Psychological Distress in Patients With Asbestos-Related Diseases and Their Families: A Systematic Literature Review

Our plain-English summary of Psychological Distress in Patients With Asbestos-Related Diseases and Their Families: A Systematic Literature Review, by I.G. Franzoi, M.D. Sauta, M. Bonafede, et al (Psycho-oncology, 2025).

The study

• Authors: I.G. Franzoi, M.D. Sauta, M. Bonafede, G. Francioso, A. De Luca, F. Barbagli, A. Granieri
• Journal: Psycho-oncology
• Published: 2025;34(1):e70051
• Type of article: Systematic review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Exposure to asbestos in the workplace is currently recognized as one of the leading causes of work-related deaths, with more than half of deaths attributable to cancer.

Aims: The aim of this systematic literature review was to investigate the mental health and psychological distress of patients affected by asbestos-related diseases and their caregivers.

Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The studies were identified in October 2023 by searching four electronic databases: Scopus, Web of Science, PubMed and PsycInfo/PsycArtcicles. Risk of bias was assessed using the JBI checklist.

Results: Fourteen articles were identified. The studies focused exclusively on the psychological distress of patients with malignant mesothelioma (MM) and their caregivers. MM appears to have traumatic effects on both patients and caregivers, who may experience anxiety and depression, an impoverished emotional life, somatization, social withdrawal, and a deterioration in their quality of life. In addition, a need for information about MM, its progression and associated care tasks was identified, and patients and caregivers reported frequently seeking information from online sources.

Conclusions: Our review has shown that there are still few studies addressing psychological distress in MM patients and their caregivers, and none addressing distress in the context of other asbestos-related diseases. The somatopsychic consequences of MM in patients and caregivers should encourage institutions and health professionals to develop assessment and intervention models that are tailored to the specific suffering and needs of MM patients and their caregivers and promote their residual vitality.

© 2025 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.

In plain English

This was a systematic review of published studies; the authors collected no new patient data. The authors searched four databases up to October 2023 for English-language quantitative studies on psychological distress in asbestos-related disease patients and caregivers. Of 6859 records, 14 articles were included. The authors stated that all 14 concerned malignant mesothelioma, but their table describes one as involving 204 lung cancer patients. They found no studies on the psychological effects of other asbestos-related diseases. They rated all 14 as cross-sectional with a moderate risk of bias. The included studies described anxiety, depression, post-traumatic symptoms and impaired quality of life in patients and caregivers. In one Japanese study of 72 bereaved family members, 19.4% had moderate to severe depression. In that study, survivors not compensated by the asbestos health-injury compensation system were more likely to be depressed. The review also noted that the legal process for compensation could become a source of stress. The authors concluded that few such studies exist. They noted that varied instruments, excluding qualitative studies and searching only in English may have caused missed findings.

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: Systematic literature review of published quantitative studies, using narrative synthesis with no meta-analysis; no new data were collected
• Who was studied: 14 published quantitative articles on patients with malignant mesothelioma and/or their caregivers, found in four databases (Scopus, Web of Science, PubMed, PsycInfo) in October 2023. Eight studied patients only, 3 caregivers only and 3 both. Patients were aged 35 to 92 and caregivers 24 to 85.
• Exposure: The review sought studies of asbestos-related diseases in general, but the authors state all included studies concerned malignant mesothelioma. The review does not analyze fiber types or doses.
• Main results:
  • The search found 6859 articles, 4079 after removing duplicates; 14 articles were included
  • The authors stated that all included articles addressed patients with malignant mesothelioma and/or their caregivers
  • The authors' own Table 1 describes the sample of included study ID 13 as 204 lung cancer patients, with no separate mesothelioma subgroup shown
  • All 14 included articles were rated by the authors as cross-sectional studies with a moderate risk of bias
  • Included studies came from Australia (4), Italy (4), Japan (3), Switzerland (1), the USA (1) and Mexico (1)
  • Across the included studies, the authors reported that anxiety, depression, post-traumatic symptoms, anger, fear, alienation and somatization may occur in mesothelioma patients and caregivers
  • In one included study of 72 bereaved family members in Japan, 19.4% had moderate to severe depression
  • In that Japanese study of bereaved family members, two groups were more likely to suffer from depression: survivors not compensated by the asbestos health-injury compensation system, and those whose family felt the financial impact of the patient's mesothelioma
  • Two included studies indicated that the legal process to obtain justice and compensation could become a source of stress for patients and caregivers
  • One included study found that patients and caregivers often sought information about mesothelioma after diagnosis, particularly online
  • No included studies came from countries where asbestos is still manufactured and exported, such as Brazil, China, Kazakhstan and Russia
• The authors' conclusion: The authors concluded that few studies address psychological distress in mesothelioma patients and their caregivers, and none address it for other asbestos-related diseases. They called for assessment and intervention models tailored to these patients and caregivers.
• Limitations the authors state:
  • Results may be affected by the varied instruments used and by the exclusion of qualitative studies
  • Only English-language articles were included, so important findings may have been missed

Topics

Medical terms in this study, explained in our Lexicon: Systematic Review, Malignant Mesothelioma, Quality of Life.

Related studies

• Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato — M. Bonafede, A. Granieri, et al. (2020)
• Preliminary validation of a questionnaire assessing psychological distress in caregivers of patients with malignant mesothelioma: Mesothelioma Psychological Distress Tool-Caregivers — M. Bonafede, C. Chiorri, et al. (2022)
• What are the psychological effects of mesothelioma on patients and their carers? A scoping review — V. Sherborne, J. Seymour, et al. (2020)
• The psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects: A systematic review of published studies — M. Bonafede, M. Ghelli, et al. (2018)
• Living with mesothelioma: a systematic review of mental health and well-being impacts and interventions for patients and their informal carers — V. Sherborne, S. Ejegi-Memeh, et al. (2024)
• Dusted community: piloting a virtual peer-to-peer support community for people with an asbestos-related diagnosis and their families — D. Kozlowski, S.C. Provost, et al. (2014)

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