Abstract
Purpose
Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved.
Methods
We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008–2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs.
Results
Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78–1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01–2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population.
Conclusion
Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Depression and anxiety disorders–Common Mental Disorders (CMDs)—are highly prevalent [1] and are the important causes of disability [2]. The association between CMDs and chronic medical illnesses such as cardiovascular diseases, diabetes, and cancer may even increase the risk of premature death [3].
The relationship between depressive–anxiety disorders and neoplasms has been increasingly studied in the last two decades [4]. Not surprisingly, studies of patients with cancer found a high prevalence of depression and anxiety disorders [5]. Moreover, CMDs have been suggested to be predictors of newly diagnosed neoplasms [6] and are associated with a worsening of cancer outcomes, including mortality [7]. Therefore, it has been hypothesized that depression and anxiety may play an etiologic role in the development and progression of neoplasms [8].
Epidemiological studies examining the relationship between CMD and cancer have yielded mixed and inconclusive findings. Some studies did not find any associations between depression and increased cancer mortality [9], while others suggested that only a small and non-significant relationship exists [10]. A recent meta-analysis of 51 studies found that people affected by depression and anxiety have a significantly higher risk (RR 1.21, 95% CI 1.16–1.26) of neoplasm mortality than psychologically healthy individuals [4]. However, included studies were characterized by high clinical and methodological heterogeneity [4]. In particular, most of them recruited patients with depressive and anxiety symptoms (e.g., so-called psychological distress syndrome) [8,9,10,11]; only a minority included patients with a verified clinical diagnosis [12]. Moreover, the bulk of the existing literature concerns the survival of oncological patients with newly diagnosed CMDs, usually enrolled from hospital cancer units [13,14,15,16]. Very few studies included patients from specialist mental healthcare settings [12]. Using the latter recruitment strategy would improve the reliability of the diagnosis, as in that setting it would be made by a psychiatrist according to standardized criteria. Some additional limitations of the published literature include a predominant focus on depressive disorders [11, 17,18,19], even if the few studies including people with anxiety disorders found they had an increased risk of cancer death. Specifically, mortality rates were similar to those estimated for depressive disorders [13, 20]. Given that anxiety disorders are also widespread, their association with cancer mortality deserves a greater attention [21]. Finally, most studies examined cancer-related mortality without differentiating between site specific-cancers [11, 22, 23]. The association between CMDs and cancer may vary according to cancer type [4] because of different biological and behavioral mechanisms and risk factors.
The aim of this study was to explore cancer-related mortality in a large sample of individuals with CMDs, including both depression and anxiety, and to consider the mortality for specific types of cancer.
Methods
This registry-based, retrospective cohort study examined a large dataset of patients diagnosed and treated by mental health specialists over a 10-year period (2008–2017) in the Mental Health Departments of Emilia-Romagna (ER), a region in northern Italy with about 4.5 million inhabitants.
In ER, patients suffering from psychiatric disorders that are reactive to cancer can be referred to different clinical services. A psycho-oncology service has been operating for many years in the region [24]. Specific psychological support services are usually integrated within hospital cancer units [25] and home palliative care units [26]. In addition, a consultation liaison psychiatric service for primary care is available to support general practitioners, usually treating individuals with milder clinical conditions. More severe cases requiring multidisciplinary care, social support, and/or intensive psychiatric rehabilitation are usually referred to secondary mental healthcare services [27]. ER has a community-based mental healthcare system based on eight Mental Health Departments (MHD), one for each Local Health Trust, as detailed in previous studies [28, 29]. This study included all patients aged 18 years or over who accessed the regional MHD and received a diagnosis of a CMD, namely depression or neurotic disorders (the ICD-9 equivalent of DSM anxiety, trauma, and somatic related disorders) during the period 1 January 2008 to 31 December 2017. Psychiatric diagnoses were defined according to the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9 CM). For the diagnostic codes included in our study see Table 1 in Online Resources.
The regional Mental Health Registry was used to identify study participants and retrieve demographic data (age, gender, citizenship, and residency), psychiatric diagnosis, and the date of first referral. The registry was developed for administrative, clinical, and epidemiological purposes; it contains information on psychiatric diagnoses, dates of visits, and treatments (pharmaceutical, psychological, and rehabilitative) of all inpatients and outpatients who accessed the MHD. Demographic features, as well as diagnoses, are routinely recorded at the first clinical evaluation and then constantly updated by clinicians; all data are collected together via an information system at the regional level. Residents outside the ER region and patients who had accessed the MHD before 2008 were excluded.
To retrieve information on deaths (dates and causes of death), the Mental Health Registry was linked with the Regional Cause of Death Registry (for the years 2008–2017). For this purpose, we assigned a single numeric anonymous identity code to subjects registered in all regional health archives. The Regional Cause of Death Registry covers all deaths of the regional population and contains information about socio-demographic characteristics, date, location, and circumstances of death. The main cause of death is routinely collected immediately after death. Within 1 year, all deaths are coded according to the ICD-10 classification (International Classification of Disease, tenth revision, Clinical Modification). The cause of death that arose first and/or had the greatest influence on death is chosen, following the criteria of the World Health Organization [30] Both registries undergo regular systematic quality control.
