Psychiatric symptoms in gliomas: a systematic review

Abstract

Psychiatric symptoms are prevalent among adults with gliomas, yet their recognition and characterization remain limited. This systematic review aimed to synthesize evidence on prevalence, temporal course, and disease-specific correlates of all reported psychiatric symptoms in adults with glioma. PubMed, CINAHL, and PsycInfo were searched from inception to September 1st, 2025. Eligible studies enrolled adults with glioma and assessed psychiatric symptoms using validated psychometric instruments or structured/semi-structured clinical interviews. Reporting followed PRISMA guidelines and risk of bias was assessed using the ROBINS-E framework. Among 4327 records, 130 studies met criteria for qualitative synthesis. Depressive (20-55%) and anxiety (20-58%) symptoms emerged as the most frequent and relevant manifestations. Depressive symptoms were more common in high-grade glioma and were associated with poorer survival and functional impairment, whereas anxiety symptoms were mainly linked to reduced quality of life and showed inconsistent prognostic associations, with distinct phase-dependent patterns across the disease course. Beyond affective disorders, a range of non-affective psychiatric manifestations was identified, including psychotic symptoms, personality traits, sleep disturbances, obsessive symptoms and eating disturbances, and post-traumatic stress symptoms. These manifestations were less frequently reported and tended to occur in specific clinical contexts, such as the peri-operative or treatment phases, or in association with involvement of specific neuroanatomical regions. Psychiatric symptoms are integral, phase-dependent features of the glioma trajectory, shaped by tumor-related factors and active treatments. Screening and management should be prioritized at clinically high-risk stages. Future studies should integrate psychiatric assessments with tumor-related variables to refine mechanistic understanding.