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Depressive symptoms and palliative care concerns among patients with non-communicable diseases in two Southern African countries

Research output: Contribution to journalArticlepeer-review

Eve Namisango, Richard A Powell, Steve Taylor, Radbruch Lukas, Rachel Freeman, Desderius Haufiku, Beatrice M Mwagomba, Wilson Acuda, Lameck Thambo, Immaculate Kambiya, Emmanuel Bk Luyirika, Faith N Mwangi-Powell, Richard Harding

Original languageEnglish
Pages (from-to)26-37
Number of pages12
JournalJournal of pain and symptom management
Issue number1
Early online date23 Sep 2022
E-pub ahead of print23 Sep 2022
PublishedJan 2023

Bibliographical note

Funding Information: All the authors declare that they have no conflict of interest. This study was funded by the Open Society Initiative for Southern Africa , grant number 5700 . This article presents independent research that is partly funded by the National Institute for Health and Care Research (NIHR) under the Applied Health Research program for Northwest London. The views expressed in this publication are those of Richard A. Powell and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2022 American Academy of Hospice and Palliative Medicine

King's Authors


CONTEXT: Non-communicable diseases (NCDs), associated with health-related suffering, can benefit from palliative care in resource-limited settings, where over four-fifths of these deaths occur.

OBJECTIVE: To measure the prevalence of depressive symptoms, palliative care-related concerns, physical and other psychological symptoms among adult patients with NCDs in Malawi and Namibia.

METHODS: This multi-center, cross-sectional study consecutively recruited outpatients from four tertiary referral hospitals. Stepwise regression analysis was used to assess factors associated with physical and psychological symptom burden.

RESULTS: Among 457 participants, primary diagnosis was cancer (n=147, 32%); cardiovascular disease (CVD) (n=130, 28%), chronic respiratory disease (CRESD) (n=73, 16%) or diabetes (n=107, 23%). Over half were female (58.9%; n=269), mean age was 48 (SD=15.7). Clinically significant psychological distress was identified among cancer (57.2%), diabetes (57.0%), CRESD (45.2%) and CVD patients (43.1%), with criterion for major depression symptoms met for cancer (42.9%), diabetes (39.2%), CVD (30.0%) and CRESD (28.8%). Most severe palliative care concerns were: first sharing feelings (i.e., not at all/not very often), reported by CVD (28%), CRESD (23%), cancer (22%) and diabetes (21%) patients; second help and advice (i.e., none/very little), among cancer (28%), CVD (26%), diabetes (22%), and CRESD (16%) patients. High prevalence of moderate-to-severe pain was reported (cancer 54%, CVD 41%, CRESD 38%, diabetes 38%). Functional status, age and presence of comorbidities were associated with physical and psychological symptom distress.

CONCLUSION: Given the high burden of physical and psychosocial symptoms and symptom distress, the findings highlight the need for integrated person-centered palliative care for NCDs to optimize care outcomes.

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