For this study, we considered deaths for all causes and for total neoplasms, further divided into site-specific malignant neoplasms identified by specific ICD-10 codes (Table 2 in Online Resources). Patients who changed their residence to another region according to the Regional Population Archive were considered lost to follow-up because of the impossibility of ascertaining their life status. The regional population was used as the comparator group. The Regional Population Archive provided aggregated data on the age and gender composition of this population. The study was approved by the local Ethical Committee (N. 341/2019).
Statistical analyses
We calculated frequency of death for all causes, for neoplasms, and for each site-specific malignant neoplasm in the whole study population and separately by diagnosis (depression or neurotic disorders). We calculated the standardized mortality ratio (SMR) with 95% confidence intervals (CI) to compare the risk of mortality between the regional and the study population. The SMR is the ratio between the number of observed deaths and the number of expected deaths as if the study population had the same gender and age rates (the latter grouped in classes) as the regional population. An SMR equal to 1 indicates the number of observed deaths is equal to the number of expected deaths, an SMR greater than 1 indicates that there are more deaths than expected and an SMR lower than 1 indicates that the deaths are lower than expected. The SMR was also calculated by gender (controlling for age class only), type of cancer, and psychiatric diagnosis in cases in which there were more than three observed deaths. The differences between observed and expected deaths were considered statistically significant if the 95% CI of the SMR did not include the value of one. Person-years were used as the denominator and were calculated as the difference between the date of the first access to a Mental Health Department and either the 31 December 2017, the date of death or the date of moving to another region, whichever was earlier.
Results
The cohort consisted of 101,487 subjects suffering from common mental disorders, 56,489 from depressive disorders, and 44,998 from neurotic disorders. Table 1 shows the main demographic characteristics of the population at their first admission to the Mental Health Department.
During the study period, there were 8,172 deaths for all causes and 3,087 deaths for in the study population, with a higher proportion of cancer mortality compared to the regional population (37.8 vs. 29.6%, p = 0.001).
As shown in Table 2, the proportion of deaths due to neoplasms does not differ between neurotic disorders and depression. As site-specific neoplasms are concerned, the five most frequent causes of death are: cancer of the trachea/bronchus and lung, lymphoid and hematopoietic neoplasms, cancer of the colon/rectum/anus, pancreatic and breast cancer in both the regional population and in the population with CMDs. They appear in the same ranking except for breast cancer that is more frequent in the CMDs population than in the regional population.
The standardized all-cause mortality ratio was 1.8 times (95% CI 1.78–1.86) higher in patients with CMDs than in the regional population and the mortality for neoplasms was more than double in the CMDs population (SMR 2.08, 95% CI 2.01–2.16). The mortality ratio was higher in patients with depression than in patients with neurotic disorders (SMR 2.18, 95% CI 2.09–2.28 vs. 1.91, 95% CI 1.79–2.03) (Table 3).
Males showed a higher mortality ratio than females when considering all-cause mortality (SMR 2.04, 95% CI 1.98–2.11 vs SMR 1.67, 95% CI 1.62–1.72), but not when considering only cancer-related deaths (Table 4). Table 4 shows that the SMR was greater than 1 in all cases except for colon/rectal/anal cancer in women with neurotic disorders. The SMR was always significant except for melanoma in males with any common mental disorders, cancer of the oesophagus in neurotic patients (of both genders), and cancer of the bladder in women with depression.
As shown in Tables 3 and 4, the SMR for larynx cancer was significantly higher than the SMR for all neoplasms in depressed patients and in neurotic patients, in particular for males. A higher SMR was also registered for cancer of the oesophagus in depressed patients. Moreover, standardized mortality was also notably high for central nervous system (CNS) cancers in neurotic patients as well as for ovarian cancer, especially among patients with depression. A lower SMR was registered for melanoma in both depressed and neurotic patients and for the cancer of the liver and biliary tract. With the exception of cancer of the larynx, no significant differences in the SMR were observed between most cancer subtypes (see Fig. 1).
Discussion
Our study investigated cancer-related mortality among people with CMDs, recruiting its sample from the public mental healthcare setting. Our main finding is that the risk of dying from cancer was substantially higher in people with CMDs than in the regional population. Higher mortality was found for almost all neoplasms in patients affected by depressive and neurotic disorders, although there was some variability in the additional risk depending on the type of tumor. In particular, larynx and oesophagus cancer were the main causes of cancer mortality in both genders; while the SMR for ovarian cancer was particularly elevated among women, and the SMR for CNS cancers was highest among men.
