title: Depression and risk of epithelial ovarian cancer: Results from two large prospective cohort studies.
abstract: OBJECTIVE
  While emerging evidence supports a possible link between depression and ovarian cancer progression, no prospective studies have explored the association with ovarian cancer risk.
  
  
  METHODS
  We prospectively followed 77,451 women from the Nurses' Health Study (1992-2010) and 106,452 women from the Nurses' Health Study II (1993-2011). Depression was defined as having one or more of the following: a 5-item Mental Health Index (MHI-5) score≤52, antidepressant use, or physician-diagnosed depression. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between depression and incident ovarian cancer.
  
  
  RESULTS
  We documented 698 incident cases of epithelial ovarian cancer during follow-up. In multivariable analyses, depression assessed 2-4years before cancer diagnosis was associated with a modestly higher incidence of ovarian cancer (HR=1.30, 95% CI 1.05-1.60). Compared to women with persistent negative depression status, the adjusted HRs were 1.34 (95% CI 1.01-1.76) for women with persistent positive depression status and 1.28 (95% CI 0.88-1.85) for women with worsening depression status over follow-up. The association did not appear to vary by ovarian cancer risk factors or tumor characteristics.
  
  
  CONCLUSIONS
  Our findings suggest that depression may be associated with a modestly increased risk of ovarian cancer. Given the relatively high prevalence of depression in women, future work in larger prospective human studies is needed to confirm our results.
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States. Electronic address: tih541@mail.harvard.edu.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Huang
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Poole
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Olivia I
authors.initials: OI
authors.lastname: Okereke
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
authors.forename: A Heather
authors.initials: AH
authors.lastname: Eliassen
authors.affiliation: Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
authors.forename: Molin
authors.initials: M
authors.lastname: Wang
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Tworoger
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D000077216:Carcinoma, Ovarian Epithelial; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology* / Q000523:psychology; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents
keywords: Chronic stress; Depression; Etiology; Latency period; Ovarian cancer; Repeated measures