Prevalence and Influencing Factors of Anxiety and Depression in Patients With Breast Cancer: A Meta-Analysis

BACKGROUND: Breast cancer (BC) patients shoulder considerable psychologicalstrain asthey traverse the illness trajectory. While anxiety and depression among this population have received substantial research attention, comprehensive global estimates that distinguish anxiety from depression remarkably scarce. Even more understudied is the systematic review of factors unique to each condition. Our meta-analysis was designed to redress these gaps by establishing worldwide pooled prevalence figures for both anxiety and depression among BC patients, alongside mapping their associated risk and protective influences. OBJECTIVE: This study aimed to obtain consolidated global estimates of anxiety and depression prevalence within BC populations, and to explore various risk and protective factors that shape these. METHODS: This systematic review and meta-analysis included cross-sectional and cohort studies from multiple databases reporting anxiety/depression prevalence in BC patients. Two investigators independently conducted study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). A random-effects model pooled prevalence estimates; heterogeneity was explored via subgroup analysis and meta-regression. Publication bias was assessed with Egger's test and funnel plots. RESULTS: This meta-analysis included 32 studies comprising 21,507 BC patients. The pooled prevalence of anxiety was 35% (95% confidence intervals (CI): 30%-39%), and that of depression was 26% (95% CI: 23%-30%), with significant heterogeneity for both (p < 0.001). For anxiety, a high Life Orientation Test-Revised (LOT-R) score was protective, whereas low income was a risk factor. For depression, protective factors included older age, higher income, early tumor stage, and a high LOT-R score. Risk factors were low education, rural residence, disrupted marital status, comorbidities, lack of social support, and a history of mental illness. Sensitivity analysis confirmed that the results of this study were robust; although there was bias in anxiety and depression, its effect is limited after correction. Conclusion: Anxiety and depression are highly prevalent in breast cancer patients, influenced by distinct sociodemographic and clinical factors, necessitating targeted psychological assessment and intervention.