Acta Neurochirurgica

, Volume 160, Issue 6, pp 1187–1194 | Cite as

Psychiatric co-morbidity, distress, and use of psycho-social services in adult glioma patients—a prospective study

  • Susanne Singer
  • Julia Roick
  • Helge Danker
  • Rolf-Dieter Kortmann
  • Kirsten Papsdorf
  • Sabine Taubenheim
  • Mirjam Renovanz
  • Katja Jähne
  • Jürgen Meixensberger
Original Article - Tumor - Glioma



Distress impacts the daily life of glioma patients. This study explored its course over time and the usage of psychosocial care.


A consecutive sample of glioma patients completed the Hospital Anxiety and Depression Scale to assess distress levels at admission to the hospital (t1), before discharge (t2), after 3 months (t3), and after 6 months (t4). They were interviewed with the Structured Clinical Interview for DSM-IV to ascertain psychiatric disorders at t2. Psycho-oncological care in the hospital was determined with the Hospital Information System, and the use of outpatient treatment was evaluated with the Health Care Usage Questionnaire at t4. We compared the percentages of elevated distress, psychiatric co-morbidity, and care usage between men and women.


During the study period, 37 patients were enrolled. Nineteen percent of the patients were diagnosed with a psychiatric disorder. The percentages of patients with elevated distress were 56, 59, 39, and 40% at t1, t2, t3, and t4, respectively. Participants who did not survive the 6 months presented with higher levels of distress. In the hospital, 14% of those with elevated distress were visited by a psycho-oncologist. In the outpatient setting, 43% of those with elevated distress visited a neuro-psychiatrist, and 14% went to a psychotherapist. There was no evidence for an effect of gender on psychiatric co-morbidity, distress, or care use.


A significant proportion of glioma patients report elevated distress during the hospital stay and thereafter. Only a fraction of them receive mental health care.


Depression Anxiety Glioma Glioblastoma Astrocytoma Patient-reported outcomes 



This study was funded by the German Federal Ministry of Health (#NKP-332-026).

Compliance with ethical standards

Conflict of interest

SS received a grant from Pfizer, the quality of life prize from Lilly, and lecture fees from Pfizer, Bristol-Myers Squibb, and Boehringer Ingelheim. These were unrelated to the study presented here. The other authors declare that they have no conflict of interest.


All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. The study protocol was approved by the local ethics committee. All participants provided written informed consent.


