Comparison of Depressive Symptoms among Women with Gynecological Cancer and other Cancer Types Before and during the COVID-19 Pandemic

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Abstract
Objective: Cancer patients are at a high risk of exhibiting depressive symptoms. However, what remains unknown is whether gynecological cancer (GC) worsens this risk. This study seeks to compare depressive symptoms amongst women diagnosed with GC and women diagnosed with other cancer types before COVID-19 pandemic and during the COVID-19 pandemic. It also seeks to compare both study periods to confirm if COVID-19 influenced depressive symptoms of women with GC. Methods: A retrospective cross-sectional study was conducted to find an association between depressive symptoms and gynecological cancers using other cancer type diagnosis in females as a reference. We utilized the sample adult file of NHIS (National Health Interview Survey) data from 2019 (Pre-Pandemic data) and data from 2020 (Pandemic data). We also utilized the PHQ-8 scale to quantify major depressive disorder. Each of the 8 items were scored from 0-3. All statistical analysis were performed using SAS v9.4 ((SAS Institute Inc, Cary, NC), and statistical significance was set at α = 0.05. Results: A weighted population of women with GC vs other cancer types was obtained. Women with GC tend to have lesser Age, Educational status, Health status, Income. They also tend to be more obese and smokers. Women with GC tend to have had hysterectomy (68.03% vs 35.43%) and access to care during COVID-19 (71.63% vs 68.01%). Severe depressive symptoms were higher before pandemic and among women with GC OR 2.89 (95%CI 1.64 - 5.12). Moderate depressive symptoms were higher during the pandemic and among women with GC OR 2.19 (95%CI 1.35 – 3.57). Among women with GC, depressive symptoms were less likely in 2020 than 2019 with an OR 0.57 (95%CI 0.36 – 0.91) Conclusion: Based on the data available, women with gynecologic cancer are more prone to having depressive symptoms than women with other cancer types. Therefore, policies should be implemented to improve wellness of women with gynecologic cancer. Although, depressive symptoms wasn’t worsened by the COVID-19 pandemic.