Anxiety and depression in patients with intracranial meningioma:
Mixed methods analysis
Graham Kasper, Shannon Hart, Nardin Samuel, Colleen Fox and Sunit Das
Canadian study
Abbreviations
ESCC-SM: The health survey in Canadian communities on mental health (ESCC-SM)
HADS: Hospital Anxiety and Depression Scale (Hospital anxiety and depression scale)
WHO: World Health Organization
Ww: surveillance
Summary
Context : while the diagnosis of a high -grade intracranial tumor is known to be associated with a larger psychosocial burden, the burden associated with meningiomas is less well described . This study aimed to examine the burden of mental health in patients with meningiomas who have undergone surgical resection or series observation, in order to identify and make the gaps better known.
Methods : the hospital anxiety and depression scale (HADS) was subject to participants. Fisher's exact tests were carried out to assess frequency distributions and tests were applied to compare HADS scores of postoperative and non -surgical patients. Semi-structured interviews were carried out with a subset of participants. The thematic analysis of interviews made it possible to identify emerging themes.
Results : Thirty patients with intracranial meningomes met the inclusion criteria. The average age of the cohort was 56.01 years and 66.67% were women (n = 20). Fourteen have undergone surgery; Sixteen were treated in a conservative manner with observation. The average delay since the sample diagnosis was 37.6 months. The prevalence of light to severe anxiety symptoms was 28.6 % in patients treated with surgery and 50 % in patients under active surveillance (p = 0.325). The prevalence of light to severe depression symptoms was 7.14% in patients treated with surgery and 6.25% in patients in active surveillance (p = 0.533). The emerging themes of eight interviews reveal the influence of resilience, uncertainty and time, social support, interactions with medical experts and difficulties during restoration on mental health.
Conclusion : The results of this study reveal that patients with meningiomas undergo a heavy burden in terms of mental health, which illustrates the need to improve patient centered care and mental health.
Keywords : anxiety, depression, analysis of mixed methods, meningioma, surveillance.
Context
Meningiomas are the most frequent primary intracranial tumors in North America, representing about a quarter of all non -metastatic lesions.
Compared to other intracranial tumors, meningiomas often evolve slowly and generally have a good prognosis : the rate of survival at 5 years and the rate of survival at 15 years reach 85-90 % respectively and 75-80 %. The slowness of their growth, associated with the increasingly widespread use of cranial imaging, means that many patients are fortuitously diagnosed and often without any associated symptoms.
Surgery remains the pillar of the treatment of meningiomas and is often curative if total resection is obtained . However, many asymptomatic meningiomas are not treated and are subject to regular monitoring by series imaging. Despite their favorable prognosis, there is a risk of recurrence after resection, especially for high -grade tumors.
Meningiomas are relatively little studied compared to their malignant counterparts . This statement is true when the mental and emotional well-being of patients with meningiomas are examined compared to patients with higher grade brain tumors. For example, depression and anxiety are common in patients with brain tumors, with a prevalence of depression ranging from 10 to 40 % and a prevalence of anxiety ranging from 5 to 50 %; However, the majority of studies on this relationship have focused on populations of high -grade tumors, without significantly taking into account meningiomas.
In addition, compared to patients with more aggressive tumors, patients with meningiomas have lower recurrence rates , often avoid adjuvant treatments and benefit from a longer long -term monitoring period. Each of these elements contributes to a unique experience for the patient. Given their relative preponderance compared to other brain tumors (aggravated by their favorable prognosis and higher patient survival rates), the consequences of mental health problems, such as anxiety and depression, on patients living with meningiomas are probably much more important than you currently think. In addition, as the Canadian health system continues to focus on the provision of holistic care and centered on the patient, recognition of well-being or mental and emotional distress of patients with meningiomas must be part of the new standard of care. It is therefore necessary to assess and understand the burden of symptoms of anxiety and depression in this population of patients in order to improve the quality of the care they receive.
