Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms.

OBJECTIVES: The aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms. MATERIALS AND METHODS: Patients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64 %), moderate (n = 52; 28 %), and severe (n = 15; 8 %) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms. RESULTS: Patients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms. CONCLUSIONS: Depressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.

Emotion dysregulation in multiple sclerosis: Impact on symptoms of depression and anxiety.

BACKGROUND: There is consistent evidence for higher prevalence of affective disorders, specifically mood and anxiety disorders, in people with MS (PwMS). PURPOSE: The goal of this study was to examine the role of emotion dysregulation in explaining symptoms of depression and anxiety in PwMS. METHODS: Data from 100 PwMS and 98 community controls (CC) were analyzed. Participants completed survey measures assessing symptoms of depression and anxiety, difficulties in emotion regulation, general and health-related quality of life, and use of emotion regulation strategies during emotionally evocative situations in the previous two weeks. RESULTS: PwMS had higher scores on depression, endorsed greater difficulty regulating emotions, and reported lower health-related quality of life compared with CC. Higher scores on both measures of depression and anxiety were associated with difficulties in emotion regulation and greater use of maladaptive emotion regulation strategies. Additionally, emotion dysregulation - quantified via use of maladaptive strategies and difficulties in regulating emotions - mediated the effect of MS on symptoms of depression. CONCLUSIONS: Emotion dysregulation is associated with symptoms of depression and anxiety in PwMS. Given the malleability of this construct, this study underscores the importance of further investigating emotion dysregulation, and possibly adopting it as a surrogate endpoint in interventions targeting affective disorders in PwMS.