Incidence of Medication-Treated Depression and Anxiety Associated with Long-Term Cancer, Cardiovascular Disease, Diabetes and Osteoarthritis in Community-Dwelling Women and Men

Abstract

Background: Physical chronic conditions may increase the risk of mental disorders but the findings are inconsistent between studies and whether the associations differed between genders is unclear. This study aimed to examine whether long-term cancer, cardiovascular disease, diabetes and osteoarthritis were associated with higher risks of incident depression and anxiety and these associations in women compared with men. Methods: We included 115,094 participants (54.3% women) aged 45-64 years from the 45 and Up Study who were free of depression, anxiety, and Parkinson's disease at baseline (2006-2009). The incidence of depression and anxiety was identified using claim databases during follow-up until December 2016. Cox regression models were used to examine the association of cancer, cardiovascular disease, diabetes, and osteoarthritis at baseline with incident depression and anxiety. Findings: During a mean eight-year follow-up (958,785 person-year), the cumulative incidence of depression and anxiety was 12·5% and 5·9% in the healthy population. The hazard ratios ([HRs] (95% CI) VS healthy population) for incident depression associated with long-term cancer, cardiovascular disease, diabetes, and osteoarthritis were 1·19 (95% CI: 1·13-1·25), 1·08 (1·00-1·16)), 1·18 (1·09-1·28), and 1·94 (1·80-2·10), respectively. The corresponding HRs (95% CIs) for incident anxiety were 1·11 (1·03-1·20), 1·26 (1·14-1·39), 1·10 (0·98-1·24), and 2·01 (1·80-2·23), respectively. The positive association between cancer and incident depression was more evident in men (HR (95% CI): 1·24 (1·13-1·35) than in women (1·14 (1·07- 1·21). Long-term diabetes was an independent risk factor for incident anxiety in men (1·21 (1·02-1·44) but not in women (1·09 (0·93-1·28)). Other associations were significant in men and women. Interpretation: Long-term osteoarthritis, cardiovascular disease, and cancer were independent risk factors for incident depression and anxiety in both genders with osteoarthritis having the highest relative risk. Depression screen deserves more concern in men with long-term cancer and anxiety screen in men with long-term diabetes. Funding Statement: Professor Mingguang He receives support from the University of Melbourne at Research Accelerator Program and the CERA Foundation. The Centre for Eye Research Australia (CERA) receives Operational Infrastructure Support from the Victorian State Government. The specific project is funded by Australia China Research Accelerator Program at CERA. Professor Mingguang He is also supported by the Fundamental Research Funds of the State Key Laboratory in Ophthalmology, National Natural Science Foundation of China (81420108008). The sponsor or funding organization had no role in the design or conduct of this research. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study protocol was approved by the Royal Victorian Eye and Ear Hospital Human Research Ethics Committee. Participants provided consent to follow-up and link their data to routine health datasets.