In addition, the research that has explored the weight of depression and anxiety in patients with meningiomas were mainly based on quantitative data. The absence of qualitative analysis, exploring the perspectives of patients concerning the effect of their diagnosis, their treatment and follow -up care, has probably contributed to the lack of conclusive results in this field of study. Qualitative methods add depth and context to the extent of the information provided by quantitative data and it is widely used in mental health research. The use of such an approach for this population of patients has the advantage of improving the understanding by the scientific community of unique experiences experienced by patients with benign brain tumors, to obtain the personal point of view of patients directly and to allow the formulation of new hypotheses for future research.
The combination of quantitative and qualitative methods allows a better understanding of the data collected than one or the other approach alone. This is an excellent tool for studying the symptoms of anxiety and depression in patients with low -grade meningioma, because it is necessary to explore the depth and context of these symptoms (which qualitative analysis makes it possible to better grasp), while obtaining complementary and convergent data describing the prevalence and intensity of these symptoms (what quantitative analysis to input).
To this end, we carried out a mixed method study using a quantitative and qualitative analysis to identify the load and prevalence of depression and anxiety symptoms in patients with meningioma. We have sought to compare these symptoms and the experiences of patients between those who have been treated by surgery and those who have undergone a series observation.
Material and methods
Study design
A mixed sequential explanatory method has been used. Patients identified during recruitment were informed of the study during a visit to the neurosurgery clinic, or by phone. After obtaining their informed consent, the participants fulfilled the HADS questionnaire immediately or planned a later evaluation by phone. The results were depersonalized.
A subset of twelve participants, five who underwent surgery and seven who continued the wait under surveillance, was random identified to participate in the maintenance phase. The interviews, in which only the investigator and the questioned person participated, were carried out and recorded by phone. The recordings were then transcribed, depersonalized and analyzed. Four people identified to participate in the study's maintenance phase did not finish the interviews (three for logistical reasons and one which withdrew its consent for this study phase). The maintenance process continued until a satisfactory level of thematic saturation was reached, which occurred after eight interviews (surgery = 5, ww = 3). All assessments and interviews were administered and documented by the first author.
Participants were divided into a “surgery” or “vigilant expectation” subgroup for comparison.
Selection of participants
The study was approved by the Unity Health Toronto Research Ethics Committee, and all research was carried out in accordance with the relevant directives, including the Helsinki Declaration. Adult patients with intracranial meningiomas of Grade I or II according to the World Health Organization (WHO) and taken care of by the Senior Researcher (SD) were considered as possible participants. This decision was made secondarily to logistical constraints. From July 2018 to February 2019, 56 people were contacted and 32 agreed to participate. For the participants who were recruited during remote/telephone appointments, verbal consent was obtained, otherwise written consent was obtained from all the other participants. This procedure was approved by the Ethics Committee. The exclusion criteria were as follows: diagnosis of anxiety and/or depression preexisting to a diagnosis of meningioma, absence of mastery of English and cognitive disorders preventing the understanding and communication of the study and its objectives. Two patients were removed due to a prior diagnosis of anxiety and/or depression.
Results measures
Anxiety and depression
The hospital anxiety and depression scale (HADS) has been used to detect symptoms of anxiety and depression. HADS consists of 14 questions designed to assess anxiety and depression (7 questions each). Each question is noted from 0 to 3, with 3 representing a more serious symptomatology, generating a score for anxiety and another for depression. Scores ≤ 7 indicate a normal score, scores ≥ 11 indicate clinically relevant anxiety or depression, and scores from 8 to 10 indicate anxiety or light depression. The HADS has shown reliability of high internal coherence with an alpha Cronbach coefficient of 0.816 for anxiety and 0.776 for depression.
Semi-structured interviews were conducted to study the perspectives of participants concerning their mental health (additional file 1: maintenance guide). This format allowed a certain flexibility to explore the relevant subjects that freely emerged from the discussion. The questions focused on the mental health and well-being of participants, in particular on symptoms of anxiety and depression, as well as on their general concerns, access to support networks or their absence, and satisfaction or dissatisfaction with their cumulative experience as a patient.
Additional measures
Socio -demographic and clinical data
The age, sex, grade and location of the tumor, the symptoms presented (neurological deficits), the treatments used (surgery, radiation, series monitoring) and the results of the treatment (extent of resection) were recorded from the medical file.
