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Psychological distress among cancer patients in African countries: a systematic review and meta-analysis study

BMC Psychology volume 13, Article number: 128 (2025) Cite this article

A Correction to this article was published on 13 March 2025

This article has been updated

Abstract

Background

Cancer is a disease causing abnormal cell proliferation, and can cause stress, anxiety, and emotional reactions in patients. Despite studies in Africa showing psychological distress in cancer patients, a systematic review on this topic has not yet been conducted.

Methods

To find papers, searches were conducted using PubMed, Scopus, Cochrane Library, Science Direct, African Journal Online, and Google Scholar. This systematic review and meta-analysis encompassed fifteen primary articles from seven African countries that underwent assessment and inclusion. A Microsoft Excel spreadsheet was used to extract the data, which were then transferred to STATA version 14 for analysis. The statistical heterogeneity was evaluated by using Cochran’s Q and I2 statistics. Egger regression tests and funnel plot analysis were employed to look for publication bias. A sensitivity analysis and a subgroup analysis were performed.

Result

This systematic review and meta-analysis comprised a total of 1567 research participants from 15 different investigations. In Africa, 42.83% of cancer patients overall had a pooled prevalence of psychological distress (95% CI: 19.40, 66.27). Being a rural area (AOR = 2.30; 95% CI: 1.49 to 3.55), having no social support (AOR = 4.63; 95% CI: 2.18 to 9.86), being in stage II cancer (AOR = 2.72; 95% CI: 1.38 to 5.38), having a co-occurring chronic illness (AOR = 2.78; 95% CI: 1.34, 5.74), experiencing financial difficulties (AOR = 16.52; 3.56, 76.63), and experiencing difficult emotional life (AOR = 2.53; 1.07, 5.97) were associated with psychological distress.

Conclusion

This study shows that there is a high prevalence of psychological distress among cancer patients in Africa. We have also found a significant relationship between psychological distress and rural living, a lack of social support, an advanced stage of the disease, coexisting medical conditions, financial problems, and emotional difficulties. Early detection to lessen psychological discomfort in this susceptible population is essential to reduce the burden of psychological distress among cancer patients.

Peer Review reports

Introduction

Cancer is a disease in which aberrant cells proliferate and develop out of control, encroaching on surrounding tissues and eventually traveling to other parts of the body via blood vessels and lymphatic systems, impairing the normal cells’ ability to function [1, 2]. The world population is growing and aging, and smoking and other cancer-causing behaviors are becoming more common in developing nations. These factors together account for a major portion of the rising global cancer burden [3]. Cancer is a major global public health issue that is imposing an increasing burden every day [4].

Cancer is a major public health concern and the leading cause of mortality worldwide, accounting for one-sixth of all fatalities [5]. The World Health Organization estimates that the occurrence of cancer will increase exponentially by the year 2030, with the annual number of new cases rising from 14.1 million in 2012 to 21.6 million in 2030 and deaths due to cancer rising from 8.8 million worldwide in 2015 to more than 12 million in 2030 [6]. Receiving a cancer diagnosis can cause patients to experience a great deal of stress and anxiety. It can also cause emotional reactions, including pessimism, worthlessness, remorse, anger, despair, and melancholy [7].

Distress can take many different forms, from everyday worries, concerns, and melancholy to incapacitating issues like clinical depression, panic attacks, isolated feelings, or existential or spiritual crises [8]. Distress symptoms and mental health issues lead to maladaptive coping mechanisms and aberrant sick behavior [9]. Psychological distress and psychosocial issues resulting from a cancer diagnosis or progression can manifest as distressing emotional or psychological experiences, such as sadness, anxiety, delirium, adjustment disorders, and other mood disorders [10,11,12,13,14]. Because of its rising occurrence, cancer is a serious public health issue that affects people all over the world and significantly impairs their psychological well-being [9, 15]. Several issues, including physical limitations, weariness, discomfort, anxiety, fear, treatment options, transportation difficulties, role changes, and unsatisfactory social support, can contribute to psychosocial distress in cancer patients [16].

