Depression and loss to follow-up among patients treated for premalignant cervical lesions at a tertiary hospital in Uganda: a cross-sectional study

Abstract

Background Cervical cancer prevention relies on timely treatment and follow-up of premalignant cervical lesions, yet loss to follow-up (LTFU) remains common in many low-resource settings. Depression may be associated with poor engagement in care, but evidence among women treated for premalignant lesions in Uganda is limited. We assessed the prevalence of depression and its association with LTFU among women treated for premalignant cervical lesions at Mbarara Regional Referral Hospital in Uganda. Methods This was a retrospective cross-sectional study at the Cervical Cancer Clinic of Mbarara Regional Referral Hospital in southwestern Uganda. Women treated for premalignant cervical lesions between January 2017 and December 2022 with complete records and active telephone contacts were enrolled (n = 112). Follow-up status was defined by clinic attendance on the scheduled review date or within three months thereafter. Depressive symptoms were assessed during telephone interviews (May–June 2023) using the Patient Health Questionnaire-9 (PHQ-9), categorized as moderate/severe (≥ 10) versus no/mild (< 10). sociodemographic and treatment-related data were collected using a separate structured questionnaire/clinical record abstraction. Logistic regression was used to assess the association between depression and LTFU, adjusting for district of residence, marital status, education level, and employment status. Results Of 112 participants, 75.0% (84/112) were LTFU. The mean age was 36.4 years (SD = 8.8). Moderate to severe depressive symptoms were present in 17.9% (20/112). Mean PHQ-9 scores were higher among participants who were LTFU than those retained in care (6.2 ± 5.2 vs. 0.7 ± 3.1; p < 0.001). Depression was associated with increased odds of LTFU (AOR = 9.697; 95% CI: 1.087–86.536; p = 0.042). Conclusion Women treated for premalignant cervical lesions at Mbarara Regional Referral Hospital had high LTFU, and depressive symptoms were strongly associated with disengagement from follow-up care.