title: Psychiatric morbidity and survival after surgery for esophageal cancer: a population-based cohort study.
abstract: OBJECTIVE
  To determine the cumulative incidence of and risk factors for psychiatric morbidity and establish the impact on survival among surgically treated patients with esophageal cancer.
  
  
  METHODS
  A nationwide Swedish cohort of 1,615 patients who underwent surgery for esophageal cancer between 1987 and 2010 with follow-up until 2012 was linked to national health registries for information on psychiatric morbidity (inferred from mental health care use). Multivariable logistic regressions were used to determine potential risk factors for postoperative psychiatric morbidity. A multivariable-adjusted Cox proportional hazard model was used to analyze overall survival.
  
  
  RESULTS
  In patients without a history of psychiatric morbidity, the 2-year cumulative incidence for treatment in psychiatric in-patient care was 2.5%, for psychiatric out-patient care was 4.2%, and for treatment with psychotropic drugs was 32.3%. Married patients were less likely to be treated postoperatively in psychiatric in-patient care (odds ratio [OR], 0.42; 95% CI, 0.22 to 0.80) or out-patient care (OR, 0.41; 95% CI, 0.17 to 1.02), whereas patients with higher tumor stage were more likely to be treated in psychiatric out-patient care (OR, 4.99; 95% CI, 1.16 to 21.38) or with psychotropic drugs (OR, 2.78; 95% CI, 1.10 to 7.01). Bearing in mind possible residual confounding, new-onset psychiatric morbidity was associated with mortality (hazard ratio [HR], 1.65 [95% CI, 1.17 to 2.33] for treatment in psychiatric in-patient care; HR, 1.93 [95% CI, 1.18 to 3.16] for treatment in psychiatric out-patient care; and HR, 2.77 [95% CI, 1.72 to 4.44] for treatment with psychotropic drugs).
  
  
  CONCLUSIONS
  These results highlight the importance of recognizing and addressing psychiatric morbidity in surgically treated patients with esophageal cancer.
authors.affiliation: All authors, Karolinska Institutet, Stockholm, Sweden; and Jesper Lagergren, King's College London, London, United Kingdom. anna.wikman@ki.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Wikman
authors.affiliation: All authors, Karolinska Institutet, Stockholm, Sweden; and Jesper Lagergren, King's College London, London, United Kingdom.
authors.forename: Rickard
authors.initials: R
authors.lastname: Ljung
authors.affiliation: All authors, Karolinska Institutet, Stockholm, Sweden; and Jesper Lagergren, King's College London, London, United Kingdom.
authors.forename: Asif
authors.initials: A
authors.lastname: Johar
authors.affiliation: All authors, Karolinska Institutet, Stockholm, Sweden; and Jesper Lagergren, King's College London, London, United Kingdom.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Hellstadius
authors.affiliation: All authors, Karolinska Institutet, Stockholm, Sweden; and Jesper Lagergren, King's College London, London, United Kingdom.
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.affiliation: All authors, Karolinska Institutet, Stockholm, Sweden; and Jesper Lagergren, King's College London, London, United Kingdom.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000523:psychology / Q000601:surgery; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000523:psychology / Q000601:surgery; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D009017:Morbidity; D016017:Odds Ratio; D010045:Outpatients / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D013548:Sweden / Q000453:epidemiology