Depressive and Anxiety Symptoms Among Patients with Asbestos-Related Diseases in Korea

Our plain-English summary of Depressive and Anxiety Symptoms Among Patients with Asbestos-Related Diseases in Korea, by M.S. Kang, M.R. Lee, Y. Hwangbo (Toxics, 2025).

The study

• Authors: M.S. Kang, M.R. Lee, Y. Hwangbo
• Journal: Toxics
• Published: 2025;13(8)
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos-related diseases (ARDs), including malignant mesothelioma, asbestos-related lung cancer, and asbestosis, are known for their long latency periods and poor prognoses. Although the physical effects of ARDs have been widely studied, limited research has examined the psychological burden faced by affected individuals. This study investigated depressive and anxiety symptoms among 275 patients officially recognized as asbestos victims in Korea. Mental health was assessed using the Korean version of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Hospital Anxiety and Depression Scale (HADS). The analysis revealed that the mean ± standard deviation of depression and anxiety levels among patients with asbestos-related diseases were 8.06 ± 6.27 for PHQ-9, 6.02 ± 5.64 for GAD-7, 7.09 ± 5.44 for HADS-A, and 8.41 ± 5.47 for HADS-D. Patients with asbestosis had higher levels of depressive and anxiety symptoms than those with malignant mesothelioma or lung cancer, with symptom severity increasing alongside asbestosis grade. When compared with national data from the 2020-2021 Korea National Health and Nutrition Examination Survey (KNHANES), PHQ-9 and GAD-7 scores among ARD patients, particularly those with Grade 1 asbestosis, were higher than the scores reported for all major cancer types. These findings highlight the substantial psychological distress experienced by individuals with ARDs and emphasize the urgent need for targeted mental health interventions in this population.

In plain English

This cross-sectional survey examined depression and anxiety in 275 Korean patients officially recognized as asbestos victims: 4 with malignant mesothelioma, 21 with asbestos-related lung cancer and 250 with asbestosis. In 2024, trained specialists interviewed patients with two depression scales (PHQ-9, HADS-D) and two anxiety scales (GAD-7, HADS-A). Overall, the mean PHQ-9 score was 8.06 and the mean GAD-7 score was 6.02. Asbestosis patients scored higher than mesothelioma or lung cancer patients, and scores increased with asbestosis severity. Grade 1 (severe) patients averaged 11.75 on the PHQ-9, and 10 of 16 scored in the HADS-D probable depression range. The proportions in the HADS-A anxiety ranges did not differ significantly between lung cancer and asbestosis patients. The mesothelioma group was too small to compare. Mean PHQ-9 and GAD-7 scores exceeded those of every major cancer type in a national survey and were about four times the general Korean population's (PHQ-9 1.91, GAD-7 1.53). The authors concluded that care should include comprehensive psychosocial interventions. They noted that the cross-sectional design cannot establish cause and that income and education were not analyzed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional survey using structured interviews with standardized self-report questionnaires (PHQ-9, GAD-7, Korean-version HADS), with scores compared against national survey (KNHANES 2020–2021) data
• Who was studied: 275 patients in Korea officially recognized as asbestos victims under the Asbestos Damage Relief Act, surveyed in 2024: 4 with malignant mesothelioma, 21 with asbestos-related lung cancer, 250 with asbestosis (16 Grade 1: Severe, 95 Grade 2: Moderate, 139 Grade 3: Mild). Most were aged 70–89 and lived in Busan or South Chungcheong Province.
• Exposure: Asbestos exposure as accepted by the Korean government's recognition process for asbestos-related disease. The article does not specify fiber types, products or jobs. The comparison is by disease type and asbestosis grade.
• Main results:
  • All 275 patients: mean PHQ-9 8.06 ± 6.27, GAD-7 6.02 ± 5.64, HADS-A 7.09 ± 5.44, HADS-D 8.41 ± 5.07 (the table value; the abstract gives 5.47 for the HADS-D standard deviation)
  • Patients with asbestosis had higher depression and anxiety scores than those with malignant mesothelioma or lung cancer, and scores increased with asbestosis severity. Mean PHQ-9 scores for asbestosis were 11.75 for Grade 1 (severe), 9.36 for Grade 2 (moderate) and 7.01 for Grade 3 (mild). The lung cancer group averaged 6.62 and the mesothelioma group 6.50 (p = 0.005).
  • Within the asbestosis group, the share of patients scoring 10 points or more (moderate or higher) on the PHQ-9 and GAD-7 increased with disease severity. Among Grade 1 (severe) asbestosis patients, 9 of 16 (56.3%) were in the moderate PHQ-9 range.
  • Probable depression (HADS-D 11 or higher) was found in 10 of 16 (62.5%) Grade 1 (severe), 33 of 95 (34.7%) Grade 2 (moderate) and 42 of 139 (30.2%) Grade 3 (mild) asbestosis patients, and in 4 of 21 (19.0%) lung cancer patients. The proportions of patients in the HADS-A anxiety score ranges (suggestive, probable) did not differ significantly between lung cancer and asbestosis (p = 0.256 across diagnosis groups). This applies to the score categories only: mean HADS-A scores did differ across diagnosis groups (p = 0.017).
  • After adjustment for sex, age, smoking status and region, asbestosis patients generally had higher scores than lung cancer patients on all four measures, and scores rose with asbestosis severity. The mesothelioma group was not compared because of its small size.
  • Compared with KNHANES 2020–2021 data, the mean PHQ-9 and GAD-7 scores of these patients were higher than those for all major cancer types. The highest of those was cervical cancer, at PHQ-9 5.50 and GAD-7 5.00. The patients' scores were about four times those of the general Korean population (PHQ-9 1.91, GAD-7 1.53).
• The authors' conclusion: The authors concluded that people with asbestos-related diseases, particularly asbestosis, experience significant psychological distress, often exceeding that seen in patients with other major cancers. They concluded that care strategies should include comprehensive psychosocial interventions.
• Limitations the authors state:
  • The number of malignant mesothelioma patients was small, which limited the reliability of comparisons with other groups.
  • Individual socioeconomic status (education, income) was not included in the analyses because many respondents declined to provide it.
  • The cross-sectional design cannot establish causal relationships between asbestos-related diseases and mental health outcomes.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer, Latency.

Related studies

• Past occupational dust exposure, depressive symptoms and anxiety in retired Chinese factory workers: the Guangzhou Biobank Cohort Study — Q.H. Lin, C.Q. Jiang, et al. (2014)
• Anxious and depressive symptoms in the French Asbestos-Related Diseases Cohort: risk factors and self-perception of risk — I. Mounchetrou Njoya, C. Paris, et al. (2017)
• Disease Latency according to Asbestos Exposure Characteristics among Malignant Mesothelioma and Asbestos-Related Lung Cancer Cases in South Korea — D.A. Huh, W.R. Chae, et al. (2022)
• Predicting the mortality from asbestos-related diseases based on the amount of asbestos used and the effects of slate buildings in Korea — S.Y. Kim, Y.C. Kim, et al. (2016)
• Occupational Burden of Asbestos-Related Diseases in Korea, 1998-2013: Asbestosis, Mesothelioma, Lung Cancer, Laryngeal Cancer, and Ovarian Cancer — D.M. Kang, J.E. Kim, et al. (2018)
• The characteristics of asbestos-related disease claims made to the Korea Workers' Compensation and Welfare Service (KCOMWEL) from 2011 to 2015 — Y.S. An, H.D. Kim, et al. (2018)

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