What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Depression (n=127840). Intervention: Depression vs. No depression. Primary outcome: Subsequent overall cancer risk (RR 1.12, 95% CI 0.99-1.26).

What does this research mean for the field?

Depression has a small, marginally significant association with subsequent overall cancer risk and is associated with a stronger increase in breast cancer risk that emerges many years later. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2007Clinical Practice and Epidemiology in Mental Health122 citationsOpen Access

A meta-analysis on depression and subsequent cancer risk

MOMarjolein Oerlemans MAMarjan van den Akker ASAgnes G. Schuurman

Key Result

Depression showed a tendency towards a small, marginally significant association with subsequent overall cancer risk (adjusted RR 1.12) and a stronger increase in breast cancer risk emerging many years later.

Study Design

Type

Meta-Analysis (n=127,840)

Structured PICO

Does depression increase subsequent overall cancer risk in population-based samples?

Population

13 prospective epidemiological cohort studies with population-based samples having structured measurement of depression and known cancer outcomes for depressed and non-depressed subjects

Intervention

Depression (exposure)

Comparator

Non-depressed subjects

Outcome

Subsequent overall cancer riskhard clinical

Depression shows a marginally significant association with subsequent overall cancer risk, with a potentially stronger increase in breast cancer risk emerging 10 or more years after a previous depression.

Main Result

Effect estimate: RR 1.12 (95% CI 0.99-1.26)

Limitations

Ten different questionnaires were used for the measurement of depression across the included studies.
Differences in the sets of potential confounding factors adjusted for in multivariable analyses across studies.
Possible random error due to multiple statistical tests performed.
Inability to disentangle the possible effects of depression from the effects of antidepressant medications on cancer risk.

Abstract

BACKGROUND: The authors tested the hypothesis that depression is a possible factor influencing the course of cancer by reviewing prospective epidemiological studies and calculating summary relative risks. METHODS: Studies were identified by computerized searches of Medline, Embase and PsycINFO. as well as manual searches of reference lists of selected publications. Inclusion criteria were cohort design, population-based sample, structured measurement of depression and outcome of cancer known for depressed and non-depressed subjects RESULTS: Thirteen eligible studies were identified. Based on eight studies with complete crude data on overall cancer, our summary relative risk (95% confidence interval) was 1.19 (1.06-1.32). After adjustment for confounders we pooled a summary relative risk of 1.12 (0.99-1.26).No significant association was found between depression and subsequent breast cancer risk, based on seven heterogeneous studies, with or without adjustment for possible confounders. Subgroup analysis of studies with a follow-up of ten years or more, however, resulted in a statistically significant summary relative risk of 2.50 (1.06-5.91).No significant associations were found for lung, colon or prostate cancer. CONCLUSION: This review suggests a tendency towards a small and marginally significant association between depression and subsequent overall cancer risk and towards a stronger increase of breast cancer risk emerging many years after a previous depression.

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