Advanced cancer as a risk for major depressive episodes.
OBJECTIVE
Major depression adversely affects health communication, quality of life, and survival in patients with advanced cancer. Prior research provides limited insight into how patients with advanced cancer differ from the general population in risk for developing a major depressive episode (MDE). This study aims to determine whether advanced cancer poses distinct risks for initial and recurrent MDEs.


METHODS
Advanced cancer patients (N = 628) from Coping with Cancer were compared with propensity-weighted general population controls (N = 9282) from the National Comorbidity Survey Replication.


RESULTS
Patients with advanced cancer were more likely than comparisons to have an initial MDE [OR = 27.3, 95% CI = (14.8-50.4); p < 0.001] but no more likely than comparisons to have a recurrent MDE [OR = 1.5, 95% CI = (0.9-2.6); p = 0.160]. Nearly two thirds (64.4%) of current MDEs in patients were initial onset; the vast majority (91.8%) of current MDEs in comparisons were recurrent.


CONCLUSIONS
Advanced cancer increases risk of an initial MDE but appears not to enhance risk of a recurrent MDE. This suggests the importance of screening widely for depression in patients with advanced cancer as opposed to targeting screening to presumably high-risk subgroups of those with psychiatric histories.
Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
Fremonta
F
Meyer
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Kalen
K
Fletcher
Center for Research on End of Life Care, Departments of Medicine and Radiology, Weill Cornell Medical College, New York, NY, USA.
Holly G
HG
Prigerson
Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
Ilana M
IM
Braun
Center for Research on End of Life Care, Departments of Medicine and Radiology, Weill Cornell Medical College, New York, NY, USA.
Paul K
PK
Maciejewski
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology* / Q000523:psychology*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
cancer; depression; epidemiology; etiology; oncology