Depressive and Anxiety Symptoms at Initial Psychiatric Assessment in Patients Entering Hematopoietic Stem Cell Transplantation Protocols: A Cross-Sectional Study Using PHQ-9 and GAD-7

Objective Depression and anxiety are common across hematopoietic stem cell transplantation (HSCT) and predict poorer adherence and worse outcomes, yet their burden at the initial psychiatric evaluation has not been documented in Mexican patients. Brief validated screeners such as the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) could detect these symptoms at this early, accessible window, before conditioning begins. We aimed to describe the frequency and severity of depressive and anxiety symptoms, assessed by the PHQ-9 and GAD-7, in patients entering an HSCT protocol at a Mexican tertiary center during their initial psychiatric evaluation. Methods A retrospective, cross-sectional, observational study was conducted at the Centro Medico Nacional "20 de Noviembre" (ISSSTE), Mexico City. We reviewed records of 104 adult patients evaluated by the Psychiatry Department as part of the HSCT protocol between January 2024 and November 2025; 103 met the inclusion criteria. PHQ-9 and GAD-7 scores, demographic data, hematological diagnosis, and transplantation type were extracted. Clinically significant depression was defined as PHQ-9 ≥10 and clinically significant anxiety as GAD-7 ≥10. Data were analyzed with descriptive statistics, non-parametric tests, and Fisher's exact tests (alpha=0.05). Results The median age was 51 years (interquartile range [IQR] 38.5-60.5); 55.3% were men. The most common diagnosis was multiple myeloma (48.5%); 66% were scheduled for autologous transplantation. Median PHQ-9 was 0 (IQR 0-2); clinically significant depression was detected in eight patients (7.8%; 95% confidence interval [CI] 4.0-14.6). Median GAD-7 was 0 (IQR 0-1.5); clinically significant anxiety was present in two patients (1.9%; 95% CI 0.5-6.8). Co-occurrence of both was also 1.9%. Patients aged 18-35 years had a fourfold higher prevalence of mild anxiety compared with those aged 36-55 years (prevalence ratio [PR]=4.2; 95% CI 1.17-15.10; p=0.026). PHQ-9 and GAD-7 scores correlated positively (p<0.0001). Conclusions At the initial psychiatric encounter, most HSCT patients reported minimal affective symptoms; the timing of assessment, before conditioning begins, and the prior selection of medically and psychosocially stable candidates likely explain these low rates. The 7.8% rate of clinically significant depression and the concentration of mild anxiety in younger patients support systematic screening with validated tools at this early stage. The age-anxiety association is confounded with diagnosis and transplantation type and requires replication in larger samples. Longitudinal studies are needed to characterize symptom trajectories throughout the transplantation process.