title: Risk of depression following uterine cancer: A nationwide population-based study.
abstract: BACKGROUND
  Depression happens commonly in cancer patients. However, there is limited literature on uterine cancer. In this study, we aimed to evaluate the association between uterine cancer and depression as well as the moderating effect of age and hormone replacement therapy (HRT).
  
  
  METHODS
  This was a population-based study using Taiwan's National Health Insurance Research Database. We conducted a matched cohort study and identified 6526 patients with uterine cancer and 65 260 controls. We adopted the competing risk analysis model as the statistical method and adjusted for potential confounding factors.
  
  
  RESULTS
  From 1997 to 2008, 71 786 patients were included (6526 patients with uterine cancer and 65 260 controls). In the study, uterine cancer was not linked to depression. However, when we stratified the different age groups, those cancer patients aged <40 and 40 to 49 years showed significant higher risk of developing depression (subdistribution hazard ratio 1.64 and 1.41, respectively). In addition, among uterine cancer patients, 4602 patients had never used HRT and 1921 patients were prescribed HRT. The analysis of time-dependent Cox model showed that, compared with no use of HRT, patients with cumulative doses ≥168 DDD had significant lower risk of depression (hazard ratio 0.49, 95% confidence interval = 0.26-0.92).
  
  
  CONCLUSIONS
  An increased risk of depression among younger uterine cancer patients was observed. Our preliminary finding suggests a possible protective factor for developing depression after HRT usage.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, and School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.|Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Yao-Hsu
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Chuan-Pin
authors.initials: CP
authors.lastname: Lee
authors.affiliation: Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ting-Yao
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Bi-Hua
authors.initials: BH
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yin-Cheng
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.|Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Sophie Hsin-Yi
authors.initials: SH
authors.lastname: Liang
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.affiliation: Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Vincent Chin-Hung
authors.identifier: http://orcid.org/0000-0002-1971-4922
authors.initials: VC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D003866:Depressive Disorder; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000150:complications / Q000453:epidemiology / Q000523:psychology*
keywords: National Health Insurance Research Database; depression; hormone replacement therapy; population-based; uterine cancer