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Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies

Molecular Psychiatry volume 25, pages 1487–1499 (2020)Cite this article

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Abstract

The link between depression and anxiety status and cancer outcomes has been well-documented but remains unclear. We comprehensively quantified the association between depression and anxiety defined by symptom scales or clinical diagnosis and the risk of cancer incidence, cancer-specific mortality, and all-cause mortality in cancer patients. Pooled estimates of the relative risks (RRs) for cancer incidence and mortality were performed in a meta-analysis by random effects or fixed effects models as appropriate. Associations were tested in subgroups stratified by different study and participant characteristics. Fifty-one eligible cohort studies involving 2,611,907 participants with a mean follow-up period of 10.3 years were identified. Overall, depression and anxiety were associated with a significantly increased risk of cancer incidence (adjusted RR: 1.13, 95% CI: 1.06–1.19), cancer-specific mortality (1.21, 1.16–1.26), and all-cause mortality in cancer patients (1.24, 1.13–1.35). The estimated absolute risk increases (ARIs) associated with depression and anxiety were 34.3 events/100,000 person years (15.8–50.2) for cancer incidence and 28.2 events/100,000 person years (21.5–34.9) for cancer-specific mortality. Subgroup analyses demonstrated that clinically diagnosed depression and anxiety were related to higher cancer incidence, poorer cancer survival, and higher cancer-specific mortality. Psychological distress (symptoms of depression and anxiety) was related to higher cancer-specific mortality and poorer cancer survival but not to increased cancer incidence. Site-specific analyses indicated that overall, depression and anxiety were associated with an increased incidence risks for cancers of the lung, oral cavity, prostate and skin, a higher cancer-specific mortality risk for cancers of the lung, bladder, breast, colorectum, hematopoietic system, kidney and prostate, and an increased all-cause mortality risk in lung cancer patients. These analyses suggest that depression and anxiety may have an etiologic role and prognostic impact on cancer, although there is potential reverse causality; Furthermore, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. Early detection and effective intervention of depression and anxiety in cancer patients and the general population have public health and clinical importance.

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References

  1. Scott KM, Lim C, Al-Hamzawi A, Alonso J, Bruffaerts R, Caldas-de-Almeida JM, et al. Association of mental disorders with subsequent chronic physical conditions: world mental health surveys from 17 countries. JAMA Psychiatry. 2016;73:150–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Scott KM, de Jonge P, Alonso J, Viana MC, Liu Z, O’Neill S, et al. Associations between DSM-IV mental disorders and subsequent heart disease onset: beyond depression. Int J Cardiol. 2013;168:5293–9.

    Article  PubMed  Google Scholar 

  3. Kisely S, Smith M, Lawrence D, Maaten S. Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. Br J Psychiatry J Ment Sci. 2005;187:552–8.

    Article  Google Scholar 

  4. Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–544.

    Article  Google Scholar 

  5. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43:476–93.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA. 2011;306:1241–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol. 2010;56:38–46.

    Article  PubMed  Google Scholar 

  8. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27:2763–74.

    Article  PubMed  Google Scholar 

  9. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12:160–74.

    Article  PubMed  Google Scholar 

  10. Maddock C, Pariante CM. How does stress affect you? An overview of stress, immunity, depression and disease. Epidemiol Psichiatr Soc. 2011;10:153–62.

    Article  Google Scholar 

  11. Spiegel D, Giese-Davis J. Depression and cancer: mechanisms and disease progression. Biol Psychiatry. 2003;54:269–82.

    Article  PubMed  Google Scholar 

  12. Strine TW, Mokdad AH, Dube SR, Balluz LS, Gonzalez O, Berry JT, et al. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry. 2008;30:127–37.

    Article  PubMed  Google Scholar 

  13. Kisely S, Crowe E, Lawrence D. Cancer-related mortality in people with mental illness. JAMA Psychiatry. 2013;70:209–17.

    Article  PubMed  Google Scholar 

  14. Oerlemans ME, van den Akker M, Schuurman AG, Kellen E, Buntinx F. A meta-analysis on depression and subsequent cancer risk. Clin Pract Epidemiol Ment Health. 2007;3:29.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Satin J, Linden W, Phillips M. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115:5349–61.