Statistical analysis
Statistical analyzes were carried out using SPSS Statistics version 27 (IBM Corporation, Armonk, NY). Summary statistics have been calculated for the cohort and each subgroup. An exact Fisher test for categorical variables has been carried out to assess the statistical significance of the frequency distributions of normal scores (≤ 7) compared to light/high scores (> 7). Tests of independent samples supposing unequal variances were carried out to compare the average anxiety and HADS depression scores between the subgroups. Statistical tests were considered significant if value P was less than 0.05 (bilateral).
Thematic analysis
Qualitative data has been evaluated using a data -descriptive data analysis approach. An open coding has been indeed generated, in parallel and independently by two investigators for each maintenance transcription, by labeling ideas, concepts and themes in the text. Emerging themes have been refined, using iterative comparative analyzes to identify models and develop relationships between concepts established in transcriptions. Using the axial coding, the transcription data was linked to reveal the themes and final sub-themes. We then compared their analyzes and generated themes and sub-themes general describing the sum of the data. The analyzes were then revised by our experienced co-investigator in qualitative research.
Results
Thirty participants were included in the study, including 14 (46.7%) in the surgery subgroup and 16 (53.3%) in the WW subgroup . There were no significant differences in demographic data between the two groups. Table 1 presents in detail all summary statistics.
Table 1 Demographic and medical information of participants
Variable post-surgical resection resection, n (%) surveillance, n (%)
Number 14 (46,67) 16 (53,33)
Age (years)
Fork 39-80 33-84
MX (SX) 55.71 (10.59) 56.31 (14.35)
Sex
Men 5 (35.71) 5 (31.25)
Women 9 (64.29) 11 (68.75)
Grade of the tumor
Stade I of WHO 11 (78.57) -
Grade II of WHO 3 (21.43) -
Extent of the tumor's resection
Total 12 (85.71) -
Subtotal 2 (14.29)-
Lateralization of the tumor
Right 6 (42.86) 11 (68.75)
Left 5 (35.71) 3 (18.75)
Other (bilateral, not specified) 3 (21.43) 2 (12.50)
Location of the tumor
Ponto-cerebellar angle 0 (0) 2 (12.50)
Convexity 3 (21.43) 2 (12.50)
Falcine 3 (21.43) 3 (18.75)
Foramen Magnum 1 (7.14) 0 (0)
Olfactory furrow 1 (7.14) 2 (12.50)
Parasagittal 0 (0) 1 (6.25)
Posterior pit 1 (7.14) 2 (12.50)
Sphenoidal 3 (21.43) 2 (12.50)
Tentorielle 1 (7.14) 2 (12.50)
Other (bilateral, multiple) 1 (7.14) 2 (12.50)
Radiotherapy history
Yes 3 (21.43) 2 (12.50)
No 11 (78.57) 14 (87.50)
Current symptoms
Cephalae 8 (57.14) 7 (43.75)
Engine deficit 8 (57.14) 3 (18.75)
Epilepsy 3 (21.43) 1 (6.25) crisis)
Dizziness/dizziness/
Instability 4 (28.57) 3 (18.75)
Visual deficit 5 (35.71) 4 (25.00)
Antecedent of neurological risk factor (HTN, DLD, smoking)
Yes 6 (42.86) 6 (37.50)
No 8 (57.14) 10 (62.50)
Frequency and intensity of anxiety and depression
The prevalence of light to clinically relevant anxiety (HADS> 7) in the cohort studied was 40 %; In the surgery subgroup, the prevalence was 28.6 % and in the WW subgroup, it was 50 %. The prevalence of light to clinically relevant depression (HADS> 7) in the cohort was 6.67 %; In the surgery subgroup, the prevalence was 7.14 % and in the WW subgroup, it was 6.25 %. The frequency distributions of positive anxiety and depression (scores> 7) and non-positive (scores ≤ 7) do not differ significantly between the surgery and ww subgroups (anxiety: p = 0.325, depression: p = 0.533) (Table 2). There was no significant difference in the average anxiety or depression scores by comparing the two sub-groups (anxiety: p = 0.587, depression: p = 0.798) (Table 2).
