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Cited by 885Cancer, Stress, Anesthesia, and Immune ResponseCancer survivorship and careGlobal Cancer Incidence and Screening

Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies

Open access
Wang, Yun-He, Li, Jin-Qiao, Shi, Ju-Fang, Que, Jian-Yu, Liu, Jia-Jia, Lappin, Julia M., Leung, Janni, Ravindran, Arun V. +5 more·2020·Molecular Psychiatry
DOI 10.1038/s41380-019-0595-x
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Abstract

The link between depression and anxiety status and cancer outcomes has been well-documented but remains unclear. We comprehensively quantified the association between depression and anxiety defined by symptom scales or clinical diagnosis and the risk of cancer incidence, cancer-specific mortality, and all-cause mortality in cancer patients. Pooled estimates of the relative risks (RRs) for cancer incidence and mortality were performed in a meta-analysis by random effects or fixed effects models as appropriate. Associations were tested in subgroups stratified by different study and participant characteristics. Fifty-one eligible cohort studies involving 2,611,907 participants with a mean follow-up period of 10.3 years were identified. Overall, depression and anxiety were associated with a significantly increased risk of cancer incidence (adjusted RR: 1.13, 95% CI: 1.06-1.19), cancer-specific mortality (1.21, 1.16-1.26), and all-cause mortality in cancer patients (1.24, 1.13-1.35). The estimated absolute risk increases (ARIs) associated with depression and anxiety were 34.3 events/100,000 person years (15.8-50.2) for cancer incidence and 28.2 events/100,000 person years (21.5-34.9) for cancer-specific mortality. Subgroup analyses demonstrated that clinically diagnosed depression and anxiety were related to higher cancer incidence, poorer cancer survival, and higher cancer-specific mortality. Psychological distress (symptoms of depression and anxiety) was related to higher cancer-specific mortality and poorer cancer survival but not to increased cancer incidence. Site-specific analyses indicated that overall, depression and anxiety were associated with an increased incidence risks for cancers of the lung, oral cavity, prostate and skin, a higher cancer-specific mortality risk for cancers of the lung, bladder, breast, colorectum, hematopoietic system, kidney and prostate, and an increased all-cause mortality risk in lung cancer patients. These analyses suggest that depression and anxiety may have an etiologic role and prognostic impact on cancer, although there is potential reverse causality; Furthermore, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. Early detection and effective intervention of depression and anxiety in cancer patients and the general population have public health and clinical importance.

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  • MDD and anxiety are associated with a significantly increased risk of cancer incidence (RR 1.13, 95% CI 1.06-1.19).

    “A recent meta-analysis reported that MDD and anxiety were associated with a significantly increased risk of cancer incidence (RR: 1.13, 95% CI: 1.06-1.19) and cancer-specific mortality (RR: 1.21, 95% CI: 1.16-1.26)82.”

    From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [82]

    The cancer-incidence results report the stated RR of 1.13 (95% CI 1.06–1.19) for overall depression and anxiety. That estimate includes conditions measured by symptom scales as well as clinical diagnoses; the clinically diagnosed subgroup has a different estimate (1.15, 1.07–1.24). The paper therefore does not establish the quoted RR specifically for MDD and anxiety. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • MDD and anxiety are associated with a significantly increased risk of cancer-specific mortality (RR 1.21, 95% CI 1.16-1.26).

    “A recent meta-analysis reported that MDD and anxiety were associated with a significantly increased risk of cancer incidence (RR: 1.13, 95% CI: 1.06-1.19) and cancer-specific mortality (RR: 1.21, 95% CI: 1.16-1.26)82.”

    From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [82]

    The cancer-specific mortality Results report a pooled RR of 1.21 (95% CI 1.16–1.26) for overall depression and anxiety. That estimate includes symptoms as well as clinically diagnosed disorders; it is not specific to major depressive disorder (MDD). The clinically diagnosed subgroup has a different estimate, 1.24 (1.17–1.32). (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 1

  1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epide- miology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008-12.

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Authors
Wang, Y.-H., Li, J.-Q., Shi, J.-F., Que, J.-Y., Liu, J.-J., Lappin, J. M., Leung, J., Ravindran, A. V., Chen, W.-Q., Qiao, Y.-L., Shi, J., Lu, L., & Bao, Y.-P.
Affiliations
  • UNSW Sydney (AU)
  • The University of Queensland (AU)
  • University of Toronto (CA)
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
ORCID
Venue
Molecular Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2019-11-19
Volume
25
Issue
7
Pages
1487-1499
ISSN
  • 1359-4184 (ISSN-L)
  • 1476-5578
DOI
10.1038/s41380-019-0595-x
OpenAlex
W2990323914
Cited by
885
References
101
Citations by year
2026: 123 · 2025: 165 · 2024: 203 · 2023: 191 · 2022: 117 · 2021: 61 · 2020: 22
FWCI
8.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Molecular Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
Funders
  • National Natural Science Foundation of China (2016YFC0800907)
  • Ministry of Science and Technology of the People's Republic of China (2016YFC0800907)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
depression, anxiety, psychological distress, cancer incidence, cancer-specific mortality, all-cause mortality, cancer survival, lung cancer, site-specific cancer risk
MeSH terms
Anxiety, Depression, Humans, Neoplasms, Cohort Studies, Incidence

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