Factors associated with anxiety and depression in the management of acoustic neuroma patients

Abstract

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.

Introduction

Management options for acoustic neuromas include observation, or the active treatments of microsurgery or radiation.¹ Post-management psychological wellbeing is an important factor in evaluating the success of management options for an acoustic neuroma.² Two central aspects of psychological wellbeing are depression and anxiety,³ however, little is known about these outcomes in acoustic neuroma patients.⁴ It is therefore important to investigate anxiety and depression in this patient group, given that the individual symptoms associated with acoustic neuromas have been related to these outcomes in other patient groups.5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 For example, elevated levels of anxiety and/or depression have been found in patients with tinnitus,9, 10, 11, 12 hearing loss,8, 13, 14 facial paralysis,¹⁵ headaches,6, 7, 16 and dizziness and vertigo.5, 17 Given that most acoustic neuroma patients typically experience many of these physical symptoms before or after active management,¹⁸ it is likely that the burden of multiple impairments would increase the risk of anxiety and depression in this population. Depression is a particularly important construct to examine given anecdotal evidence from a number of treatment centres of increased rates of suicide among acoustic neuroma patients compared to the general population.⁴ Furthermore, in a recent focus group study among acoustic neuroma patients, an association was found between severe post-operative headaches, depression and suicidal ideation.¹⁹

Although there has been some research regarding post-management anxiety and depression among acoustic neuroma patients, in most studies non-validated measures have been used to assess these constructs.18, 20, 21, 22, 23, 24, 25, 26 In the few studies in which validated measures were used, only patients who had undergone microsurgery were included.27, 28 There appears to have been no study in which anxiety and depression were compared across microsurgery, radiation and observation.

To identify factors that may predict anxiety and depression in patients with an acoustic neuroma, it was hypothesised that these factors would be similar to those associated with psychological wellbeing in this patient group. Although the findings across studies are equivocal, a variety of demographic and medical factors have been associated with psychological wellbeing among acoustic neuroma patients including age²⁹; sex27, 29; management type21, 30, 31, 32, 33; time since active management³⁴; tumour size²²; and residual symptoms.24, 27, 31, [35], [36]

The current study had three aims:

• To describe levels of depression and anxiety among recently diagnosed, or treated, acoustic neuroma patients.

• To investigate differences in depression and anxiety by management type.

• To examine factors that might predict anxiety and depression, including age, sex, management type, time since active treatment (or diagnosis for observation patients), tumour size, and number of residual symptoms and comorbid conditions.