk of severe depression was also 8.25 times higher in patients with advanced-stage (III & IV) cancer compared to those with early-stage cancer (RRR: 8.25, 95% CI = 4.24–16.05). Cancer patients in rural areas are disproportionately affected by severe depression. Patients with advanced-stage cancer and those with head and neck cancer are at particularly high risk. Integrating mental health screening and support into routine oncology care is essential for these high-risk groups.