Table 2 results concerning anxiety and depression
HADS Post-surgery Relations Total Vigilante
n (%) gross scores, n (%) gross scores, n (%) gross scores,
M (sd) m (sd) m (sd)
HADS A - 6.21 (3.91) - 7.06 (4.54) - 7 (4.00)
Bas (≤ 7) 10 (71.43) 4.2 (2.20) 8 (50) 3.25 (2.66) 18 (60) 3.78 (2.39)
Moderate/high (> 7) 4 (28.6) 11.25 (2.06) 8 (50) 10.88 (1.96) 12 (40) 11 (1.91)
HADS D - 3.21 (2.99) - 2.94 (2.85) - 3.07 (2.88)
Bas (≤ 7) 13 (92.86) 2.77 (2.59) 15 (93.75) 2.4 (1.96) 28 (93.33) 2.57 (2.23)
Moderate/high (> 7) 1 (7.14) 9 1 (6.25) 11 2 (6.67) 10 (1.41)
Time relationship on anxiety and depression
At the time of the evaluation with the HADS questionnaire, the time elapsed since the diagnosis for the entire cohort was between 2 and 182 months, with an average of 37.6 months. A linear regression analysis has been carried out to assess the impact of time elapsed since the diagnosis on HADS scores. Although the scores have tended to decrease over time since the diagnosis, no significant relationship has been revealed (p = 0.217 for depression and p = 0.113 for anxiety).
Thematic analysis
The average duration of interviews was 41.9 minutes. The thematic analysis revealed four common themes: personal resilience, the impact of uncertainty and time, the importance of social support and mental health difficulties during recovery. The summary statistics of the interview participants are presented in Table 3.
Table 3 Selected Demographic Information of Participants in Maintenance and HADS scores
Variable post-surgical resection, resection, n (%) surveillance, expectation, n (%) total
Number 5 (62.5) 3 (37.5) 8
Age (years)
Fork 46-68 33-52 33-68
Average 52.8 43 49.1
Sex
Men 2 (40) 0 (0) 2 (25)
Women 3 (60) 3 (100) 6 (75)
Symptoms present
Headed 2 (40) 3 (100) 5 (62.5)
Engine deficit 3 (60) 2 (66.7) 6 (75)
Epilepsy 2 (40) 0 (0) 2 (25)
Dizziness/dizziness/
Instability 0 (0) 1 (33.3) 1 (12.5)
Visual deficit 2 (40) 1 (33.3) 3 (37.5)
Time has elapsed since the diagnosis (month)
Fork 15-66 6-64 6-66
Average 42.6 27.3 36.9
Time has elapsed since the operation (month)
Fork 15-65--
Average 42.4 - -
HADS A> 7 2 (40) 3 (100) 5 (62.5)
HADS D> 7 1 (20) 1 (33.3) 2 (25)
Theme 1: Personal resilience
This theme encompasses the capacity of participants to face their diagnosis and to bounce during their recovery period. Six people interviewed specifically mentioned having a positive self -proclaimed vision of life: "Being positive is the only thing I must say that is important” (participant B1). The A4 participant highlighted an example of this optimism when he said: "Emotionally, even if there are a lot to manage ... We can dwell on it, or we can dwell on the fact that," hey, I'm going to dine this evening ". Optimism has been noted as a long -standing character trait among the participants - "My default configuration is to be happy and positive and ... to see the good side of things" (participant A5) - and has been frequently attributed to family values and education: "We take the best party of any situation in which we find ourselves, and this has always been the case in [our family]" (Participant A4).
Theme 2: The impact of uncertainty and time
An important part of the diagnostic and monitoring periods involved cope with a certain degree of uncertainty, which was an anxiety catalyst among the participants . The participants reported an increased feeling of concern and fear associated with the unknown and the lack of information. Delays in the evaluation after the initial diagnosis were a notorious cause of distress: “It was probably more stressful for this [reason], because of the waiting period to know the result ... It is stressful to wonder:“ Oh my God, what happens to me? (Participant B1). Participator B14 described the fear associated with the unknown: "[I] started to worry ... because I don't know why it is there, or how it happened, or anything like this, so it was very scary".
A similar scenario occurs during the monitoring of patients supported in a surgical or conservative manner: a similar scenario occurs during follow-up, both for patients who have undergone surgery and for those who have benefited from conservative management: "[The lack of information] definitively modifies ... my mood and my way of working before [the meeting]” (participating B14). The impact of uncertainty or lack of knowledge is underlined by the attenuation of stress once the information is available: "The more I knew, the better I felt" (participant B14).