    Article  PubMed  CAS  Google Scholar 

  16. Ahn H, Bae J, Ahn H, Hwang I. Risk of cancer among patients with depressive disorder: a meta-analysis and implications. Psychooncology. 2016;25:1393–9.

    Article  PubMed  Google Scholar 

  17. Russ TC, Stamatakis E, Hamer M, Starr JM, Kivimaki M, Batty GD. Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ. 2012;345:e4933.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Smith HR. Depression in cancer patients: pathogenesis, implications and treatment (Review). Oncol Lett. 2015;9:1509–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Batty G, Russ T, Stamatakis E, Kivimäki M. Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ. 2017;356:j108.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.

    Article  CAS  PubMed  Google Scholar 

  22. Dew M, Rosenberger E, Myaskovsky L, DiMartini A, DeVito Dabbs A, Posluszny D, et al. Depression and anxiety as risk factors for morbidity and mortality after organ transplantation: a systematic review and meta-analysis. Transplantation. 2015;100:988–1003.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  24. Davies HT, Crombie IK, Tavakoli M. When can odds ratios mislead? BMJ. 1998;316:989–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  PubMed  Google Scholar 

  26. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  27. Global Burden of Disease Cancer C, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017;3:524–48.

    Article  Google Scholar 

  28. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–59.

    Article  Google Scholar 

  29. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.

    Article  PubMed  Google Scholar 

  30. Akechi T, Okamura H, Okuyama T, Furukawa T, Nishiwaki Y, Uchitomi Y. Psychosocial factors and survival after diagnosis of inoperable non-small cell lung cancer. Psychooncology. 2009;18:23–9.

    Article  PubMed  Google Scholar 

  31. Archer G, Pikhart H, Head J. Do depressive symptoms predict cancer incidence?: 17-year follow-up of the Whitehall II study. J Psychosom Res. 2015;79:595–603.

    Article  PubMed  Google Scholar 

  32. Batty GD, McIntosh AM, Russ TC, Deary IJ, Gale CR. Psychological distress, neuroticism, and cause-specific mortality: early prospective evidence from UK Biobank. J Epidemiol Community Health. 2016;70:1136–9.

    Article  PubMed  Google Scholar 

  33. Brown KW, Levy AR, Rosberger Z, Edgar L. Psychological distress and cancer survival: a follow-up 10 years after diagnosis. Psychosom Med. 2003;65:636–43.

    Article  PubMed  Google Scholar 

  34. Brown SB, Hankinson SE, Arcaro KF, Qian J, Reeves KW. Depression, antidepressant use, and postmenopausal breast cancer risk. Cancer Epidemiol Biomarkers Prev. 2016;25:158–64.

    Article  CAS  PubMed  Google Scholar 

  35. Chang CK, Hayes RD, Broadbent MT, Hotopf M, Davies E, Moller H, et al. A cohort study on mental disorders, stage of cancer at diagnosis and subsequent survival. BMJ Open. 2014;4:e004295.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Chang H, Keyes K, Mok Y, Jung K, Shin Y, Jee S. Depression as a risk factor for overall and hormone-related cancer: the Korean cancer prevention study. J Affect Disord. 2015;173:1–8.

    Article  PubMed  Google Scholar 

  37. Chen YC, Kao LT, Lin HC, Lee HC, Huang CC, Chung SD. Increased risk for urological cancer associated with anxiety disorder: a retrospective cohort study. BMC Urol. 2016;16:67.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chen YH, Lin HC. Increased risk of cancer subsequent to severe depression–a nationwide population-based study. J Affect Disord. 2011;131:200–6.

    Article  PubMed  Google Scholar 

  39. Dalton SO, Mellemkjaer L, Olsen JH, Mortensen PB, Johansen C. Depression and cancer risk: a register-based study of patients hospitalized with affective disorders, Denmark, 1969–1993. Am J Epidemiol. 2002;155:1088–95.

    Article  PubMed  Google Scholar 

  40. Friedman GD. Psychiatrically-diagnosed depression and subsequent cancer. Cancer Epidemiol Biomarkers Prev. 1994;3:11–3.

    CAS  PubMed  Google Scholar 

  41. Giraldi T, Rodani MG, Cartei G, Grassi L. Psychosocial factors and breast cancer: a 6-year Italian follow-up study. Psychother Psychosom. 1997;66:229–36.