Cancer patients are more likely than the general population to experience psychological discomfort from the time of diagnosis through the long-term effects of the disease’s post-treatment phase. Higher mortality, a decreased quality of life and decreased daily activities, poorer treatment compliance and efficacy, and a higher likelihood of suicidal thoughts are all associated with psychological distress. In the first year of cancer, treating the symptoms of anxiety and sadness can therefore help these individuals live better. Anxiety and despair can also be exacerbated by the outward signs of certain tumors [17,18,19,20].

Diagnoses of psychological issues are becoming more common, and 97.5% of cancer patients who seek mental health treatment do so because of this [21, 22]. Numerous studies have demonstrated that significant variables are connected to cancer patients’ psychological distress levels. These are sometimes grouped into a various of demographic, socioeconomic, and informational elements in addition to psychological, physical, and therapy considerations [23, 24]. The rates of anxiety and depression also vary depending on the kind of cancer, the clinical context (hospitals, outpatient clinics, and palliative care), the stage of the disease (early diagnosis, recurrence, and advanced stages), and the treatment phase [25, 26].

Previous research on cancer patients in African countries has yielded inconsistent findings about their anxiety and despair levels. Consequently, gaining knowledge about the effects of psychological distress on cancer patients in African countries can help increase awareness, advance healthcare policies for cancer patients, and enable more effective use of the limited resources in African countries. As a result, the information on the prevalence of psychological and emotional discomfort (especially anxiety and depression) among cancer patients in African countries was summarized in the current review.

Research questions

What is a pooled prevalence of psychological distress among cancer patients?

What are the pooled associated factors of psychological distress among cancer patients?

Methods

The present review was carried out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) criteria for carrying out and disclosing systematic reviews [27]. PRISMA is primarily concerned with reporting reviews that estimate the effects of interventions. It can be used as the foundation for publishing systematic reviews that don’t evaluate interventions.

Search strategy

A systemic review and meta-analysis were carried out using research studies that revealed the prevalence of psychological distress among cancer patients living with cancer. The databases Scopus, African-Wider, PsycINFO, EMBASE, Google Scholar, Psychiatry Online, World Health Organization (WHO) reports, and PubMed/MEDLINE were used to search for research articles. References were retrieved from a list of studies that met the eligibility requirements. Each database has a customized search technique that combines controlled vocabulary (i.e., caregiver words) with free texts. Google Scholar and ProQuest Dissertations & Thesis Global were used to search for unpublished studies.

Combinations of the following keywords were used for study publications in the English language: “prevalence” OR “magnitude” OR burden”, OR “epidemiology” OR “proportion” OR “incident.” In addition, there are other references to “psychological distress,” “distress symptoms OR psychological distress AND “cancer patients,” and “Africa”. Through email communication with the relevant authors, we attempted to get the primary or correspondence author to provide any missing information after the data had been retrieved from the papers. Additionally, the included studies’ reference list was discussed, and studies based on the study era were not specifically specified. Once the eligibility of the studies had been determined, predefined eligibility assessment criteria were used to include them in the meta-analysis.

Eligibility criteria

Inclusion criteria

Articles were included if they met two requirements: they evaluated the result of interest in cancer patients, and the main outcome of interest would be the prevalence of psychological distress and/or associated factors. The study was designed as a cross-sectional, case-control, and cohort study centered in a community or institution. All primary articles conducted in African countries and available online before January 30, 2024, were included.

Exclusion criteria

Previous research reviews, studies on cancer patients who have a known mental health issue, animal studies, editorials, and studies that only describe psychological distress in paid cancer patients were disqualified. Additionally, studies whose complete data were unavailable even upon the authors’ request were not included.

Data extraction

By employing a defined data extraction format, GK, YAW, and MK were able to separately extract all relevant data from the articles. The included primary studies were extracted from January 01, 2024 to January 30, 2024. A screening tool to assess psychological distress, the prevalence of psychological distress, measures of effect (odds ratio (OR)), confounding variables, and possible associated factors are all included in the data extraction format. The first author’s name, publication year, the region the study was conducted in, number of participants, types of tools used to measure psychological distress, and other information were also included. A table divided into two rows was the format used for the data extraction. After the searches, SF and GN were cross-checked with each other.

When two authors have divergent opinions during the data extraction process, they talk it over until they agree, at which point they double-examine the data with other authors. When comparing the observed and expected agreements across writers, either randomly or solely by chance, we used kappa statistics to illustrate the differences. We performed sensitivity analysis to determine the reliability of the meta-analytic results.

Outcome measurements

This review aims to ascertain the pooled prevalence and associated factors of psychological distress among cancer patients in Africa and to estimate the pooled effects of associated factors on psychological distress among cancer patients in Africa. STATA version 14.0 was utilized to calculate the pooled prevalence of psychological distress.

Quality assessment

For cross-sectional studies, the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the research papers included in this review. The compatibility of the included studies, the methodological quality of the study, and the original article quality in terms of statistical analysis are the components that comprise this quality assessment tool. The original research’s quality was assessed by each author separately using NOS. The instrument yields a total score of 10, and the articles that score 6 or higher on the quality scale were considered medium- and high-quality articles for consideration in this study. If there were disagreements among the authors on the included studies’ quality evaluation, they were resolved by averaging them all.

Statistical procedure

STATA 14.0 was used for analysis after the data had been extracted and opened in Microsoft Excel. Using texts, tables, and forest plots, the features of the primary studies were displayed. We used the binomial distribution to examine the standard error of prevalence and associated factors for each primary or original study. We applied a heterogeneity Q test and an I2 test to assess the prevalence and associated factors of the original research on heterogeneity. Der Simonian and Laird’s pooled effect of psychological distress was estimated using a random-effects meta-analysis approach. In addition, we performed a leave-one-out sensitivity analysis to determine the potential cause of heterogeneity in the pooled meta-analysis of African cancer patients’ prevalence and associated factors of psychological distress. By using Egger’s correlation and Begg’s regression intercept tests at a 5% significant level, respectively, publication bias was examined (x, y). If our analysis reveals publication bias, we formalize the use of funnel plots, estimate the number and outcome of missing studies, and account for hypothetically absent studies using the non-parametric “trim and fill” approach developed by Duval and Tweedie (2000) To find out how a given group’s characteristics affect the prediction of the pooled prevalence and associated factors of psychological distress, subgroup analysis was carried out. To see how removing a single study result from the analysis affects the anticipated pooled prevalence and associated factors of psychological distress and its conclusion, we conducted a leave-one-out sensitivity analysis. If we found evidence of heterogeneity during the analysis, we used the sensitivity analysis outcome to pinpoint its potential cause.

Results

Search results

1567 Studies were found for this study by using a variety of electronic search techniques, such as Scopus, African-wider, PsycINFO, EMBASE, Google Scholar, Psychiatry Online, World Health Organization (WHO) reports, PubMed/MEDLINE and African Journal Online. 656 of these studies were eliminated due to redundancy. Additionally, 632 studies were disregarded after we examined their abstracts and titles because their full texts were unavailable, they weren’t done in Africa, their study demographics and locations differed, and they weren’t relevant to our review. Nine investigations were eliminated for different reasons after an additional 24 full-text papers were evaluated for eligibility based on the inclusion criteria. Ultimately, this systematic review and meta-analysis contained 15 studies that matched the eligibility criteria (Fig. 1).

