Breast cancer is the most common malignancy among women worldwide [1] , with significant physical and psychological burdens [2] . In low- and middle-income countries, including Nigeria, the psychological impact of breast cancer is often overlooked despite its significant effect on treatment adherence, quality of life, and overall prognosis [3] . Depression and Generalized Anxiety Disorder (GAD) are highly prevalent in cancer patients due to disease-related stressors, including uncertainty about prognosis, treatment side effects, and financial difficulties [4] . Biologically, breast cancer triggers inflammation, for example elevated IL-6 and TNF-alpha and hypothalamic-pituitary-adrenal (HPA) axis dys-regulation, contributing to depression [5] . Psychologically, fear of body image concerns, treatment side effects and mortality heightens anxiety [6] . Socially, stigma and financial burden in Nigeria may exacerbate mental health issues [7] . Globally, the prevalence of depression among breast cancer patients ranges from 0% to 58% [8] , while Nigerian studies reported much lower rates (11.4% and 15.5%) [2] [9] . The prevalence of anxiety disorders among breast cancer patients is higher in western studies (e.g., Germany [10] , the United States of America [11] ) than in Nigeria [12] . These variations may reflect differences in healthcare access, cultural stigma and screening tools [13] . Socio-demographic associations with depression and GAD vary: a Nigerian study found no links [14] , while others reported marital status, educational and income associations [15] [16] . Furthermore, a study in Greece linked age, place of domicile, religion, educational level and marital status to depression [8] . In Nigeria, cultural and religious beliefs shape mental health experiences, particularly in Kano State, where help-seeking is limited [17] . Clinical factors including cancer stage, duration of breast cancer before diagnosis, treatment modality [18] , and recurrence [19] , are strongly associated with depression and GAD. Few studies have explored these in Kano, where cultural and religious influences may shape mental health experiences and help-seeking behaviors.

This cross-sectional study was conducted among female breast cancer patients at the surgical outpatient department (SOPD) clinics of Aminu Kano Teaching Hospital (AKTH) and Murtala Muhammad Specialist Hospital (MMSH), Kano State, Nigeria, over six months (September 2023 - February 2024). A systematic sampling method recruited 240 participants, with proportional allocation based on patient volume at each hospital. The first participant was selected using a random number table, followed by every second patient until the sample size was reached. Ethical approval was obtained from AKTH’s Research Ethics Committee (AKTH/ MAC/SUB/12A/P-3/VI/3748). Informed consent was obtained from all the participants.

Inclusion criteria: Women aged ≥ 18 years with a histopathologically confirmed breast cancer diagnosis.

Exclusion criteria: Participants with severe mental illness impairing response capability, severe medical conditions preventing participation, or pre-existing psychiatric disorders before breast cancer diagnosis were excluded from the study.

Using the MINI-7, depression prevalence was 63.7% (95% CI: 57.4 - 69.7%) and GAD prevalence was 21.3% (95% CI: 16.4 - 27.0%) among 240 participants. Figure 1 (pie chart) illustrates depression prevalence, and Figure 2 shows GAD prevalence. Socio-demographic factors: Age (p = 0.001) and religion (p = 0.004) were associated with depression ( Table 1 ). No socio-demographic factors were significantly associated with GAD (all p > 0.05). Table 1 details associations, with Christianity linked to higher depression (90.9% vs. 61.1% for Islam). Clinical Factors: Age at diagnosis (<45 vs. ≥45 years) was the only clinical factor associated with depression (p = 0.014), with no clinical factors linked to GAD ( Table 2 ). Table 2 summarizes clinical associations.

Regression Analysis: Binary logistic regression of significant bivariate factors (age, religion, age at diagnosis) identified age at diagnosis (≥45 years) as the sole independent determinant of depression (AOR: 1.069, CI: 1.076 - 3.679, p = 0.028) ( Table 3 ). The wide CI for the 20 - 29 age group (AOR: 1.069, CI: 0.105 - 10.891) reflects the small sample size (n = 33), reducing estimate precision.

The 63.7% prevalence of depression in this study is high, exceeding prior Nigerian studies (11.4 - 15.5%) [2] [9] , and a South African study (36.6%) [23] . GAD prevalence (21.3%) is significantly higher than the general Nigerian population rate of 1.8% [24] , and aligns with Southwest Nigerian cancer study (18.5%) [25] [26] . These differences may be due to confounders like limited healthcare access, higher stigma in Kano, and use of MINI 7.0 which is more sensitive than self-report tools used elsewhere [20] . Socio-cultural factors, including stigma and low mental health awareness, amplify psychological distress, with breast cancer often perceived as a “death sentence”. Age was associated with depression, particularly among the participants aged ≥60 and 20 - 29 years. Older women may face spousal loss, reduced independence, and physical decline, while younger women experience career disruptions and body image issues, lowering self-esteem [27] - [29] , Religion influenced depression, with Christians showing higher prevalence (90.9% vs. 61.1% for Muslims). This variation may reflect differences in religious coping styles. Certain Islamic beliefs emphasizing acceptance of life challenges might offer some psychological buffering. Age at diagnosis (≥45 years) was the sole independent determinant of depression (AOR: 1.994), consistent with Vahdaninia et al. (2015) [30] . Older women perceive cancer as terminal, compounded by menopausal hormonal changes (e.g., low estrogen) [31] . No clinical factors, including recurrence, were associated with GAD, possibly due to the cross-sectional design’s inability to capture temporal anxiety triggers.

The cross-sectional design precludes causal inferences, as depression and GAD may precede or follow cancer diagnosis. The hospital-based sample may limit generalizability to community settings. The wide CI for the 20 - 29 age group’s GAD estimate (n = 33) indicates low precision due to small subgroup size.

Routine screening should be integrated into oncology clinics, prioritizing women diagnosed at ≥45 years. Counselling services, for older and younger patients, can address stigma and body image concerns. Training health care workers in oncology unit in empathetic communication can improve mental health support.