    Article  CAS  PubMed  Google Scholar 

  42. Goldacre MJ, Wotton CJ, Yeates D, Seagroatt V, Flint J. Cancer in people with depression or anxiety: record-linkage study. Soc Psychiatry Psychiatr Epidemiol. 2007;42:683–9.

    Article  PubMed  Google Scholar 

  43. Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Res Treat. 2007;105:209–19.

    Article  PubMed  Google Scholar 

  44. Gross AL, Gallo JJ, Eaton WW. Depression and cancer risk: 24 years of follow-up of the Baltimore epidemiologic catchment area sample. Cancer Causes Control. 2010;21:191–9.

    Article  PubMed  Google Scholar 

  45. Guan NC, Termorshuizen F, Laan W, Smeets HM, Zainal NZ, Kahn RS, et al. Cancer mortality in patients with psychiatric diagnoses: a higher hazard of cancer death does not lead to a higher cumulative risk of dying from cancer. Soc Psychiatry Psychiatr Epidemiol. 2013;48:1289–95.

    Article  PubMed  Google Scholar 

  46. Jansen F, Verdonck-de Leeuw IM, Cuijpers P, Leemans CR, Waterboer T, Pawlita M, et al. Depressive symptoms in relation to overall survival in people with head and neck cancer: a longitudinal cohort study. Psychooncology. 2018;27:2245–56.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kisely S, Forsyth S, Lawrence D. Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower? Aust N Z J Psychiatry. 2016;50:254–63.

    Article  PubMed  Google Scholar 

  48. Knekt P, Raitasalo R, Heliovaara M, Lehtinen V, Pukkala E, Teppo L, et al. Elevated lung cancer risk among persons with depressed mood. Am J Epidemiol. 1996;144:1096–103.

    Article  CAS  PubMed  Google Scholar 

  49. Kroenke CH, Bennett GG, Fuchs C, Giovannucci E, Kawachi I, Schernhammer E, et al. Depressive symptoms and prospective incidence of colorectal cancer in women. Am J Epidemiol. 2005;162:839–48.

    Article  PubMed  Google Scholar 

  50. Laan W, Termorshuizen F, Smeets HM, Boks MP, de Wit NJ, Geerlings MI. A comorbid anxiety disorder does not result in an excess risk of death among patients with a depressive disorder. J Affect Disord. 2011;135:284–91.

    Article  PubMed  Google Scholar 

  51. Lemogne C, Consoli SM, Melchior M, Nabi H, Coeuret-Pellicer M, Limosin F, et al. Depression and the risk of cancer: a 15-year follow-up study of the GAZEL cohort. Am J Epidemiol. 2013;178:1712–20.

    Article  PubMed  Google Scholar 

  52. Lemogne C, Niedhammer I, Khlat M, Ravaud JF, Guillemin F, Consoli SM, et al. Gender differences in the association between depressive mood and mortality: a 12-year follow-up population-based study. J Affect Disord. 2012;136:267–75.

    Article  CAS  PubMed  Google Scholar 

  53. Liang JA, Sun LM, Su KP, Chang SN, Sung FC, Muo CH, et al. A nationwide population-based cohort study: will anxiety disorders increase subsequent cancer risk? PLoS ONE. 2012;7:e36370.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Liang X, Margolis KL, Hendryx M, Reeves K, Wassertheil-Smoller S, Weitlauf J, et al. Effect of depression before breast cancer diagnosis on mortality among postmenopausal women. Cancer. 2017;123:3107–15.

    Article  CAS  PubMed  Google Scholar 

  55. Lin J, Blalock JA, Chen M, Ye Y, Gu J, Cohen L, et al. Depressive symptoms and short telomere length are associated with increased mortality in bladder cancer patients. Cancer Epidemiol Biomarkrs Prev. 2015;24:336–43.

    Article  CAS  Google Scholar 

  56. Nakaya N. Effect of psychosocial factors on cancer risk and survival. J Epidemiol. 2014;24:1–6.

    Article  PubMed  Google Scholar 

  57. O’Neill S, Posada-Villa J, Medina-Mora M, Al-Hamzawi A, Piazza M, Tachimori H, et al. Associations between DSM-IV mental disorders and subsequent self-reported diagnosis of cancer. J Psychosom Res. 2014;76:207–12.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry. 2006;28:396–402.

