OBJECTIVE: The adverse impact of depression in relation to survival among cancer 
patients is currently a subject of great interest in research. In a 5-year 
follow-up study, we investigated the association of depression with survival of 
patients with a primary brain tumor.
METHODS: The study population consisted of 75 patients with a solitary primary 
brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu 
University Hospital, in Northern Finland. The patients were interviewed during 
admission to the hospital for the tumor surgery. Assessment of depression was 
made using the Beck Depression Inventory and the Crown-Crisp Experiential Index. 
Information on all deaths within 60 months after tumor operation was collected 
from the Cause of Death Register, provided by Statistics Finland.
RESULTS: The patients with a high-grade glioma had a survival time of 22.5 
months (standard deviation, 21.4 mo), whereas the corresponding time was 50.2 
months (standard deviation, 19.9 mo) for patients with a low-grade glioma and 
58.2 months (standard deviation, 9.4 mo) for the patients with a histologically 
benign tumor (P < 0.001, difference between groups, Kruskal-Wallis test). In the 
subgroup of patients with low-grade gliomas, depressive patients had a 
significantly shorter survival time compared with nondepressive subjects (P = 
0.031, Kaplan-Meier survival analysis). A corresponding difference was not found 
in patients with high-grade gliomas or benign tumors. Tumor location in one 
hemisphere compared with bilateral location and wider extent of tumor surgery 
was associated with better survival in patients with low-grade gliomas and 
benign tumors but not in patients with high-grade gliomas.
CONCLUSION: Preoperative depression seemed to be a significant prognostic factor 
for worse survival in low-grade glioma patients. In clinical practice, an 
evaluation of depression among brain tumor patients by structured and 
standardized diagnostic methods is needed to distinguish the patients whose 
depression actually needs treatment. The effective treatment of clinical 
depression among brain tumor patients and the impact of treatment on the 
patients' chances of survival should be a focus of future research.