  1. 1.
    Aaronson N, Ahmedzai S, Bergmann B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F, for the EORTC Study Group on Quality of Life (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMedGoogle Scholar
  2. 2.
    Aaronson NK, Taphoorn MJB, Heimans JJ, Postma TJ, Gundy CM, Beute GN, Slotman BJ, Klein M (2011) Compromised health-related quality of life in patients with low-grade Glioma. J Clin Oncol 29:4430–4435CrossRefPubMedGoogle Scholar
  3. 3.
    Boele FW, van Uden-Kraan CF, Hilverda K, Reijneveld JC, Cleijne W, Klein M, Verdonck-de Leeuw IM (2016) Attitudes and preferences toward monitoring symptoms, distress, and quality of life in glioma patients and their informal caregivers. Support Care Cancer 24:3011–3022PubMedPubMedCentralGoogle Scholar
  4. 4.
    Borooah VK (2010) Gender differences in the incidence of depression and anxiety: econometric evidence from the USA. J Happiness Stud 11:663–682CrossRefGoogle Scholar
  5. 5.
    Brebach R, Sharpe L, Costa DSJ, Rhodes P, Butow P (2016) Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psychooncology 25:882–890CrossRefPubMedGoogle Scholar
  6. 6.
    Briest S, Papsdorf K, Köhler U, Krauß O, Singer S (2015) Sind Brustkrebspatientinnen mit frühen Stadien weniger psychisch belastet als jene mit fortgeschrittenen Stadien? Onkologe 21:245–249CrossRefGoogle Scholar
  7. 7.
    DAngelo C, Mirijello A, Leggio L, Ferrulli A, Carotenuto V, Icolaro N, Miceli A, D'Angelo V, Gasbarrini G, Addolorato G (2008) State and trait anxiety and depression in patients with primary brain tumors before and after surgery: 1-year longitudinal study. J Neurosurg 108:281–286CrossRefGoogle Scholar
  8. 8.
    Dirven L, Reijneveld JC, Taphoorn MJB (2014) Health-related quality of life or quantity of life: a difficult trade-off in primary brain tumors? Semin Oncol 41:541–552CrossRefPubMedGoogle Scholar
  9. 9.
    Efficace F, Taphoorn M (2012) Methodological issues in designing and reporting health-related quality of life in cancer clinical trials: the challenge of brain cancer studies. J Neuro-Oncol 108:221–226CrossRefGoogle Scholar
  10. 10.
    Erharter A, Giesinger J, Kemmler G, Schauer-Maurer G, Stockhammer G, Muigg A, Hutterer M, Rumpold G, Sperner-Unterweger B, Holzner B (2010) Implementation of computer-based quality-of-life monitoring in brain tumor outpatients in routine clinical practice. J Pain Symptom Manag 39:219–229CrossRefGoogle Scholar
  11. 11.
    First M, Spitzer R, Gibbon M, Williams J (1997) Structured clinical interview for DSM-IV Axis I disorders (SCID-I), clinician version. American Psychiatric Press, Washington, DCGoogle Scholar
  12. 12.
    Ford E, Catt S, Chalmers A, Fallowfield L (2012) Systematic review of supportive care needs in patients with primary malignant brain tumors. Neuro-Oncology 14:392–404CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Geue K, Richter R, Buttstädt M, Brähler E, Böhler U, Singer S (2012) Art therapy in psycho-oncology - recruitment of participants and gender differences in usage. Support Care Cancer 20:679–686CrossRefPubMedGoogle Scholar
  14. 14.
    Glaesmer H, Brahler E, Martin A, Mewes R, Rief W (2008) Gender differences in subjective help seeking threshold and health care utilization: is there an interrelation between both features? Int J Psychol 43:438Google Scholar
  15. 15.
    Goebel S, Strenge H, Mehdorn HM (2012) Acute stress in patients with brain cancer during primary care. Support Care Cancer 20:1425–1434CrossRefPubMedGoogle Scholar
  16. 16.
    Goebel S, von Harscher M, Mehdorn HM (2011) Comorbid mental disorders and psychosocial distress in patients with brain tumours and their spouses in the early treatment phase. Support Care Cancer 19:1797–1805CrossRefPubMedGoogle Scholar
  17. 17.
    Grassi L, Watson M, on behalf of the IPOS Federation of Psycho-Oncology Societies' co-authors (2012) Psychosocial care in cancer: an overview of psychosocial programmes and national cancer plans of countries within the International Federation of Psycho-Oncology Societies. Psycho-Oncology 21:1027–1033CrossRefPubMedGoogle Scholar
  18. 18.
