Depressive symptomology and cancer incidence in men and women: Longitudinal evidence from the HUNT study,Journal of Affective Disorders

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Depressive symptomology and cancer incidence in men and women: Longitudinal evidence from the HUNT study
Journal of Affective Disorders ( IF 4.9 ) Pub Date : 2022-08-04 , DOI: 10.1016/j.jad.2022.08.002
Stephanie P Cowdery ₁ , Ottar Bjerkeset ₂ , Erik R Sund ₃ , Mohammadreza Mohebbi ₄ , Julie A Pasco ₅ , Michael Berk ₆ , Lana J Williams ₁

Affiliation

Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.
Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Trøndelag Hospital Trust, Levanger, Norway.
Deakin University, Faculty of Health, Biostatistics Unit, Geelong, Australia.
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia.
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia.

Background

Depressive symptoms and mood disorders are associated with a host of physical conditions. However, it is inconclusive whether depressive symptoms are also associated with cancer onset. The aim of this study was to investigate whether depressive symptoms are associated with cancer incidence in a large population-based sample of men and women.

Methods

This study examined data from waves two (HUNT 2, 1995–97) and three (HUNT 3, 2006–08) of the Trøndelag Health Study (HUNT). Depressive symptoms were ascertained using the Hospital Anxiety and Depression Scale (HADS-D ≥ 8), cancer onset was identified via linkage with the Cancer Registry of Norway, death records by the national Cause of Death Register (CDR), and information on lifestyle and demographic factors was self-reported. Cox-proportional hazard regression models were used to test associations. Unadjusted, age-adjusted and multivariable best models accounting for smoking, education, marital status and current employment are presented.

Results

Men and women (n = 61,985; 46.0 % men) were followed from baseline over a period of 778,802 person-years. During the 20-year study period, there were 6856 (11.1 %) individuals with incident cancers and 12,480 (20.1 %) deaths (n = 2498 attributed to cancer). For men with depressive symptoms, 505 (15.3 %) developed incident cancer during the follow-up period, whereas among those without depressive symptoms, 3164 (12.5 %) developed incident cancer. Following adjustment for age, depressive symptomology was not significantly associated with risk of overall cancer onset, nor among prostate, colon or melanoma subtypes. Depressive symptoms were associated with an increased risk of bronchus and lung cancer both before (HR 1.90, 95 % CI 1.43–2.50, p ≤0.001) and after adjustment for age (HR 1.38, 95 % CI 1.04–1.80, p = 0.025). However, further adjustment for additional possible confounders explained this association. For women with depressive symptoms, 384 (11.2 %) developed incident cancer during the follow-up period, whereas among those with no depressive symptomology, 2803 (9.3 %) developed incident cancer. After accounting for age, depressive symptomology was not associated with risk of overall cancer onset, nor among breast, colon, lung and bronchus, or melanoma subtypes. Additional analyses evaluating relationship of depression symptom severity and cancer onset did not alter findings for men or women.

Limitations

This report is limited by the post-hoc study design and subsequent non-randomised nature. Future prospective studies are required.

Conclusion

These results suggest that depressive symptoms are not associated with an increased risk of overall or site-specific cancer onset in these men and women. Given the increased co-occurrence of other medical conditions such as cardiovascular disease, diabetes, stroke and musculoskeletal disorders in people with depression, the role of clinically diagnosed depression and other psychiatric disorders in association with cancer onset necessitates further consideration.

中文翻译：

男性和女性的抑郁症状和癌症发病率：来自 HUNT 研究的纵向证据

背景

抑郁症状和情绪障碍与许多身体状况有关。然而，抑郁症状是否也与癌症发作有关尚无定论。本研究的目的是调查抑郁症状是否与大量基于人群的男性和女性样本的癌症发病率相关。

方法

本研究检查了特伦德拉格健康研究 (HUNT) 的第二波 (HUNT 2, 1995-97) 和第三波 (HUNT 3, 2006-08) 的数据。使用医院焦虑和抑郁量表 (HADS-D ≥ 8) 确定抑郁症状，通过与挪威癌症登记处、国家死因登记处 (CDR) 的死亡记录以及生活方式和人口因素是自我报告的。Cox比例风险回归模型用于测试关联。提出了考虑吸烟、教育、婚姻状况和当前就业的未调整、年龄调整和多变量最佳模型。

结果

男性和女性（n = 61,985；46.0 % 男性）在 778,802 人年期间从基线开始进行随访。在 20 年的研究期间，有 6856 人（11.1%）患有癌症，12480 人（20.1%）死亡（n = 2498 归因于癌症）。对于有抑郁症状的男性，505 人（15.3%）在随访期间发生了癌症，而在没有抑郁症状的人中，3164 人（12.5%）发生了癌症。在调整年龄后，抑郁症状与总体癌症发病风险没有显着相关性，在前列腺、结肠或黑色素瘤亚型之间也没有显着相关性。抑郁症状与支气管癌和肺癌风险增加相关（HR 1.90, 95 % CI 1.43–2.50, p ≤0.001) 和年龄调整后 (HR 1.38, 95 % CI 1.04–1.80, p = 0.025)。然而，对其他可能的混杂因素的进一步调整解释了这种关联。对于有抑郁症状的女性，384 人（11.2%）在随访期间发生了癌症，而在没有抑郁症状的女性中，2803 人（9.3%）发生了癌症。考虑到年龄后，抑郁症状与总体癌症发病风险无关，在乳腺癌、结肠癌、肺癌和支气管癌或黑色素瘤亚型中也没有相关性。评估抑郁症状严重程度与癌症发病之间关系的其他分析并未改变男性或女性的研究结果。