Association between depression, anxiety, and problematic opioid use among adults with cancer at a tertiary referral hospital in northern Iran

Cancer is frequently accompanied by psychological distress, particularly symptoms of depression and anxiety, which may adversely affect patients’ well-being and adherence to treatment. However, the relationship between psychological symptoms and problematic opioid use among patients with cancer has been insufficiently investigated in Iran. This study examined the correlation between symptoms of depression and anxiety and problematic opioid use in adults with cancer. A cross-sectional study was conducted among 350 adults with confirmed cancer diagnoses attending a tertiary referral hospital in northern Iran between January and December 2023. Psychiatric assessment was conducted through clinical interviews based on DSM-5 diagnostic criteria by a psychiatrist and a trained medical intern. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), and problematic opioid use was screened using the Drug Abuse Screening Test (DAST-10), administered with reference to opioid use. Associations between depression, anxiety, and problematic opioid use were examined using correlation analyses. Multivariable linear regression models were used to identify factors associated with anxiety and depression after adjustment for demographic and clinical characteristics. A total of 350 patients were included (mean age: 58.39 ± 14.45 years; 52.9% male). HADS-A and HADS-D scores ≥ 11, indicating clinically significant anxiety and depressive symptoms, were observed in 43.5% and 40.3% of participants, respectively, while 15.2% screened positive for problematic opioid use according to the DAST-10. Anxiety and depression scores were positively correlated with DAST-10 scores indicating problematic opioid use ( r = 0.34 and 0.28, respectively; both P < 0.001). Female sex, lower educational attainment, and hematologic malignancy were associated with higher anxiety and depression symptom scores, whereas none of these variables was significantly associated with problematic opioid use. Higher levels of depression and anxiety symptoms were associated with higher DAST-10 scores indicating problematic opioid use among adults with cancer. These findings support routine psychological assessment and integrated psycho-oncology services as part of comprehensive cancer care. Owing to the cross-sectional design, causal relationships cannot be inferred.