Prevalence and Correlates of Depression and Anxiety Among Women with HPV-Related Cervical Disease: A Hospital-Based Cross-Sectional Study in Shenzhen, China.

BACKGROUND

Human papillomavirus (HPV) infection is a prevalent sexually transmitted infection, significantly contributing to cervical lesions and cancer. It not only damages physical health but also causes substantial mental problems, including depression and anxiety. However, research remains fragmented in China.

METHODS

A hospital-based cross-sectional study was conducted in Shenzhen, China, from December 2024 to February 2025. Five hundred and one female participants with HPV infection, cervical lesions, or cancers were recruited via convenience sampling. Data on demographic characteristics, HPV-related information, and psychosocial indicators were collected using a self-reported questionnaire. Key measures included the 9-item Patient Health Questionnaire (PHQ-9, cutoff ≥10 for PHQ-defined depression), 7-item Generalized Anxiety Disorder Scale (GAD-7, cutoff ≥10 for GAD-defined anxiety), 14-item Fatigue Scale (FS-14, higher scores = more severe fatigue), 10-item Connor-Davidson Resilience Scale (CD-RISC-10, higher scores = stronger resilience), and 5-item Mindful Attention Awareness Scale (MAAS-5, higher scores = lower mindfulness levels). Univariate analysis and multivariable binary logistic regression were performed to identify factors associated with depression and anxiety.

RESULTS

The prevalence of PHQ-defined depression and GAD-defined anxiety was 22.36% (n=112/501, 95% CI: 0.187-0.260) and 21.36% (n=107/501, 95% CI: 0.178-0.250), respectively. Multivariable binary logistic regression indicated that high-grade cervical lesions or cervical cancer (vs HPV infection or low-grade cervical lesions; Depression: OR = 8.879, P < 0.00; Anxiety: OR = 14.154, P < 0.001) and poor sleep condition (Depression: OR = 1.155, P = 0.004; Anxiety: OR = 1.175, P < 0.001) emerged as significant predictors of depression and anxiety, whereas higher levels of resilience (Depression: OR = 0.896, P = 0.001; Anxiety: OR = 0.934, P = 0.018) demonstrated a protective effect among females infected with HPV. Meanwhile, the results also found that fatigue (OR = 1.284, P = 0.008) and lower mindfulness level (OR = 1.163, P = 0.011) were also associated with depression among females infected with HPV.

CONCLUSION

This study reveals a high prevalence of depression and anxiety among HPV-infected women, along with the associations between PHQ-defined depression, GAD-defined anxiety, and advanced disease staging, fatigue, lower mindfulness, and higher resilience in women infected with HPV. Routine mental health assessment is warranted for this population, especially for those with high-grade cervical lesions or cervical cancer.