title: Increased risk of antidepressant use in childhood cancer survivors: a Danish population-based cohort study.
abstract: OBJECTIVE
  Childhood cancer survivors are at risk of both somatic and mental late effects, but large population-based studies of depression are lacking.
  
  
  METHODS
  Risk of antidepressant use was evaluated in a population-based cohort of 5452 Danish children treated for cancer in 1975-2009 by linkage to the National Prescription Drug Database, which worldwide is the oldest nationwide registry of prescription medication. Hazard ratios (HRs) for antidepressant use were estimated in a Cox proportional hazards model stratified on sex, with population comparisons as referents.
  
  
  RESULTS
  Overall, childhood cancer survivors were at increased risk of having antidepressants prescribed (HR, 1.4; 95% confidence interval (CI), 1.3-1.5). The excess absolute risk of antidepressant use was 2.5 per 1000 person-years (95% CI, 1.7-3.3), equivalent to an excess of 2.5 survivors for every 100 survivors followed for 10years. Increased HRs of 30-50% were seen for survivors of cancers of all main groups (haematological malignancies, central nervous system (CNS) and solid tumors); the highest risk was among children treated with haematopoietic stem cell transplantation (HR, 1.9; 95% CI, 1.2-3.1). Our data suggested that the risk was most pronounced for children treated in the most recent calendar periods (test for interaction between cancer and calendar periods: P<0.001), especially for survivors of haematological cancers (P=0.007). Interaction analysis of the effect of parental socioeconomic position and psychiatric disease on the association between childhood cancer and antidepressant use indicated no modifying effect.
  
  
  CONCLUSIONS
  Childhood cancer survivors should be followed-up for depression. Our results indicate an increasing need for follow-up especially in survivors treated by more recent, intensive anticancer treatment.
authors: Danish Cancer Society Research Center, Survivorship, Strandboulevarden 49, DK 2100 Copenhagen, Denmark; Paediatrics and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark. Electronic address: wegener@cancer.dk.
authors: Lasse Wegener
authors: LW
authors: Lund
authors: Danish Cancer Society Research Center, Survivorship, Strandboulevarden 49, DK 2100 Copenhagen, Denmark.
authors: J F
authors: JF
authors: Winther
authors: Danish Cancer Society Research Center, Statistics, Bioinformatics, and Registry, Denmark.
authors: L
authors: L
authors: Cederkvist
authors: Danish Cancer Society Research Center, Statistics, Bioinformatics, and Registry, Denmark.
authors: K K
authors: KK
authors: Andersen
authors: Danish Cancer Society Research Center, Survivorship, Strandboulevarden 49, DK 2100 Copenhagen, Denmark.
authors: S O
authors: SO
authors: Dalton
authors: Danish Cancer Society Research Center, Survivorship, Strandboulevarden 49, DK 2100 Copenhagen, Denmark.
authors: C W
authors: CW
authors: Appel
authors: Paediatrics and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark.
authors: C
authors: C
authors: Rechnitzer
authors: Paediatrics and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark.
authors: K
authors: K
authors: Schmiegelow
authors: Danish Cancer Society Research Center, Survivorship, Strandboulevarden 49, DK 2100 Copenhagen, Denmark.
authors: C
authors: C
authors: Johansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressive agents; Childhood cancer; Cohort; Late effects; Population-based; Psychiatry; Psychology