The association between Major Depressive Disorder and premature death risk in hematologic and solid cancer: a longitudinal cohort study.

Abstract

Background: the aim was to verify the association between Major Depressive Disorders (MDD) and the risk of premature death in people with oncological diseases, and to collect evidence about the causality of a possible association from a longitudinal perspective.Design and Method: it is a cohort study lasting 9 months, involving people with solid or hematologic cancers. The assessment was conducted by an ad hoc form to collect socio-demographic and clinical- oncological data, the PHQ-9 to screen MDD (cut-off ≥10) and the SF-12 to evaluate HRQoL. Relative Risk (RR) of early death between MDD exposed and not-exposed and Kaplan-Meier survival were carried out.Design and Method: it is a cohort study lasting 9 months, involving people with solid or hematologic cancers. The assessment was conducted by an ad hoc form to collect socio-demographic and clinical- oncological data, the PHQ-9 to screen MDD (cut-off ≥10) and the SF-12 to evaluate HRQoL. Relative Risk (RR) of early death between MDD exposed and not-exposed and Kaplan-Meier survival were carried out.Results: people exposed to MDD during the follow-up were 107/263 (40.7%). Among them, 36 deceased during the observation period. Overtime, having MDD and death’ occurrence showed a strong association (RR=2.15; 95% CI (1.10-4.20); χ2=5.224, p=0.0022), confirmed by Kaplan-Meier survival analysis (χ2=4.357, p=0.037). Among people who died, there was not any association between MDD, age, gender, HRQoL, cancer stage and site.Conclusions: the study confirms the association between MDD and early death in people with cancer. The absence of any association between the onset of MDD and advanced stage of cancer may suggest that it could be due to the consequences of MDD in worsening the clinical conditions related to cancer. The findings point out the relevance of MDD’ early detention among people with cancer. Significance for public health This cohort study lasting 9 months pointed out a high prevalence of Major Depressive Disorder (MDD) among people with cancer. During the time of observation, 36 deceases occurred. A strong association was observed regarding the survival rates between the MDD exposed subjects who died along the time and the MDD not exposed who survived. This association could be due to the consequences of MDD, if considering that it was not found any significant association between MDD among patients who died and a worse HRQoL when the MDD episode had been occurred, nor with age, gender, cancer stage and site. These findings point out the importance of the early detention of MDD among people with cancer, to promptly provide effective interventions for a good management of symptoms related to cancer and depression. Further studies are needed to explore the causal association between MDD and premature death in people suffering from cancer.