(004) Antidepressant use and depressive symptoms in cancer survivors: a Danish population-based study

Background: Cancer is a risk factor for mental disorders. Previous studies, primarily of clinically diagnosed mental disorders, indicate that the adverse mental health consequences of cancer may vary by factors such as cancer site and time since cancer diagnosis. There is sparse evidence on the prevalence of less severe mental health conditions such as self-reported depressive symptoms.

Objectives: To compare the prevalence of depressive symptoms and antidepressant use in cancer survivors with individuals without cancer.

Methods: We conducted a cross-sectional study using the novel population-based “Better Health in Late Life” (BHLL) survey—a 2021-2022 cohort of Danish residents aged 50–65 years. The survey data was linked to population-based health and administrative registries. We ascertained data on cancer diagnoses from the Danish Cancer Registry and antidepressant prescriptions from the Danish National Prescription Registry. Antidepressant use was defined as >= 2 prescriptions in the year before study participation. The survey included items from the Major Depression Inventory. Those who reported at least two core symptoms and two associated symptoms were classified as having depressive symptoms. Using the log-binomial method, we computed prevalence ratios (PRs) and 95% confidence intervals (CIs) of depressive symptoms and antidepressant use comparing cancer survivors to those without cancer. We stratified the analyses by cancer site and time since cancer diagnosis and adjusted for age and sex.

Results: Among 105,692 BHLL participants, 7096 (6.7%) were cancer survivors. Cancer site was classified as either breast (29%), melanoma (15%), colorectal (8%), prostate (7%), lung (3%), or other (38%). Compared with participants without a history of cancer, cancer survivors had higher prevalence of depressive symptoms (PR=1.1, 95%CI=1.0, 1.3) and antidepressant use (PR=1.1, 95%CI=1.0, 1.2). Depressive symptoms were most prevalent among lung cancer survivors (PR=2.6, 95%CI=1.6, 4.0) and least prevalent among melanoma survivors (PR=0.52, 95%CI=0.33, 0.78). Similarly, lung cancer survivors had the highest prevalence of antidepressant use (PR=1.7, 95%CI=1.2, 2.4). The prevalence of depressive symptoms and antidepressant use was highest in those diagnosed with cancer 2-4 years and up to 2 years before survey participation (PR=1.6, 95%CI=1.2, 2.0 and PR=1.3, 95%CI=1.0, 1.5, respectively).

Conclusions: Overall, we found higher prevalence of depressive symptoms and antidepressant use in cancer survivors compared with those without cancer. The prevalence was highest up to 4 years after cancer diagnosis and among lung cancer survivors. Our findings highlight the importance of focusing on mental health in certain groups of cancer patients.