Fig. 1
figure 1

Shows flow charts to describe the selection of studies for the systematic review and meta-analysis on the prevalence of psychological distress among cancer patients in Africa

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Characteristics of included studies

Fifteen primary researches on the prevalence of psychological distress and the factors that are linked to it among patients with cancer in Africa were included in the current systematic review and meta-analysis. Of those studies, five studies were conducted from April 2015 to May 2023 while the study time was not disclosed in ten studies and published between 2013 and 2022.All the studies included in this investigation were a cross-sectional study design and five African countries were included. Three article were conducted in morocco [28,29,30] two in Ethiopia [11, 31] four in Egypt [32,33,34,35] three in Nigeria. The rest of the three articles were conducted in Sudan, Kenya, and Tanzania [36,37,38]. A total of 4046 study respondents participated, with sample sizes ranging from 91 in Nigeria to 605 in Ethiopia. Regarding measurement tools, seven studies investigated the Distress thermometer (DT) including three studies in Egypt and one each in Ethiopia, Nigeria, Morocco, and Kenya. Four studies used the Hospital Anxiety and Depression Scale (HADS), two of which were in Morocco and the other two in Tanzania and Sudan. The remaining four studies were carried out using modified psychological distress scale in Nigeria, the Depression anxiety distress stress scale 21 in Egypt, the Questionnaire on Stress in Cancer Patients Revised 10 (QSC-10) in Ethiopia and the General Health Questionnaire-12 item version (GHQ-12) in Nigeria. All original studies included in the current review were completed using a cross-sectional study design. As stated in the included studies, psychological distress in Sudan Cancer Institute, 25.5%, and Nigeria Cancer Center, 76%, had the minimum and maximum magnitude of psychological distress of patients with cancer in Africa respectively (Table 1).

Table 1 Characteristics of studies included in this systematic review and meta-analysis on psychological distress among patients with cancer in Africa
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The pooled prevalence of psychological distress among cancer patients in Africa

In order to determine the pooled prevalence of psychological distress among cancer patients, 15 published publications were included in this systematic review and meta-analysis. The pooled prevalence of psychological distress among cancer patients in seven African countries was found to be 42.83% with a 95% CI (19.40, 66.27) (Fig. 2).

Fig. 2
figure 2

Forest plot showing the pooled prevalence of psychological distress among cancer patients in Africa

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Heterogeneity and publication biases

The included papers in the current systematic review and meta-analysis had heterogeneity, as shown by the test statistics (I2 = 97.2%, p-value < 0.001). To determine whether there was publication bias in the included papers, two methods were employed. A funnel plot, which was used to verify the first, demonstrated the symmetric distribution and lack of publication bias in the included papers (Fig. 3). Additionally, p = 0.447 (Table 2) indicates that the Eggers test was used to verify that there was no publication bias.

Fig. 3
figure 3

A funnel plot test of psychological distress among cancer patients

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Table 2 Egger’s test of psychological distress among patients with cancer in Africa
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Subgroup analysis

A subgroup analysis was carried out to pinpoint the potential cause of the heterogeneity. The results of the subgroup analysis are shown in (Table 3). This review found that there were differences in the prevalence of psychological distress depending on the population of the study participants. The pooled prevalence of psychological distress in patients with cancer was different in the study population. The subgroup analysis showed that the pooled prevalence of psychological distress in the studies that were 56.61 (95.7% CI: 47.49, 65.72) was higher than those breast cancers at 56.37 (97.2%CI: 47.59, 65.15).

Table 3 Subgroup analysis of depression among primary caregivers of patients with cancer in Africa
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Sensitivity analysis

To ascertain the impact of each study’s findings on the pooled prevalence of psychological distress of patients with cancer, sensitivity analysis was performed in the current systematic review and meta-analysis to investigate the heterogeneity of those studies by methodically eliminating one author or one study. It can be inferred from the results that the omission of one study did not substantially change the prevalence of this review because all of the numbers fall within the predicted 95% CI (Table 4).

