Socioeconomic disparities of depressive symptoms and cytokines in hepatocellular carcinoma.

OBJECTIVE: To examine the associations among socioeconomic factors, depressive symptoms, and cytokines in patients diagnosed with hepatocellular carcinoma (HCC). METHODS: A total of 266 patients diagnosed with HCC were administered a battery of questionnaires including a sociodemographic questionnaire and the Center for Epidemiologic StudiesDepression (CES-D) scale. Blood samples were collected to assess serum levels of cytokines using Luminex. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, linear regression, and Bonferroni corrections were performed to test the hypotheses. RESULTS: Of the 266 patients, 24% reported depressive symptoms in the clinical range (CES-D ≥ 22). Females had higher CES-D score than males (Mann-Whitney U = 7135, P = .014, Padj  = .028). Being unemployed/disabled (Kruskal-Wallis = 14.732, P = .001, Padj  = .005) was found to be associated with higher depressive symptoms in males but not in females. Serum level of IL-2 (Kruskal-Wallis = 17.261, P = .001, Padj  = .005) were found to be negatively associated with education level. Gender (ß = .177, P = .035), income (ß = -.252, P = .004), whether the patient's income met their basic needs (ß = .180, P = .035), and IL-1ß (ß = -.165, P = .045) independently predicted depressive symptoms and together explained 19.4% of variance associated with depressive symptoms. CONCLUSIONS: Sociodemographic and socioeconomic factors were predictive of inflammation and depressive symptoms. Recommendations include the development of gender-targeted interventions for patients diagnosed with HCC who have low socioeconomic status (SES) and may suffer from depressive symptoms.

Substance Use, Depression, and Illness Perception Among Cancer Patients.

Objectives: Research demonstrates a link between alcohol and tobacco use in the development of cancer, but limited research exists regarding substance use after a cancer diagnosis. In this study, we examine the rates of alcohol and tobacco use in advanced cancer patients, investigate the link between depression and tobacco and alcohol use pre- and post-diagnosis, and determine the relationship between illness perception and tobacco and alcohol use post-diagnosis.Methods: We performed a secondary data analysis on 2 prospective studies of patients with advanced gastrointestinal cancers. We administered a battery of questionnaires to assess substance use, depression, and illness perception. Results: Patients who reported tobacco use post-diagnosis had higher levels of depressive symptoms when compared to patients with a history of tobacco use or no alcohol or tobacco use (Kruskal-Wallis = 25.77, p < .0125). Patients who reported being more emotionally affected by their illness reported greater tobacco use (Mann-Whitney U = 17, 284.5, p < .003). Conclusions: Tobacco use post-diagnosis was associated with higher levels of depression.