    Article  PubMed  Google Scholar 

  59. Penninx BW, Guralnik JM, Pahor M, Ferrucci L, Cerhan JR, Wallace RB, et al. Chronically depressed mood and cancer risk in older persons. J Natl Cancer Inst. 1998;90:1888–93.

    Article  CAS  PubMed  Google Scholar 

  60. Phillips KA, Osborne RH, Giles GG, Dite GS, Apicella C, Hopper JL, et al. Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study. J Clin Oncol. 2008;26:4666–71.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pirl WF, Temel JS, Billings A, Dahlin C, Jackson V, Prigerson HG, et al. Depression after diagnosis of advanced non-small cell lung cancer and survival: a pilot study. Psychosomatics. 2008;49:218–24.

    Article  PubMed  Google Scholar 

  62. Ponizovsky AM, Haklai Z, Goldberger N. Association between psychological distress and mortality: the case of Israel. J Epidemiol Community Health. 2018;72:726–32.

    Article  PubMed  Google Scholar 

  63. Poole E, Kubzansky L, Sood A, Okereke O, Tworoger S. A prospective study of phobic anxiety, risk of ovarian cancer, and survival among patients. Cancer Causes Control. 2016;27:661–8.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Prasad SM, Eggener SE, Lipsitz SR, Irwin MR, Ganz PA, Hu JC. Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer. J Clin Oncol. 2014;32:2471–8.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Robinson KL, McBeth J, Macfarlane GJ. Psychological distress and premature mortality in the general population: a prospective study. Ann Epidemiol. 2004;14:467–72.

    Article  PubMed  Google Scholar 

  66. Sehlen S, Marten-Mittag B, Herschbach P, Schweden M, Book K, Henrich G, et al. Health-related quality of life supersedes other psychosocial predictors of long-term survival in cancer patients undergoing radiotherapy. Acta Oncol. 2012;51:1020–8.

    Article  PubMed  Google Scholar 

  67. Shen CC, Hu YW, Hu LY, Hung MH, Su TP, Huang MW, et al. The risk of cancer in patients with generalized anxiety disorder: a nationwide population-based study. PLoS ONE. 2013;8:e57399.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Shinn EH, Valentine A, Jethanandani A, Basen-Engquist K, Fellman B, Urbauer D, et al. Depression and oropharynx cancer outcome. Psychosom Med. 2016;78:38–48.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Sullivan DR, Ganzini L, Duckart JP, Lopez-Chavez A, Deffebach ME, Thielke SM, et al. Treatment receipt and outcomes among lung cancer patients with depression. Clin Oncol (R Coll Radiol). 2014;26:25–31.

    Article  CAS  Google Scholar 

  70. Suthahar A, Gurpreet K, Ambigga D, Dhachayani S, Fuad I, Maniam T, et al. Psychological distress, quality of life and coping in cancer patients: a prospective study. Med J Malaysia. 2008;63:362–8.

    CAS  PubMed  Google Scholar 

  71. Vodermaier A, Linden W, Rnic K, Young SN, Ng A, Ditsch N, et al. Prospective associations of depression with survival: a population-based cohort study in patients with newly diagnosed breast cancer. Breast Cancer Res Treat. 2014;143:373–84.

    Article  CAS  PubMed  Google Scholar 

  72. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet. 1999;354:1331–6.

    Article  CAS  PubMed  Google Scholar 

  73. Whooley MA, Browner WS. Association between depressive symptoms and mortality in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1998;158:2129–35.

    Article  CAS  PubMed  Google Scholar 

  74. Wise LA, Li S, Palmer JR, Rosenberg L. Depressive symptoms and risk of uterine leiomyomata. Am J Obstet Gynecol. 2015;212:617.e1–e10.

    Article  Google Scholar 

  75. Wyman L, Crum RM, Celentano D. Depressed mood and cause-specific mortality: a 40-year general community assessment. Ann Epidemiol. 2012;22:638–43.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Yu H, Wang Y, Ge X, Wu X, Mao X. Depression and survival in Chinese patients with gastric cancer: a prospective study. Asian Pac J Cancer Prev. 2012;13:391–4.

    Article  PubMed  Google Scholar 

  77. Zhu J, Fang F, Sjölander A, Fall K, Adami H, Valdimarsdóttir U. First-onset mental disorders after cancer diagnosis and cancer-specific mortality: a nationwide cohort study. Ann Oncol. 2017;28:1964–9.

