This is the first study from Southern Thailand that purposed to explore the prevalence of depression including associated factors for patients with cancer receiving radiotherapy. The prevalence of depression discovered was no MDD, with all participants having no/minimal or mild depression. Furthermore, the associated factors related to mild depression were a history of hospitalization, a perception of one’s health, the presence of physical symptoms, and pain. These findings are different from those of prior reports using PHQ-9 from India [24], Malaysia [25], Canada [26], and meta-analytical pooled prevalence of depression defined by the International Classification of Diseases (ICD) or DSM criteria that found the prevalence of MDD ranged from 14.3 to 70.0% [27, 28]. It also differed from a recent study among Thai patients with cancer who received radiotherapy from the central regions of Thailand; in that, the reported prevalence of MDD was 12.1% [3]. A potential explanation for these discrepancies may be due to different study instruments and characteristics of the population; such, as ethnicity, age group, socioeconomic status, family and social support; type or location of cancer, staging, and duration of cancer illness [29,30,31].

Most participants in this study had a high score in all subparts of meaning in life and were satisfied or appreciated with their health. Indeed, in this study, patients with cancer who had higher MLQ scores were more likely to satisfy with their general health. As mentioned above, this could be because the “narrative” model has been used with patients with cancer in this hospital to change the meaning of cancer into something more positive and to search for meaning in their life. Meaning in life may be viewed as coherent to the patient’s sense of relevance, allowing them not only to anchor or standpoint themselves in reality, but also to analyze new purposes in which to invest for the remaining life [19, 32]. Moreover, most participants (101/113, 89.4%) stayed at the Yensira building over their course of radiotherapy and on the day of data collection. The building provided basic care; including, life safety, and feelings of comfort by having friends with cancer as well as causing an exchange of attitudes in life, life solutions, and not feeling lonely. All of these may be the main psychosocial and spiritual factors that promote happiness, and life satisfaction, prevent feelings of sadness as well as make the patients with cancer perceive themselves as a person of identity, values, and connected to people in society. Because a prior study identified that life satisfaction was one of the most vigorous factors related to depression, and mediated the capability of prognostic awareness of depression. Moreover, low life satisfaction increased the risk of depression with an odd ratio of 3.01 (95% CI = 2.37,3.82) [26].

Concerning the associated factors with mild depression, our findings were similar to the prior studies reporting no effect of gender, age, marital status, occupation, education, or cancer location including the staging of illness on the presence of depressive symptoms [3, 28]. However, this study also found the factors associated with mild depression were the presence of physical symptoms and pain. Pain can produce psychological and psychiatric distress, which may be a major source of suffering for patients with cancer and their relatives [27]. It is also associated with disability, impaired physical activity, and poor social interaction [8, 33]. Moreover, the prior study identified that most Thai patients with palliative cancer, along with the general Thai population in Southern Thailand, preferred End-of-life care to be free of distressing or uncomfortable symptoms, such as pain [18, 34]. Therefore, to encourage good quality of life and happiness among patients with cancer, healthcare professionals should be aware of and manage the suffering symptoms, including pain, adequately.

In this study, cancer patients with a history of hospitalization had lower rates of mild depression. In our opinion, having a history of hospitalization may allow patients with cancer to experience adaptation or cope with life-threatening stress more so than others. After surviving a life crisis, they may perceive the remaining of their life as synonymous with life gains or rewards. Additionally, during hospitalization, necessary treatments or psychological interventions may be arranged and met with optimism. Therefore, the outlook for the rest of life is more positive and helps the patient with cancer achieve a sense of acceptance of their illness and possible death [19, 26].

Finally, evidence-based guidelines on the management of depression in cancer care recommend optimal support and care to prevent depression; early detection and severity assessment of depression; and adequate and effective management using antidepressant medication and psychological interventions [17, 35, 36]. The associated factors identified in this study may be used to design an intervention and guide clinical practice for the prevention, early diagnosis, and management of depression in patients with cancer. For palliative care providers, in this study, only 21.2% of participants were patients with palliative cancer, although this is a small number compared to the rest of the participants. However, in our opinion, the result of this study may be useful and encouraging for palliative care providers to continue their efforts to detect, reduce, and relieve both pain and depressive symptoms of their cancer patients. Additionally, it also reaffirms that trying to enable meaningful lives of our cancer patients early is crucial to making terminal palliative care more convenient and easier.