Rethinking depression diagnosis in ovarian cancer: The role of somatic symptoms

BACKGROUND: A recent meta-analysis reported that patients with ovarian cancer have a 3-fold increase in the risk of diagnosis of depression compared to the general population. However, the role of disease-related processes in depressive symptoms-particularly at diagnosis versus after treatment-remains unclear. This study aimed to examine the contribution of somatic symptoms to the assessment of depression severity in patients with ovarian cancer, both at diagnosis and 1 year later, compared to healthy controls. METHODS: A total of 428 patients with ovarian cancer completed psychosocial assessments at 1-2 weeks before surgical intervention or initiation of neoadjuvant chemotherapy and at a 1-year follow-up visit. A comparison sample from the Midlife in the United States study was included. Item factor analysis was used to examine the functioning of somatic items in a common depression symptom index in both samples. RESULTS: Somatic items demonstrated differential functioning between groups. Specifically, patients with ovarian cancer were more likely to endorse somatic symptoms at lower levels of depression as compared to healthy aging adults; they additionally required a lower level of depression to endorse somatic items as compared to nonsomatic items. These differences between patients with cancer and healthy aging adults were no longer present at 1 year postdiagnosis. CONCLUSIONS: These findings support the conclusion that somatic symptoms may disproportionately inflate depression scores among patients with ovarian cancer at diagnosis, which may potentially lead to misclassification or overestimation of depression severity. This highlights the need for refined measurement approaches that account for the somatic burden of cancer in assessing depression during active disease.