Risk of Depressive Symptoms Before and After the First Hospitalisation for Cancer: Evidence from a 16-year Cohort Study in the Czech Republic

Background: Whether depression risk starts increasing before cancer diagnosis, and whether cancer is an independent risk factor for depression, remain unclear. We aimed to quantify the risk of depressive symptoms before and after the first hospitalisation for cancer (as a proxy for cancer diagnosis) amongst patients with cancer.

Methods: We linked cohort data with national hospitalisation records in the Czech Republic. We followed 1056 incident cancer cases for up to 15 years before and 15 years after the first hospitalisation for cancer. Depressive symptoms were measured using the Centre for Epidemiological Studies-Depression (CES-D) scale. We used multilevel ordered logistic regression to assess the relationship between follow-up years (pre- and post-hospitalisation) and depressive symptoms amongst incident cancer cases. Propensity Score Matching was employed to match each case with a cancer-free control, to test the independent effect of cancer on depressive symptoms over time.

Results: Per one year of follow-up (whether pre- or post- hospitalisation) was associated with 1.07 (1.05-1.10) times more likely to have high severity of depressive symptoms amongst patients with cancer. The probability of having high severity of depressive symptoms increased from 25% at five years before hospitalisation to 33% at 7.5 years after hospitalisation. In parallel analyses amongst matched cancer-free controls, the risk of depressive symptoms had no significant changes during follow-up.

Limitations: Stratified analyses based on cancer types and stages of malignancy were infeasible.

Conclusions: The excess risk of depressive symptoms was apparent five years prior to the first hospitalisation for cancer. Using cancer-free matched controls, we confirmed that cancer was an independent predictor of depressive symptoms.