    Hickmann AK, Nadji-Ohl M, Haug M, Hopf N, Ganslandt O, Giese A, Renovanz M (2016) Suicidal ideation, depression, and health-related quality of life in patients with benign and malignant brain tumors: a prospective observational study in 83 patients. Acta Neurochir 158:1669–1682CrossRefPubMedGoogle Scholar
  19. 19.
    Johnson M, Stone GL (1989) Logic and nurture - gender differences in thinking about psychotherapy. Prof Psychol Res Pract 20:123–127CrossRefGoogle Scholar
  20. 20.
    Khan F, Amatya B (2013) Factors associated with long-term functional outcomes, psychological sequelae and quality of life in persons after primary brain tumour. J Neuro-Oncol 111:355–366CrossRefGoogle Scholar
  21. 21.
    Kvale EA, Murthy R, Taylor R, Lee JY, Nabors LB (2009) Distress and quality of life in primary high-grade brain tumor patients. Support Care Cancer 17:793–799CrossRefPubMedGoogle Scholar
  22. 22.
    Lin L, Chiang HH, Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS (2013) Uncertainty, mood states, and symptom distress in patients with primary brain tumors: analysis of a conceptual model using structural equation modeling. Cancer 119:2796–2806CrossRefPubMedGoogle Scholar
  23. 23.
    Litofsky NS, Farace E, Anderson F, Meyers CA, Huang W, Laws ER (2004) Depression in patients with high-grade glioma: results of the glioma outcomes project. Neurosurgery 54:358–366CrossRefPubMedGoogle Scholar
  24. 24.
    Lyons Z, Janca A (2009) Diagnosis of male depression does general practitioner gender play a part? Aust Fam Physician 38:743–746PubMedGoogle Scholar
  25. 25.
    Mainio A, Hakko H, Niemela A, Koivukangas J, Rasanen P (2006) Gender difference in relation to depression and quality of life among patients with a primary brain tumor. Eur Psychiatry 21:194–199CrossRefPubMedGoogle Scholar
  26. 26.
    Mehnert A, Brähler E, Faller H, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A, Hund B, Reuter K, Richard M, Sehner S, Sommerfeldt S, Szalai C, Wittchen HU, Koch U (2014) Four-week prevalence of mental disorders in cancer patients across major tumor entitites. J Clin Oncol 32:3540–3546CrossRefPubMedGoogle Scholar
  27. 27.
    Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12:160–174CrossRefPubMedGoogle Scholar
  28. 28.
    Mitchell AJ, Symonds P (2013) Implementation of distress screening by Cancer clinicians during routine clinical care. Part I. Focus on efficiency and acceptability of frontline screening. Psychooncology 22:91Google Scholar
  29. 29.
    Pelletier G, Verhoef MJ, Khatri N, Hagen N (2002) Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. J Neuro-Oncol 57:41–49CrossRefGoogle Scholar
  30. 30.
    Piil K, Jakobsen J, Christensen KB, Juhler M, Jarden M (2015) Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study. J Neuro-Oncol 124:185–195CrossRefGoogle Scholar
  31. 31.
    Renovanz M, Hickmann A-K, Coburger J, Kohlmann K, Janko M, Reuter AK, Keric N, Gutenberg A, Nadji-Ohl M, König J, Singer S, Giese A, Hechtner M (2017) Assessing psychological and supportive care needs in Glioma patients – feasibility study on the use of the supportive care needs survey short form (SCNS-SF34-G) and the supportive care needs survey screening tool (SCNS-ST9) in clinical practice. Eur J Cancer Care.
  32. 32.
    Robin AM, Walbert T, Mikkelsen T, Kalkanis SN, Rock J, Lee I, Rosenblum ML (2014) Through the patient's eyes: the value of a comprehensive brain tumor center. J Neuro-Oncol 119:465–472CrossRefGoogle Scholar
  33. 33.
    Rooney AG, Carson A, Grant R (2011) Depression in cerebral Glioma patients: a systematic review of observational studies. J Natl Cancer Inst 103:61–76CrossRefPubMedGoogle Scholar
  34. 34.
    Rooney AG, McNamara S, Mackinnon M, Fraser M, Rampling R, Carson A, Grant R (2011) Frequency, clinical associations, and longitudinal course of major depressive disorder in adults with cerebral Glioma. J Clin Oncol 29:4307–4312CrossRefPubMedGoogle Scholar
  35. 35.
    Rooney AG, McNamara S, MacKinnon M, Fraser M, Rampling R, Carson A, Grant R (2013) The frequency, longitudinal course, clinical associations, and causes of emotional distress during primary treatment of cerebral glioma. Neuro-Oncology 15:635–643CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Rooney AG, van Nieuwenhuizen D, Reijneveld JC, Grant R (2009) Female gender is not a proven risk factor for depression in glioma. J Neuro-Oncol 95:449CrossRefGoogle Scholar