    Article  CAS  PubMed  Google Scholar 

  78. Zonderman AB, Costa PT Jr., McCrae RR. Depression as a risk for cancer morbidity and mortality in a nationally representative sample. JAMA. 1989;262:1191–5.

    Article  CAS  PubMed  Google Scholar 

  79. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. JAMA. 2006;295:676–80.

    Article  CAS  PubMed  Google Scholar 

  80. Schwarzer G, Antes G, Schumacher M. Inflation of type I error rate in two statistical tests for the detection of publication bias in meta-analyses with binary outcomes. Stat Med. 2002;21:2465–77.

    Article  PubMed  Google Scholar 

  81. Lovibond PF. Long-term stability of depression, anxiety, and stress syndromes. J Abnorm Psychol. 1998;107:520.

    Article  CAS  PubMed  Google Scholar 

  82. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40:1797–810.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Jia Y, Li F, Liu Y, Zhao J, Leng M, Chen L. Depression and cancer risk: a systematic review and meta-analysis. Public Health. 2017;149:138–48.

    Article  CAS  PubMed  Google Scholar 

  84. Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009;71:171–86.

    Article  CAS  PubMed  Google Scholar 

  85. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Baltrusch HJ, Stangel W, Titze I. Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research. Acta Neurol (Napoli). 1991;13:315–27.

    CAS  Google Scholar 

  87. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.

    Article  CAS  PubMed  Google Scholar 

  88. Jensen LF, Pedersen AF, Bech BH, Andersen B, Vedsted P. Psychiatric morbidity and non-participation in breast cancer screening. Breast. 2016;25:38–44.

    Article  PubMed  Google Scholar 

  89. Walker J, Hansen CH, Martin P, Symeonides S, Ramessur R, Murray G, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry. 2014;1:343–50.

    Article  PubMed  Google Scholar 

  90. Sharpe M, Walker J, Holm Hansen C, Martin P, Symeonides S, Gourley C, et al. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet. 2014;384:1099–108.

    Article  PubMed  Google Scholar 

  91. Stark DPH, House A. Anxiety in cancer patients. Br J Cancer. 2000;83:1261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018;361:k1415.

    Article  PubMed  Google Scholar 

  93. Plöderl M, Hengartner MP. Guidelines for the pharmacological acute treatment of major depression: conflicts with current evidence as demonstrated with the German S3-guidelines. BMC Psychiatry. 2019;19:265.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Davies J, Read J, Hengartner MP, Cosci F, Fava G, Chouinard G, et al. Clinical guidelines on antidepressant withdrawal urgently need updating. BMJ. 2019;365:l2238.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by the Thirteenth Five-Year Program of the Chinese Ministry of Science and Technology (no. 2016YFC0800907) and the Natural Science Foundation of China (no. 201706015001).

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Authors and Affiliations

  1. National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China

    Yun-He Wang, Jin-Qiao Li, Jie Shi & Yan-Ping Bao

  2. School of Public Health, Peking University, Beijing, 100191, China

    Yun-He Wang, Jin-Qiao Li & Yan-Ping Bao

  3. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Ju-Fang Shi, Wan-Qing Chen & You-Lin Qiao

  4. Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, 100191, China

    Jian-Yu Que, Jia-Jia Liu & Lin Lu

  5. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia

    Julia M. Lappin & Janni Leung

  6. Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia

    Janni Leung

  7. Department of psychiatry, University of Toronto, Toronto, ON, Canada

    Arun V. Ravindran

  8. Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100191, China

    Lin Lu

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YB and LL were responsible for the study design. YW, JL, and YB were responsible for the literature search and study selection. YW, JL, YB, and JS were responsible for the data extraction and quality assessment. YW was responsible for the statistical analysis and paper drafting. JL, JQ, JL, JL, AR, WC, YQ, JS, LL, and YB were responsible for critical revision of the paper.

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Correspondence to Lin Lu or Yan-Ping Bao.

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Wang, YH., Li, JQ., Shi, JF. et al. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry 25, 1487–1499 (2020). https://doi.org/10.1038/s41380-019-0595-x

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  • DOI: https://doi.org/10.1038/s41380-019-0595-x

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