Table 4 Sensitivity analysis of depression among primary caregivers of patients with cancer in Africa
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Associated factors of psychological distress among cancer patients

Many factors have been linked to psychological distress in cancer patients, according to the primary studies we included; nevertheless, we have taken into account those findings from multiple studies. Among cancer patients, factors that have been repeatedly reported and linked to psychological distress include living in a rural area, receiving little social support, being in stage two of the disease, having a co-occurring chronic illness, having financial difficulties, and having comorbid chronic illnesses. Their equivalents were 2.30 times more likely to feel psychological distress, according to the meta-analysis’s result (AOR = 2.30; 95% CI: 1.49 to 3.55). According to the pooled odds ratio (AOR), patients with low social support had odds of psychological distress that were 4.63 times (AOR = 4.63; 95% CI: 2.18 to 9.86) higher than those of their peers. Compared to their counterparts, individuals with stage two cancer (AOR = 2.72; 95% CI: 1.38 to 5.38) experienced psychological discomfort almost twice as frequently. According to the current meta-analysis, patients with concomitant chronic illnesses were 2.78 (AOR = 2.78; 95% CI: 1.34, 5.74) times more likely than those without them to experience psychological discomfort. Comparatively speaking, individuals who were having financial difficulties had an almost 16.5-fold higher likelihood of psychological discomfort (AOR = 16.52; 3.56, 76.63). Additionally, the current meta-analysis demonstrates that those experiencing psychological distress were 2.5 times (AOR = 2.53; 1.07, 5.97) more likely than those without the experience psychological distress to have encountered a challenging emotional life (Fig. 4).

Fig. 4
figure 4

The forest plot shows associated factors of psychological distress among cancer patients in Africa

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Discussion

Cancer is a disease in which certain body cells grow uncontrollably and invade other parts of the body. An individual’s initial response to a cancer diagnosis can trigger psychological distress, which may persist throughout the various stages of the disease. Psychological distress is also influenced by personality traits such as neuroticism, extraversion, conscientiousness, and agreeableness, with higher levels of neuroticism linked to greater distress, while coping mechanisms and resilience can help mitigate its impact [39]. This study aimed to determine the frequency of psychological distress and identify the risk factors associated with it among African cancer patients. The prevalence of psychological distress varies across different countries and studies. Through a systematic review and meta-analysis of 15 studies, this research sought to estimate the pooled prevalence and explore the factors contributing to psychological distress in cancer patients from seven African countries.

In this meta-analysis and systematic review, the pooled prevalence of psychological distress among cancer patients was found to be 42.83% with a 95% CI (19.40, 66.27). This result is in line with findings from other studies. A meta-analysis and systematic review conducted to find the worldwide prevalence rate of psychological distress among cancer patients yielded a result of 29% [40], breast cancer in China (52.0%) [41], and adult cancer patients in Japan 55.3% [42].

Conversely, the present investigation yielded significantly greater results compared to a study conducted during a different period. For instance, among American cancer patients who are adolescents and young adults, the prevalence of psychological distress among cancer patients was found to be 12% [43]. The prevalence of psychological distress among cancer patients in the Philippines is 46% [44]. The higher prevalence of psychological distress among cancer patients in Africa is due to cultural differences, late diagnosis, limited treatment options, socioeconomic factors, stigma, and limited access to mental health services. These factors, along with social and economic issues like unemployment and poverty, contribute to the psychological distress experienced by cancer patients. Cultural variations in coping strategies may also play a role in these issues [45,46,47,48].

However, the current finding is lower than a multinational cross-sectional study involving cancer patients. In Iran, 173 (67.7%) of the 256 cancer patients had psychological distress, as determined by the distress thermometer [16]. This discrepancy might be due to sociocultural disparities. Strong family and community support networks are common in African countries, which may lessen the psychological suffering that cancer patients endure. The focus on kinship ties and community support may act as a protective barrier against the hopelessness and loneliness that are frequently linked to cancer diagnoses. African cultures have a strong emphasis on spirituality and perseverance, which can be helpful coping strategies for cancer patients who are experiencing psychological difficulties. Strong religious convictions and practices may bring solace and hope, which helps people feel less distressed. Also, although financial limitations may appear to prevent some African nations from having full access to mental health care, community-based support networks, traditional healers, and religious leaders frequently play important roles in offering emotional support and direction [49, 50].