  37. 37.
    Rosenblum ML, Kalkanis S, Goldberg W, Rock J, Mikkelsen T, Remer S, Whitehouse S, Nerenz D (2009) Odyssey of hope: a physician's guide to communicating with brain tumor patients across the continuum of care. J Neuro-Oncol 92:241–251CrossRefGoogle Scholar
  38. 38.
    Scaratti C, Leonardi M, Saladino A, Anghileri E, Broggi M, Lamperti E, Fariselli L, Ayadi R, Tringali G, Schiavolin S (2017) Needs of neuro-oncological patients and their caregivers during the hospitalization and after discharge: results from a longitudinal study. Support Care Cancer 25:2137–2145CrossRefPubMedGoogle Scholar
  39. 39.
    Singer S, Bringmann H, Hauss J, Kortmann R-D, Köhler U, Krauß O, Schwarz R (2007) Häufigkeit psychischer Begleiterkrankungen und der Wunsch nach psychosozialer Unterstützung bei Tumorpatienten im Akutkrankenhaus. Dtsch Med Wochenschr 132:2071–2076CrossRefPubMedGoogle Scholar
  40. 40.
    Singer S, Das-Munshi J, Brähler E (2010) Prevalence of mental health conditions in cancer patients in acute care – a meta-analysis. Ann Oncol 21:925–930CrossRefPubMedGoogle Scholar
  41. 41.
    Singer S, Hohlfeld S, Müller-Briel D, Dietz A, Brähler E, Schröter K, Lehmann-Laue A (2011) Psychosoziale Versorgung von Krebspatienten - Versorgungsdichte und -bedarf. Psychotherapeut 56:386–393CrossRefGoogle Scholar
  42. 42.
    Singer S, Kuhnt S, Götze H, Hauss J, Hinz A, Liebmann A, Krauß O, Lehmann A, Schwarz R (2009) Hospital anxiety and depression scale cut-off scores for Cancer patients in acute care. Br J Cancer 100:908–912CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Tang PL, Wang HH, Chou FH (2015) A systematic review and meta-analysis of demoralization and depression in patients with Cancer. Psychosomatics 56:634–643CrossRefPubMedGoogle Scholar
  44. 44.
    Taphoorn MJB, Sizoo EM, Bottomley A (2010) Review on quality of life issues in patients with primary brain tumors. Oncologist 15:618–626CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Thode N, Bergmann E, Kamtsiuris P, Kurth M (2005) Einflussfaktoren auf die ambulante Inanspruchnahme in Deutschland. Bundesgesundheitsblatt 48:296–306CrossRefGoogle Scholar
  46. 46.
    Velikova G, Coens C, Efficace F, Greimel E, Groenvold M, Johnson C, Singer S, van de Poll-Franse L, Young T, Bottomley A, on behalf of the EORTC Quality of Life Group (2012) Health-related quality of life in EORTC clinical trials - 30 years of progress from methodological developments to making a real impact on oncology practice. Eur J Cancer Suppl 10:141–149CrossRefGoogle Scholar
  47. 47.
    Warrington TP, Bostwick JM (2006) Psychiatric adverse effects of corticosteroids. Mayo Clin Proc 81:1361–1367CrossRefPubMedGoogle Scholar
  48. 48.
    Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jonsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21:655–679CrossRefPubMedGoogle Scholar
  49. 49.
    Zeissig SR, Singer S, Koch L, Zeeb H, Merbach M, Bertram H, Eberle A, Schmid-Höpfner S, Holleczek B, Waldmann A, Arndt V (2015) Utilisation of psychosocial and informational services in immigrant and non-immigrant German cancer survivors. Psycho-Oncology 24:919–925CrossRefPubMedGoogle Scholar
  50. 50.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Susanne Singer
    • 1
    • 2
  • Julia Roick
    • 3
  • Helge Danker
    • 4
  • Rolf-Dieter Kortmann
    • 5
  • Kirsten Papsdorf
    • 5
  • Sabine Taubenheim
    • 6
  • Mirjam Renovanz
    • 7
  • Katja Jähne
    • 8
  • Jürgen Meixensberger
    • 8
  1. 1.Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical CentreMainzGermany
  2. 2.University Cancer CentreMainzGermany
  3. 3.Department of Medical SociologyUniversity Medical CentreHalleGermany
  4. 4.Department of Medical Psychology and Medical SociologyUniversity Medical CentreLeipzigGermany
  5. 5.Department of Radiation-OncologyUniversity Medical CentreLeipzigGermany
  6. 6.Regional Clinical Cancer RegistryLeipzigGermany
  7. 7.Department of NeurosurgeryUniversity Medical CentreMainzGermany
  8. 8.Department of NeurosurgeryUniversity Medical CentreLeipzigGermany

Personalised recommendations