Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation.
OBJECTIVE
To determine the association between depression and survival among cancer patients at 1, 3, and 5 years after stem-cell transplantation (SCT).


METHODS
This was a prospective cohort study of 199 hematologic cancer patients who survived longer than 90 days after SCT and who were recruited in a University-based hospital between July 1994 and August 1997. Patients received a psychiatric assessment at four consecutive time points during hospitalization for SCT, yielding a total of 781 interviews. Depression diagnoses were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.


RESULTS
Eighteen (9.0%) and 17 patients (8.5%) met criteria for major and minor depression, respectively. Multivariate Cox regression models found major depression to be predictive of higher 1-year (hazard ratio [HR], 2.59; 95% CI, 1.21 to 5.53; P = .014) and 3-year mortality (HR, 2.04; 95% CI, 1.03 to 4.02; P = .041) but not 5-year mortality (HR, 1.48; 95% CI, 0.76 to 2.87; P = .249). Minor depression had no effect on any mortality outcome. Other multivariate significant predictors of higher mortality were higher regimen toxicity in the 1-, 3-, and 5-year models; older age and acute lymphoblastic leukemia in the 3- and 5-year models; chronic myelogenous leukemia in the 3-year model; and lower functional status and intermediate/higher risk status in the 5-year model. Use of peripheral-blood stem cells predicted lower mortality in the 5-year model.


CONCLUSIONS
After adjusting for multiple factors, major depression predicted higher 1- and 3-year mortality among cancer patients after SCT, underscoring the importance of adequate diagnosis and treatment of major depression.
Prieto
Jesús M
JM
Department of Psychiatry, Clinical Institute of Psychiatry and Psychology, University of Barcelona, Spain. jmprieto@comg.es
Atala
Jorge
J
Blanch
Jordi
J
Carreras
Enric
E
Rovira
Montserrat
M
Cirera
Esteve
E
Espinal
Anna
A
Gasto
Cristóbal
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000150:complications*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D019337:Hematologic Neoplasms / Q000523:psychology* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis