title: The risk of being depressed is significantly higher in cancer patients than in the general population: Prevalence and severity of depressive symptoms across major cancer types.
abstract: Depression is a common co-morbidity of cancer that has a detrimental effect on quality of life, treatment adherence and potentially survival. We conducted an epidemiological multi-center study including a population-based random comparison sample and estimated the prevalence of depressive symptoms by cancer site, thereby identifying cancer patients with the highest prevalence of depression.
  
  
  
  We included 4020 adult cancer inpatients and outpatients from five distinct regions across Germany in a proportional stratified random sample based on the nationwide cancer incidence and a comparison group consisting of 5018 participants. Both groups reported depressive symptoms by filling in the Patient Health Questionnaire (PHQ-9). In multivariate analyses adjusted for age and sex, we calculated the odds of being depressed.
  
  
  
  Out of 5818 eligible patients, 69% participated (51% women, mean age = 58 years). We estimated that one in four cancer patients (24%) is depressed (PHQ-9 ≥ 10). The odds of being depressed among cancer patients were more than five times higher than in the general population (OR, 5.4; 95% CI, 4.6-6.2). Patients with pancreatic (M = 8.0, SD = 5.0), thyroid (M = 7.8, SD = 6.3) and brain tumours (M = 7.6, SD = 4.9) showed the highest prevalence, whereas patients with prostate cancer (M = 4.3, SD = 3.8) and malignant melanoma (M = 5.3, SD = 4.3) had the lowest levels of depressive symptoms.
  
  
  
  Our results help clinicians identify cancer patients in need of psychosocial support when navigating in the growing survivor population.
authors.affiliation: Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany. Electronic address: tim.hartung@medizin.uni-leipzig.de.
authors.forename: T J
authors.initials: TJ
authors.lastname: Hartung
authors.affiliation: Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany; Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Brähler
authors.affiliation: Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Faller
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Härter
authors.affiliation: Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hinz
authors.affiliation: Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany; Oncology Clinic, 5073 Rigshospitalet, University of Copenhagen, Denmark; Unit of Survivorship, The Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Johansen
authors.affiliation: Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Keller
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Deanery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Koch
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schulz
authors.affiliation: Department of Psychooncology, UKF Reha gGmbh University Clinic Center Freiburg, Freiburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Weis
authors.affiliation: Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mehnert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
keywords: Cancer; Depression; Epidemiology; PHQ-9; Psychosocial oncology