Prevalence of Anxiety and Depressive Symptoms among Patients with Lymphoma before and during Chemotherapy: A Cross-sectional Study

Abstract: BACKGROUND: Psychological distress is common across the cancer trajectory, but lymphoma-specific data from Saudi clinical practice remain limited. We conducted a pilot study to evaluate the prevalence and severity of anxiety and depressive symptoms among patients with lymphoma assessed before or during chemotherapy. MATERIALS AND METHODS: This pilot cross-sectional analysis included 32 patients with lymphoma treated at a tertiary hematology service in Saudi Arabia. Anxiety and depressive symptoms were measured using the 7-item Generalized Anxiety Disorder scale (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9); scores ≥10 were prespecified as clinically significant screening thresholds. Descriptive statistics, Wilson 95% confidence intervals (CIs), Fisher’s exact tests, Mann–Whitney U -tests, and Spearman correlation were used. RESULTS: Median age was 48 years (interquartile range, 35–62; n = 31), 62.5% were male, 71.9% had non-Hodgkin lymphoma, and 75.0% had stage III–IV disease. Clinically significant anxiety was present in 7/32 patients (21.9%; 95% CI, 11.0%–38.8%) and clinically significant depressive symptoms in 10/32 (31.3%; 95% CI, 18.0%–48.6%). Twelve patients (37.5%; 95% CI, 22.9%–54.7%) screened positive for either condition and 5 (15.6%) for both. GAD-7 and PHQ-9 scores were correlated (Spearman ρ = 0.62, P < 0.001); age showed no correlation with either score (both P > 0.6). Clinically significant anxiety was numerically, but not statistically significantly, more frequent before chemotherapy than during chemotherapy (35.3% vs. 6.7%; Fisher P = 0.088) and among Saudi nationals than non-Saudi patients (35.3% vs. 6.7%; P = 0.088); no subgroup comparison including sex, lymphoma subtype, disease stage, comorbidity burden, or hospital admission reached statistical significance, and given the small sample, these subgroup findings should be regarded as exploratory and hypothesis-generating rather than confirmatory. CONCLUSIONS: In this pilot study, more than one-third of patients with lymphoma screened positive for clinically significant anxiety and/or depressive symptoms. These preliminary estimates support routine distress screening, particularly around treatment initiation, and should be confirmed in larger, longitudinal, multicenter cohorts.