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Int J Gynecol Cancer. 2014 Nov;24(9):1700-8. doi: 10.1097/IGC.0000000000000285.

The importance of social support for women with elevated anxiety undergoing care for gynecologic malignancies.

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*Johns Hopkins Department of Psychiatry and Behavioral Sciences, Baltimore, MD; †Kelly Gynecologic Oncology Service, Johns Hopkins Hospital Department of Gynecology and Obstetrics, Baltimore, MD; ‡Residency Program, Johns Hopkins Hospital Department of Gynecology and Obstetrics, Baltimore, MD; §Department of Psychiatry, St. Petersburg Pavlol State Medical University, St. Petersburg, Russia; and ∥Mercy Medical Center, Baltimore, MD.



The aim of this study was to screen for depression and anxiety and to assess well-being among women diagnosed with gynecologic malignancies, identify factors associated with elevated depressive or anxiety symptoms, and further characterize the needs of those with elevated anxiety or depressive symptoms.


Women presenting for gynecologic cancer at an academic center during the course of 10 months were offered screening for depressive and anxiety symptoms. Patients were screened with the Primary Care Evaluation of Mental Disorders' Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7. The Functional Assessment of Cancer Therapy-General assessed well-being. Demographics, psychiatric history, and components about the cancer and treatment were collected. Those who screened positive with scores of 10 or higher on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 were offered a meeting with the study psychiatrist for further evaluation both with the Structured Clinical Interview for Diagnosis as well as with an interview to discuss their experiences and to assess their desired needs.


When family and social well-being was added to the logistic regression model, higher family and social well-being was the strongest factor associated with lower amounts of anxiety (odds ratio, 0.10; P = 0.001 for a cutoff of 10; odds ratio, 0.21; P = 0.012 for a cutoff of 8). Less than 30% who screened positive met with the study psychiatrist and were not receiving optimal treatment.


Given that low family and social well-being and elevated anxiety symptoms were so highly correlated, those with anxiety symptoms would most benefit from social interventions. However, this study also found that patients with elevated depressive or anxiety symptoms were difficult to engage with a psychiatric provider. We need partnership between psychiatry and gynecology oncology to identify those with elevated depressive and anxiety symptoms and develop better ways to provide psychosocial supports.

[Indexed for MEDLINE]

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