ABSTRACT
Background: the aim was to verify the association between Major Depressive Disorders (MDD) and the risk of premature death in people with oncological diseases, and to collect evidence about the causality of a possible association from a longitudinal perspective.
Design and Methods: it is a cohort study lasting 9 months, involving people with solid or hematologic cancers. The assessment was conducted by an ad hoc form to collect socio-demographic and clinical-oncological data, the PHQ-9 to screen MDD (cut-off ≥10) and the SF-12 to evaluate HRQoL. Relative Risk (RR) of early death between MDD exposed and not-exposed and Kaplan-Meier survival were carried out.
Results: people exposed to MDD during the follow-up were 107/263 (40.7%). Among them, 36 deceased during the observation period. Overtime, having MDD and death’ occurrence showed a strong association (RR=2.15; 95% CI (1.10-4.20); χ²=5.224, p=0.0022), confirmed by Kaplan-Meier survival analysis (χ²=4.357, p=0.037). Among people who died, there was not any association between MDD, age, gender, HRQoL, cancer stage and site.
Conclusions: the study confirms the association between MDD and early death in people with cancer. The absence of any association between the onset of MDD and advanced stage of cancer may suggest that it could be due to the consequences of MDD in worsening the clinical conditions related to cancer. The findings point out the relevance of MDD’ early detention among people with cancer.
REFERENCES
Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015 22;386:743-800.
Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health 2013;34:119-38. DOI: https://doi.org/10.1146/annurev-publhealth-031912-114409
Carta MG, Aguglia E, Bocchetta A, et al. The use of antidepressant drugs and the lifetime prevalence of major depressive disorders in Italy. Clin Pract Epidemiol Ment Health 2010;6:94-100. DOI: https://doi.org/10.2174/1745017901006010094
Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. Erratum in: JAMA Psychiatry 2015;72:736. Erratum in: JAMA Psychiatry 2015;72:1259JAMA Psychiatry 2015;72:334-41. DOI: https://doi.org/10.1001/jamapsychiatry.2014.2502
Machado MO, Veronese N, Sanches M, et al. The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses. BMC Med 2018;16:112. DOI: https://doi.org/10.1186/s12916-018-1101-z
Scocco P, Idotta C, Mareschi T, et al. Do interpersonal events buffer or worsen depressive and grief related symptoms in people bereaved through suicide? Death Stud 2020:1-10. Online ahead of print. doi: 10.1080/07481187.2020.1855608 DOI: https://doi.org/10.1080/07481187.2020.1855608
Rackley S, Bostwick JM. Depression in medically ill patients. Psychiatr Clin North Am 2012;35:231-47. DOI: https://doi.org/10.1016/j.psc.2011.11.001
Cuijpers P, Vogelzangs N, Twisk J, et al. Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry 2014;171:453-62. DOI: https://doi.org/10.1176/appi.ajp.2013.13030325
Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 2009;115:5349-61. DOI: https://doi.org/10.1002/cncr.24561
Bortolato B, Hyphantis TN, Valpione S, et al. Depression in cancer: The many biobehavioral pathways driving tumor progression. Cancer Treat Rev 2017;52:58-70. DOI: https://doi.org/10.1016/j.ctrv.2016.11.004
World Health Organization. WHO report on cancer: setting priorities, investing wisely and providing care for all. Geneva: World Health Organization; 2020. Available from: https://apps.who.int/iris/handle/10665/330745
Lutgendorf SK, Andersen BL. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. Am Psychol 2015;70:186-97. DOI: https://doi.org/10.1037/a0035730
Ostuzzi G, Matcham F, Dauchy S, et al. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2018;4:CD011006. DOI: https://doi.org/10.1002/14651858.CD011006.pub3
van Dams R, Grogan T, Lee P, et al. Impact of health-related quality of life and prediagnosis risk of major depressive disorder on treatment choice for stage I lung cancer. JCO Clin Cancer Inform 2019;3:1-8. DOI: https://doi.org/10.1200/CCI.19.00072
Arrieta O, Angulo LP, Núñez-Valencia C, et al. Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Ann Surg Oncol 2013;20:1941-8. DOI: https://doi.org/10.1245/s10434-012-2793-5
Mantovani G, Astara G, Lampis B, et al. Evaluation by multidimensional instruments of health-related quality of life of elderly cancer patients undergoing three different “psychosocial” treatment approaches. A randomized clinical trial. Support Care Cancer 1996;4:129-40. DOI: https://doi.org/10.1007/BF01845762
La Nasa G, Caocci G, Morelli E, et al. Health related quality of life in patients with onco-hematological diseases. Clin Pract Epidemiol Ment Health 2020;16:174-9. DOI: https://doi.org/10.2174/1745017902016010174
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. DOI: https://doi.org/10.1001/jama.262.9.1191
Basch E, Reeve BB, Mitchell SA, et al. Development of the National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst 2014;106:dju244. DOI: https://doi.org/10.1093/jnci/dju244
Rizzo R, Piccinelli M, Mazzi MA, et al. The Personal Health Questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care. Psychol Med 2000;30:831-40. DOI: https://doi.org/10.1017/S0033291799002512
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;282:1737-44. DOI: https://doi.org/10.1001/jama.282.18.1737
Apolone G, Mosconi P, Quattrociocchi L, et al. [Questionario sullo stato di salute SF-12 Versione Italiana].[in Italian]. Milano: Istituto di Ricerche Farmacologiche Mario Negri; 2001.
Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220-33. DOI: https://doi.org/10.1097/00005650-199603000-00003
Krebber AM, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology 2014;23:121-30. DOI: https://doi.org/10.1002/pon.3409
Andersen BL, Rowland JH, Somerfield MR. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology Guideline adaptation. J Oncol Pract 2015;11:133-4. DOI: https://doi.org/10.1200/JOP.2014.002311
Thekkumpurath P, Walker J, Butcher I, et al. Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer 2011;117:218-27. DOI: https://doi.org/10.1002/cncr.25514
Hartung TJ, Friedrich M, Johansen C, et al. The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer. Cancer 2017;123:4236-43. DOI: https://doi.org/10.1002/cncr.30846
Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry 2017;4:146-58. DOI: https://doi.org/10.1016/S2215-0366(16)30263-2
Lloyd-Williams M, Shiels C, Taylor F, Dennis M. Depression–an independent predictor of early death in patients with advanced cancer. J Affect Disord 2009;113:127-32. DOI: https://doi.org/10.1016/j.jad.2008.04.002
Pinquart M, Duberstein PR. Associations of social networks with cancer mortality: a meta-analysis. Crit Rev Oncol Hematol 2010;75:122-37. DOI: https://doi.org/10.1016/j.critrevonc.2009.06.003
Hartung TJ, Brähler E, Faller H, et al. The risk of being depressed is significantly higher in cancer patients than in the general population: Prevalence and severity of depressive symptoms across major cancer types. Eur J Cancer 2017;72:46-53. DOI: https://doi.org/10.1016/j.ejca.2016.11.017
Najjar S, Pearlman DM, Alper K, et al. Neuroinflammation and psychiatric illness. J Neuroinflammation 2013;10:43. DOI: https://doi.org/10.1186/1742-2094-10-43
Moylan S, Maes M, Wray NR, Berk M. The neuroprogressive nature of major depressive disorder: pathways to disease evolution and resistance, and therapeutic implications. Mol Psychiatry 2013;18:595-606. DOI: https://doi.org/10.1038/mp.2012.33
Dantzer R, O’Connor JC, Freund GG, et al. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 2008;9:46-56. DOI: https://doi.org/10.1038/nrn2297
Reiche EM, Nunes SO, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol 2004;5:617-25. DOI: https://doi.org/10.1016/S1470-2045(04)01597-9
Seruga B, Zhang H, Bernstein LJ, Tannock IF. Cytokines and their relationship to the symptoms and outcome of cancer. Nat Rev Cancer 2008;8:887-99. DOI: https://doi.org/10.1038/nrc2507
Miller GE, Chen E, Parker KJ. Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms. Psychol Bull 2011;137:959-97. DOI: https://doi.org/10.1037/a0024768
Zhang MF, Wen YS, Liu WY, et al. Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: A meta-analysis. Medicine (Baltimore) 2015;94:e0897-0. DOI: https://doi.org/10.1097/MD.0000000000000897
Galway K, Black A, Cantwell M, et al. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database Syst Rev 2012;11:CD007064. DOI: https://doi.org/10.1002/14651858.CD007064.pub2
Spencer JC, Wheeler SB. A systematic review of Motivational Interviewing interventions in cancer patients and survivors. Patient Educ Couns 2016;99:1099-105. DOI: https://doi.org/10.1016/j.pec.2016.02.003