About the variables influencing psychological distress in cancer patients, two of the included studies in this meta-analysis study revealed that cancer patients living in rural areas were more likely than those living in urban areas to have psychological discomfort. This meta-analysis’s combined findings showed that cancer patients living in rural areas were 2.30 times more likely than their counterparts to experience psychological discomfort. This could be because living in a rural area can make cancer patients feel more psychologically distressed because of things like financial hardship, limited access to care, and other difficulties that rural populations confront [51,52,53].

According to two of the included studies in this meta-analysis, cancer patients who experience a lack of social support are more likely than those who have strong social support to have psychological discomfort. According to the meta-analysis’s pooled results, those with low social support are 4.63 times more likely than their peers to experience psychological discomfort. The reason might be cancer patients often lack strong social support networks, leading to emotional discomfort and feeling overwhelmed during difficult times. These networks provide comfort, financial assistance, and practical assistance, which can alleviate stress and foster a sense of belonging. However, feeling excluded or alienated can make it difficult for cancer patients to cope with their illness and emotions [54, 55].

The other factors affecting psychological distress among cancer patients in three of the included studies in this meta-analysis study disclosed that cancer patients who had comorbid medical illnesses were more likely to have psychological distress as compared to those having comorbid medical illnesses. The pooled result of this meta-analysis indicated that those having comorbid medical illness were about 2.78 times more likely to have psychological distress as compared to their counterparts. The reason might be growing illness cancer patients may experience physical and mental exhaustion from the burden of treating many medical issues at once. In addition to the additional burden of coexisting conditions, anxiety, despair, and a lack of social support may worsen feelings of hopelessness and concern regarding the prognosis and results of treatment. Mobility impediments, transportation restrictions, and caregiver responsibilities are some of the extra obstacles that cancer patients with concomitant medical diseases may have while trying to access social support networks. For patients managing several health issues, social isolation and a lack of peer support can make them feel even more depressed, lonely, and distressed [56, 57].

Also, two of the reviewed studies showed that people with cancer who were in stage two of the disease were more likely to have psychological distress than those who were less in stage two. The meta-analysis’s combined results showed that, in comparison to their contemporaries, stage two cancer patients had a 2.72-fold increased risk of psychological distress. The reason might be stage II cancer is classified as an intermediate stage of the disease, meaning that although the cancer has progressed from its original location, it may not have reached advanced stages. Patients’ worry, fear of the disease worsening, and discomfort may increase as a result of this prognostic uncertainty. Cancer diagnoses, regardless of stage, can have a profound emotional impact and drastically change a patient’s life. As they come to terms with their diagnosis and its implications for the future, patients with stage II cancer may suffer a range of emotional emotions, such as shock, denial, anger, and despair [58,59,60].

Furthermore, two of the studies included in this meta-analysis found that cancer patients with financial problems had higher odds of psychological discomfort than cancer patients without financial problems. Patients with financial problems had a 16.51-fold higher risk of psychological distress compared to their peers, according to the overall results of the meta-analysis. The reason might be that for patients, the hefty cost of cancer treatment, which includes medical bills, prescription drugs, and supportive care can be a major financial hardship. Managing these costs in addition to possible income loss from disability or work disruptions associated with treatment can cause anxiety and stress, which exacerbates psychological suffering [61,62,63]. Additionally, in two of the studies in this meta-analysis, cancer patients who experienced emotional difficulties in their lives were more likely to experience psychological pain than cancer patients without emotional difficulties. The total results of the meta-analysis showed that patients who experienced tough emotional times were 2.53 times more likely than their counterparts to have psychological discomfort. The reason might be that a cancer diagnosis can set off a chain reaction of challenging emotions, including fear, anxiety, despair, anger, and uncertainty. Adapting to the emotional repercussions of cancer, such as mortality, side effects from therapy, and lifestyle changes, can be extremely taxing and may lead to psychological anguish. And people differ in their capacity to manage challenging emotions. Adaptive coping methods can help reduce psychological discomfort. Some cancer patients may use these tactics, such as seeking social support, practicing mindfulness, and participating in self-care activities. On the other hand, some people could employ unhealthy coping strategies like substance abuse, denial, or avoidance, which can worsen emotional pain [64, 65].