Theme 3: Importance of social support
This theme reflects the considerable advantages that patients withdraw from significant social support , the harmful effects of isolation and loneliness on mental well-being and the desire to be supported by peers who have experienced similar experiences. There is a strong association between social support and resilience: "There are more people ... who care about you ... and who go beyond ... to the situation in which you are" (A4 participant). Having close friends ready to listen to was an important source of emotional support: "Talking with friends and ... emptying my heart of what is happening ... It was often a liberation to tell people ... and that they ... be there for me, listen to me and complain" (participant B17).
The desire to have additional resources in the form of peer support, in order to get in touch with people who have had a similar experience, is a recurring theme. Seven of the eight people interviewed said that a peer support group would have been useful to them, especially at the start of the diagnosis.
Theme 4: Recovery difficulties
After the initial diagnosis and care, the people interviewed spoke of the crossing of a period of several weeks to several months which was particularly stressful and difficult . These difficulties were linked to the lack of coordination of care, residual deficits and the desire to find the premorbid levels of operation.
The concerns of participants concerning the lack of coordination of care were focused on communication problems between health professionals and patients . Participant B1, for example, has experienced persistent visual symptoms after surgery and said it was worried not to have heard from his ophthalmologist or his primary care doctor after initial evaluation visits. Several participants estimated that links with the ambulatory rehabilitation services had never been adequately established and that they were to navigate these resources independently.
Regarding the fight against residual deficits, the participants talked about their desire to regain their basic functioning: "My objective is to return to normal" (participant A9). The fight against the inability to find the previous levels of operation was painful: "When someone removes you which is normal ... you must fight to return to normal" (participant A5). Although she accepted the idea of a new “normality”, the participant A3 described the difficulty of adapting to her new state, for example by facing memory problems and acclimating to new tolerable social stimulation thresholds.
Discussion
To our knowledge, this study is the first to examine the symptoms of anxiety and depression in patients with low grade meningiomas (Grade I or II of WHO) using a mixed method.
Our study has collected quantitative data to assess the prevalence of light and clinically relevant symptoms of depression and anxiety and supplemented it with rich qualitative data from semi-structured interviews, allowing complete analysis of the mental health of patients.
Our results show that patients with low -grade meningiomas encounter many difficulties similar to those with high -grade tumors, especially in the short term; Thus, they can share similar needs and suffer from similar psychological and psychiatric morbidity.
Prevalence and intensity of anxiety and depression
The prevalence of anxiety within the cohort was 40 % (n = 12). It is difficult to compare the punctual prevalence to the prevalence on the whole life or annual, parameters often cited in the literature; However, our results suggest a prevalence of higher depression and/or anxiety than that of the general Canadian population, including the prevalence of generalized anxiety and/or major depression varies between 9.4 % and 11.3 %. If we break down the results in anxiety and depression, we have observed a prevalence of 40 % (n = 12) for anxiety and 6.67 % (n = 2) for depression.
Anxiety analysis in the patient cohort
We found that 50 % (n = 8) and 28.6 % (n = 4) of the participants of the WW subgroups and surgery, respectively, had moderate/high hads anxiety scores (> 7). These values are much higher than the annual and life prevalence of generalized anxiety in Canada , which, according to the health survey in Canadian Mental Health Communities (ESCC-SM, Statistics Canada Canadian Community Health Survey On Mental Health ), are 2.6 % and 8.7 % respectively.
This result confirms what others have shown: despite their benign nature, meningiomas are associated with significant psychiatric comorbidity, in particular symptoms of anxiety. The prevalence of anxiety in our cohort is also comparable to the levels described in cohorts of patients with malignant tumors. However, studies that have compared the difference in prevalence of anxiety over time between patients with malignant and benign brain tumors have shown that, among patients with meningiomas, anxiety rates decrease and normalize within 5 years. Overall, our results comply with the literature and describe anxiety rates similar to those from which patients with malignant brain tumors suffer at the time of the initial diagnosis.
It is interesting to note that there was no significant difference in the average anxiety scores between the surgery and WW subgroups.
