The first study of its kind to investigate depression following cancer diagnosis among British white people and South Asians in the UK has discovered that South Asians are five times more likely to be severely depressed.
People of Indian, Pakistani, Bangladeshi or Sri Lankan historical origin – British South Asians – appeared to suffer more pain leading researchers to conclude that this could be a way of drawing attention to their psychological distress. In total, 53.8% of the British South Asian samples were born in the Indian subcontinent, 33% in Africa and 12.9% in the UK.
Professor Paul Symonds, from the University of Leicester, was the lead author of the study. He said: “This is the first study that has compared how British South Asians and British white patients cope with cancer. Our findings are strictly only relevant to the study group and patients from the county of Leicestershire. However, we think it is highly likely that there is a higher incidence of depression among British South Asian cancer patients elsewhere in the United Kingdom and our findings have important implications for the NHS.
“Depression is one of the strongest determinants of health-related quality of life and it can influence medical care and participation in treatment. It may also be linked with other serious outcomes including mortality.
“It should be of major concern to healthcare policymakers in the UK that this study provides evidence that there is a higher prevalence of depressive symptoms among BSA patients soon after the cancer diagnosis than BW patients.
“Health professionals need to be aware of a greater probability of depressive symptomatology (including somatic symptoms) and how this may present clinically in the first 9 months after diagnosis if this ethnic disparity in mental well-being is to be addressed.”
The researchers investigated whether there are differences in depressive symptoms among 94 British South Asian patients with cancer compared to 185 British White patients over a nine month period. The research, led by the University of Leicester, was part funded by Leicestershire and Rutland –based charity Hope Against Cancer and the University Hospitals of Leicester NHS Trust, and is published in BMJ Open.
British South Asian patients had twice the self-reported rate of depressive symptoms than British White patients and five times the incidence of severe depression. These differences persisted for nine months after the baseline assessment.
Professor Symonds, who is Professor of Clinical Oncology at the University, said: “The reasons for the difference in the incidence of depressive symptoms are complex. British South Asian patients use potentially maladaptive coping strategies more frequently than British white patients, particularly hopelessness, helplessness, fatalism, avoidance and denial. At baseline the use of these maladaptive strategies correlated with a higher incidence of depression.
“Interestingly, although both groups received very similar treatment, British South Asian patients had a higher symptom burden than British white patients. They appear to suffer more pain, nausea and mouth sores along with other symptoms. It may well be that British South Asia patients complain of physical symptoms as a way of drawing attention to their psychological distress.”
But the study also highlights that they may only have scratched the surface of the problem. Professor Symonds adds: “It is most likely that the rates of depressive symptoms are under-reported since anecdotally those who were most distressed often did not feel able to participate in this study.”
Professor Symonds, of the Department of Cancer Studies and Molecular Medicine at the University of Leicester, worked with colleagues from University Hospital of Leicester NHS Trust. The study team consisted of Karen Lord, Kausher Ibrahim, Sawan Kumar, Alex J Mitchell, Nicky Rudd and Paul Symonds.
- To cite: Lord K, Ibrahim K, Kumar S, et al. Are depressive symptoms more common among British South Asian patients compared with British White patients with cancer? A cross-sectional survey. BMJ Open 2013;3: e002650. doi:10.1136/ bmjopen-2013-002650
Note to Editors
Hope Against Cancer, formally known as the Hope Foundation, was established in 2003 to increase the funds available for cancer research in Leicestershire and Rutland to help improve the area’s status as a leading centre for cancer research.
Surveys demonstrate that when patients with cancer are treated at cancer centres and units carrying out research, outcomes are significantly improved.
Cancer research has historically been poorly funded in Leicestershire and Rutland and all money raised by the Hope will be used exclusively to fund vital cancer research in this area. Hope currently funds 6 research Projects looking at a range of cancers and a Specialist Research Nurse in the Hope Against Cancer Clinical Trials Unit at the LRI and is grateful for the support of the University of Leicester.