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Association of depression and anxiety disorder with the risk of mortality in breast cancer: A National Health Insurance Service study in Korea

  • Epidemiology
  • Published:
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Abstract

Purpose

To examine whether depression, anxiety disorder, and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same.

Methods

Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study.

Results

Depression and anxiety disorder were associated with an increased risk of mortality [Hazard Ratio (HR) 1.26, 95% CI 1.18–1.36; HR 1.14, 95% CI 1.08–1.22, respectively] and their co-occurrence further increased the risk (HR = 1.38, 95% CI 1.24–1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients without any psychiatric comorbidity with no antidepressant treatment, the mortality risk increased in patients with either psychiatric comorbidity or both, but the risk seemed to attenuate with antidepressant treatments.

Conclusion

The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer, and antidepressant treatment may attenuate the risk. This underscores the need for screening and treating depression and anxiety disorders to improve survival in patients with breast cancer.

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Data availability

The data that support the findings of this study are available from National Health Insurance Service in Korea but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data can be however available from the National Health Insurance Service in Korea upon reasonable request and with permission of the National Health Insurance Service in Korea.

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Acknowledgements

This work was supported by the Korean Breast Cancer Society and the Study of Multi-disciplinary Teamwork for breast cancer survivorship (SMARTSHIP).

Author information

Authors and Affiliations

  1. Department of Psychology, Pusan National University, Busan, Republic of Korea

    Eun-Jung Shim

  2. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jong Won Lee

  3. Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea

    Jihyoung Cho

  4. Department of Surgery, Seran General Hospital, Seoul, Republic of Korea

    Hong Kyu Jung

  5. Department of Advertising and Branding, Kaywon University of Art and Design, Uiwang-si, Gyeonggi-Do, Republic of Korea

    Nam Hyoung Kim

  6. Department of Food and Nutrition, Seoul National University, Seoul, Republic of Korea

    Jung Eun Lee

  7. Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea

    Junwon Min

  8. Department of Surgery, Korea Institute of Radiology and Medical Science, Korea Cancer Center Hospital, Seoul, Republic of Korea

    Woo Chul Noh

  9. Department of Surgery, Daegu Catholic University Medical Center, Daegu, Republic of Korea

    Sung-Hwan Park

  10. Department of Surgery, Chosun University College of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju, 61453, Republic of Korea

    Yoo Seok Kim

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Contributions

YSK, JWL: Conceptualization; YSK, EJS: Methodology; YSK, EJS, JWL: Formal analysis and investigation; EJS: Writing—original draft preparation; EJS, JWL, JC, HKJ, NHK, JEL, JM, WCN, SHP, YSK: Writing—review and editing; YSK: Funding acquisition; JWL, JC: Resources; WCN, SHP: Supervision.

Corresponding author

Correspondence to Yoo Seok Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (the institutional review board of Chosun University Hospital; IRB N. CHOSUN 2016-11-001) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Patient-informed consent is not required as this study used existing data of the National Health Insurance Service in Korea which are not individually identifiable.

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Eun-Jung Shim and Jong Won Lee contributed equally to this work.

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Shim, EJ., Lee, J.W., Cho, J. et al. Association of depression and anxiety disorder with the risk of mortality in breast cancer: A National Health Insurance Service study in Korea. Breast Cancer Res Treat 179, 491–498 (2020). https://doi.org/10.1007/s10549-019-05479-3

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