Higher Cancer Risk Among Patients with Major Depressive Disorder: A Nationwide Population-Based Study in Taiwan

Autor: Yi-Chung Wu, 吳懿宗
Rok vydání: 2012
Druh dokumentu: 學位論文 ; thesis
Popis: 100
Background: Three major diseases threatening human health are cancer, depression and AIDS according to the report of the World Health Organization. Many researches disclosed highly correlation between cancer and depression, for example, cancer survivors are more likely to suffer from depression and cancer patients with depression are predisposed to disease progression compared with non-depressed patients. It remains controversial that whether depressed people are more likely to have cancer since it is believed depressed patients could have unhealthy mental and physical status. Recent researches study on this topic yield inconclusive results. One of the main reasons is difficulty in measuring and defining depression. Previous studies enrolled depressed patients by community depression screen questionnaires and lack of confirm diagnosis by psychiatrist throughout diagnostic interview schedule. Beside, nationwide population-base studies are limited. Our main goal of this study is to compare cancer risk in patients with rigorously diagnosed major depression with general population. Methods: We used a longitudinal health insurance database, National Health Insurance Research Database (NHIRD), provided by the Taiwan National Health Research Institute and enrolled 33,819 major depressed disorder (MDD) patients within period of 1995-2009. Enrolled MDD patients were followed up for new cancer incidence, death or to the end of this study, December 31, 2009. We calculated background cancer incidence rates for general population from the cancer registry database, which was constructed under the regulations of the “Taiwan Cancer Control Act.” We calculated expected number of cancers by multiplying the number of person-years accumulated in each stratum of age, sex, and follow-up time by the corresponding background specific rate. The standardized incidence ratio, SIR calculated as the observed/expected number of cancer cases, was used as a measure of relative risk, with 95% CIs assuming a Poisson distribution of the observed number of cancers. Results: There were 33,819 newly diagnosed major depressive disorder patients with mean follow-up of 5.19 years and mean cancer incidence rate is 5.9 per 1000 person-years. The MDD patients had overall higher cancer risk then general population (SIR=1.48, 95% CI:(1.34-1.63)). Both female and male patients had higher cancer risk (female: 1.46 (1.29-1.66); male: 1.50 (1.29-1.66)). Stratified cancer risk by age at diagnosis of MDD, the increased cancer risk was observed in patients with onset age at 30-39, 40-49, and 50-59(age 30-39 SIR,95% CI : 2.33 (1.61-3.39) ; age 40-49 SIR,95% CI :1.93 (1.55-2.41) ; age 50-59 SIR,95% CI :1.75 (1.44-2.12). With regards to MDD duration and cancer risk, the highest cancer risk fell on first years after MDD had been diagnosed (SIR=26.9, 95% CI = 22.73-32.84). The SIR in 2nd and 3rd year decreased. (2nd year SIR,95% CI :7.91 (6.625-9.451); 3rd year SIR,95% CI :2.73 (2.41-3.09)). For site-specific cancer risk, we found male MDD patients were predisposed to oral cavity, pharynx and liver cancer; while female MDD patients had higher cancer risk for breast, liver and bladder cancer. Conclusion: Our study reported that MDD patients were associated with higher cancer risk. The increased cancer risk was observed particularly in patients with MDD diagnosed before age 60. Based on sociodemographic, site-specific cancer and disease duration analysis, higher substance abuse among early onset MDD patients may be a risk for carcinogenesis.
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