Limitations of the study

This meta-analysis and systematic review provide valuable insights into the impact of psychological distress in cancer patients but also have several limitations. The cross-sectional study design used in the included research shows only a correlation, not a cause-and-effect relationship. Additionally, the heterogeneity of the primary studies may have contributed to variability in the results. The limited number of studies included also restricts the generalizability of the findings. Furthermore, the focus on pooled prevalence rates makes it difficult to compare the results with more specific or single-finding studies. Another key limitation is the lack of consideration for the role of personality traits, such as neuroticism, extraversion, and conscientiousness, which could influence how patients experience and cope with distress. Future research should include personality assessments to better understand the complex relationship between psychological distress and individual differences in cancer patients.

Conclusion and recommendation

Based on the study’s findings, it is clear that psychological distress is a worryingly common occurrence among cancer patients in Africa. We have also found a significant relationship between psychological distress and rural living, a lack of social support, an advanced stage of the disease, coexisting medical conditions, financial problems, and emotional difficulties. These elements highlight the critical requirement of comprehensive intervention measures and early detection to lessen psychological discomfort in this susceptible population. For cancer patients in Africa, putting in place efficient support networks and focused interventions may help lessen the effects of psychological distress and enhance their general quality of life. A crucial but frequently disregarded component of cancer care, psychological discomfort can have a big influence on treatment results and quality of life. Health care systems may guarantee that cancer patients receive the all-encompassing care they require to manage their physical and mental health by implementing these guidelines at the policy and clinical practice levels.

Data availability

No datasets were generated or analysed during the current study.

Change history

Abbreviations

DT:

Distress Thermometer

QSC-10:

Questionnaire on Distress in Cancer Patients

HADS + ADNM-6:

Hospital Anxiety and Depression Scale and Adjustment Disorder–New Module

GHQ:

General health questioners

DASS-21:

Depression Anxiety Stress Scales– 21

HADS:

Hospital Anxiety Depression Scale

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Acknowledgements

The investigators are heartfelt thanks to the authors of the included primary articles as they helped as the groundwork for this systematic review and meta-analysis.

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The authors were not funded for this work.

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Authors and Affiliations

  1. Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia

    Getasew Kibralew, Mulualem Kelebie, Gidey Rtbey, Gebresilassie Tadesse, Mamaru Melkam, Fantahun Andualem, Techilo Tinsae, Setegn Fentahun & Girum Nakie

  2. Department of Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia

    Yilkal Abebaw Wassie

  3. Department of Nursing, College of Medicine and Health Science, Hawassa University, Awasa, Ethiopia

    Aklile Tsega

  4. Department of Medical Parasitology, School of Biomedical and Laboratory Science, University of Gondar, Gondar, Ethiopia

    Abebaw Setegn

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  1. Getasew Kibralew
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Contributions

GK Conceptualized the study, conceived the idea and design for the work as well as was involved in the search strategy, extraction of data, analysis, and review of the article, interpretation, report, and manuscript writing. YAW, MK, and GR were involved in the data extraction. GT, MM, AT, FA, AS, TT, SF, and GN made substantial contributions to the quality assessment of the included studies and the drafting of the manuscript. All authors contributed to the article and approved the submitted version.

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Correspondence to Getasew Kibralew.

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Kibralew, G., Wassie, Y.A., Kelebie, M. et al. Psychological distress among cancer patients in African countries: a systematic review and meta-analysis study. BMC Psychol 13, 128 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40359-025-02447-z

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Keywords

BMC Psychology

ISSN: 2050-7283

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