This result could suggest three important points:
- (1) In patients with slow growth tumors, curative treatment may not be the determining factor in improving mental and emotional well-being;
- (2) The advantages of curative surgery on anxiety can be counterbalanced by the harmful effects of postoperative recovery, healing and residual deficits;
- and (3) The approach of vigilant waiting can be associated with significant stress and psychiatric comorbidity over time, although it is only implemented for cases with a favorable prognosis.
Depression analysis in the cohort of patients
The prevalence of depression in surgery and WW subgroups was 7.14 % (n = 1) and 6.25 % (n = 1), respectively. These results indicate a burden of potentially higher depression in patients with low -grade meningiomas than in the general Canadian population, where the annual prevalence of depressive episodes was determined at around 5 %. Our results are in line with the previous data published by Goebel and Mehdorn, which described a prevalence of depression of 8 % in their cohort of patients with meningiomas.
Although there is a consensus on the fact that depression rates are higher in patients with intracranial tumors than in the general population - up to 38% - data comparing the differences between the grades of tumors are less uniform. Pringle et al found that patients with meningiomas had higher depression scores than patients with high grade tumors ; Conversely, several studies have shown the opposite. These inconsistencies can reflect the effect of time on the mental health of patients throughout their treatment. It may be a peak in the rate of depressive symptoms in patients with meningiomas around the time of diagnosis, in preoperative and perioperative , as reported by Bommakanti et al and Simoca et al. This peak of symptoms was followed by an improvement in depression scores after the operation. This contrasts with the results discussed by D'Angelo et al and Litofsky et al, which have demonstrated an increase in the prevalence of depression over time in patients with high grade tumors.
Our results are in accordance with other studies demonstrating stable depression over time in patients with meningioma. In addition, our analysis has not revealed any significant difference in the prevalence of depression or average depression scores by comparing surgery and ww subgroups. Our results suggest that in patients with meningioma, symptoms of depression are not only caused by the simple presence of the tumor, and that struggles during convalescence and management of persistent symptoms after surgery can hide any benefit of healing on depression rates.
Themes emerging from interviews with patients
Positive impacts on the well-being of patients
In our study, the factors that tend to contribute to a positive experience for the patient and his mental well-being are personal resilience and strong social support. This is not surprising, because resilience plays an important role in restoring the physical and emotional well-being of cancer patients and is associated with the adoption of adaptation strategies that improve quality of life. Social support is an important factor of resilience, and there is substantial evidence that it is essential to maintaining physical and psychological health. The participants interviewed expressed immense gratitude for the emotional support of their friends and family. Nevertheless, they indicated that there was sometimes a lack of understanding or empathy on the part of these figures of support, which suggests a role for peer support. Participants said it would be useful to speak to other people who have had similar experiences. Previous studies have shown that the feeling of camaraderie and kinship that develops thanks to the intervention of peer support increases hope, reduces loneliness and encourages a positive change in perspective and values.
Negative impacts on the well-being of patients
The uncertainty, the lack of support for the health system and the management of difficulties during convalescence had a negative impact on the well-being of patients. Uncertainty has been demonstrated that the quality of life related to patients with high -grade brain tumors are harmed; Our study confirms the conclusion that uncertainty is also an important factor in stress and anxiety in patients with benign tumors. All patients also reported an adaptation period to physical and cognitive deficits. Acceptance of “new normality” was associated with better self-evaluated mental health. Recognition of having overcome a decisive event in life, such as the diagnosis of meningioma, significantly improves self -perception and decreases anxiety; However, prolonged deficits can hinder this perception of strength and resilience.
Impact of time on well-being
Time is a primordial factor that plays a dynamic role in patient experience. More relevantly, the time that has passed since the diagnosis has been an important factor for the well-being of patients. Although the quantitative results have not revealed a significant difference in HADS scores according to the time elapsed since the diagnosis, those questioned said they lived an initial recovery period which was both physically and emotionally difficult. Previous reports have shown that objective anxiety measures decrease over time in patients with meningioma who have undergone resection, which was reflected in our interviews.
Implications for clinical practice and health systems planning
Several suggestions for improving future clinical practice and health systems planning can be deducted from the results of this study.
First of all, peer support should be offered to patients from the start of the diagnosis . Binding individuals with established programs would be beneficial in the patient level and could be instituted practically in terms of systems, rather than establishing small -scale supports specific to each hospital. Participants indicated that this support would be most useful at the start of the diagnosis, but that it would probably be so useful for promoting optimism and overcoming difficulties during recovery.
In addition, doctors should focus on individual care and subsequent adaptation of resources . The creation and dissemination of resources in a simple and suitable language should also be an objective. In the future, well -established parameters, already used by many cancer treatment centers, such as the hospital anxiety and depression scale, could be integrated into the care plans. Rehabilitation services being essential to recovery, access to these resources, in particular within the framework of external consultations, should be guaranteed to all patients who need them.
Finally, despite the absence of prolonged anxiety or clinical depression, we have found that patients often experience a period of emotional difficulty for several months after resection, and patients should be informed of this possibility.
Boundaries
Our study was a retrospective analysis with a small sample, which prevents the generalization of results and can influence the evaluation of the measures of the study results. In addition, the study was carried out in a single center with patients under the care of a single surgeon. Patient experience may be different in other centers and therefore have an impact on the accuracy of our results. In addition, HADS scores were collected at one point in patient follow -up, rather than several moments, which excludes the possibility of studying changes in mental health over time. In addition, only a subset of patients with brain tumors has been analyzed, without comparison with patients with higher grade tumors, or with healthy witnesses. Recruiting both high -grade groups of brain tumors and healthy witness groups would highlight specific conclusions for meningiomas. Finally, larger cohorts are essential to decipher the impact of the symptoms present, such as headaches and visual deficits, on mental health.
Conclusion
Overall, this study revealed that a significant proportion of patients with low -grade intracranial meningiomas have symptoms evocative of anxiety and/or depression.
The fact of undergoing surgery or continuing serial monitoring has had no impact on the prevalence or intensity of anxiety or depression in our cohort of patients.
The factors influencing mental well-being and mental distress in our cohort of patients included personal resilience, the element of uncertainty, in particular pending monitoring evaluations, the difficulty in adapting to residual symptoms or deficits, and the primordial effect of time has passed since the diagnosis or after the operation.
Future studies on larger cohorts should assess anxiety and depression in a longitudinal way at several times , using several parameters to assess the severity of the symptoms.
This will better characterize the psychiatric burden with which this population of patients is confronted and to better understand the relationship of time on their psychiatric symptoms.
Data availability and equipment
The data sets generated and/or analyzed during this study may be made available by the corresponding author on reasonable request.
Thanks
Not applicable.
Funding
GK was supported by Ontario Medical Student Association/Associated Medical Services Compassionate Care Medical Student Education Research Grant, a summer student allowance. The funder did not play any role in the design of the study, the collection, analysis and interpretation of data, nor in the preparation of the manuscript.
Author information
Affiliation
Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Graham Kasper
Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
Shannon Hart
Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
Nardin Samuel and Sunit Das
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
Nardin Samuel and Sunit Das
Personal -oriented care, Ontario Health (Ontario Cancer Action), Toronto, ON, Canada
Colleen Fox
Contributions
GK has contributed to conceptualization, methodology, formal analysis and investigation, preparing the original version, revision and publishing, as well as obtaining funding. SH contributed to the preparation of the original version, revision and publishing. NS has contributed to revision and publishing. Cf contributed to revision and publishing. SD has contributed to conceptualization, methodology, revision and publishing, as well as the supervision of the study. All the authors have read and approved the final manuscript.
Corresponding author
Correspondence with Sunit Das.
Ethical declarations
Ethical approval and consent to participation
The study was approved by the Unity Health Toronto Research Ethics Committee (study 18-120). The informed consent was obtained from all the participants in the study before the acquisition of the data. For participants recruited during remotely meetings/telephone, verbal consent was obtained, otherwise written consent was obtained from all other participants. This procedure was approved by the Ethics Committee.
Consent for publication
The informed consent of all participants in the study concerning future publication was obtained before the acquisition of data.
Competing interests
The authors declare that they have no competing interests.
Additional information
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Additional information
Additional file 1
Maintenance guide.
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