Previous studies found greater mortality from cancer in people with depressive disorders [11, 18, 19, 22, 31], but they reported risk estimates (SMRs from 1.3 to 1.8) that are significantly lower than our estimates. According to a French study, which recruited participants through a survey [11], the risk of dying from cancer was elevated only for women with depression but not for men. We found a significantly increased mortality risk in both genders. Other large prospective-cohort studies investigated the association between depressive and anxiety symptomatology, jointly defined as psychological distress, and cancer-related mortality, finding a modest but statistically significant increase [8, 32]. However, this finding was not replicated in other prospective studies [9, 10, 24]. Such heterogeneity may be explained by differences in study designs, sample sizes, and other methodological aspects, including the way in which the samples were selected. The present study was conducted on a large cohort of mental healthcare service users with relatively severe and recurrent illness, while surveys with random sampling methods recruited a smaller and probably less severely ill sample [11, 31]. Moreover, previous studies mostly ascertained the presence of CMDs using psychometric tests [9, 33], often self-administered [8, 10, 32], rather than using clinical diagnoses. The detection of lower risk, or failure to detect increased mortality may be due to the inclusion of individuals with sub-threshold syndromes, as confirmed by a recent meta-analysis [4].
Interestingly, we found that not only patients with depression but also those with neurotic disorders were at higher risk of dying from neoplasms, suggesting a possible link between cancer and the whole spectrum of CMDs. Depressive and anxiety disorders may share genetic diathesis [34]. A common genetic background has also been demonstrated between depression and some types of cancer [35, 36]. A possible mediator of this common genetic background could be underlying personality traits (such as neuroticism and extraversion) [34]. These have been shown to predispose to anxiety and depression [34], as well as to increased exposure to risk factors for cancer [37] and to cancer mortality [38]. These hypotheses need to be further explored, considering possible confounders and mediators of this relationship.
Another finding of our study is that excess mortality spanned almost all types of neoplasms. People affected by depression were at elevated risk of death from all cancer types; among patients with neurotic disorders, only the SMR for oesophageal cancer and melanoma did not reach statistical significance. These findings do not necessarily reflect a causal effect between CMDs and cancer-related mortality, but they are in line with two previous studies showing that depression and anxiety could be associated with shorter survival in patients with a broad range of cancers [14, 20]. A further study [17] found that depressed individuals had an increased cancer-related mortality irrespective of cancer site, but the leading causes of death were due to breast and lungs cancers. We detected higher mortality in people with CMDs for a wide spectrum of cancers: both characterized by high heritability and those closely related to lifestyle; both neoplasms targeted by screening programs and those not targeted, which often have a late diagnosis; and also in cancers with a variety of prognoses. Thus, multiple putative pathophysiological pathways might link CMDs with cancer-related mortality at the biological, psychological, and social levels.
First, neoplasm incidence and progression could be enhanced in people with CMDs. Several studies indicate that depression, anxiety, and all the aforementioned cancers may share a common biological liability induced by chronic inflammation and immune system function impairment [39]. For instance, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis as well as altered autonomic responses have been suggested as mediators of the vulnerability to hormone-related neoplasms (e.g., breast and ovarian cancers) due to chronic inflammation [40, 41]. In addition, CMDs may lead to unhealthy lifestyles [42]. The high propensity of patients with CMDs to smoke [43] could increase the risk of developing several types of cancers, especially those of the respiratory tract such as laryngeal cancer [44], and urothelial carcinomas such as bladder cancer [45]. Poor quality diet [46] and high alcohol consumption [47] may facilitate the process of oesophageal [48] and laryngeal [44] carcinogenesis in people with CMDs. Finally, tricyclic antidepressants and SSRIs should also be mentioned, as few studies found a link between the use of these drugs and an increased risk of breast [49] and ovarian cancer [50].
Second, cancer diagnosis and treatment could be influenced by comorbidity with CMDs. Growing evidence suggests that people with depression and anxiety disorders receive poorer levels of care compared to the general population [51]. This has been associated with a more advanced staging at cancer diagnosis and higher mortality, particularly from some neoplasms such as breast and colorectal cancer [52]. Moreover, studies conducted on insurance databases found inadequate treatment even after cancer diagnosis. In particular, men with prostate cancer and comorbid depression were less likely to undergo radical surgery and radiotherapy [53]compared with non-depressed men. Women suffering from depression prior to cancer diagnosis had a lower likelihood of receiving definitive treatment for breast cancer, such as surgery or chemotherapy [54]. In both cases, a diagnosis of depression was associated with poorer survival. Furthermore, depressive symptoms such as a loss of interest and initiative may delay or hinder treatment plans [55]. Several studies showed that having depression predicted non-adherence to adjuvant hormonal therapy in breast cancer survivors [55, 56].
The major strengths of our study are the large-scale cohort design, the considerable follow-up, the independently and consistently collected data on both depressive and anxiety disorders, and causes of death. In addition, we were able to investigate mortality for all specific types of cancer.
However, the following limitations should be taken into account. First, it could be argued that some patients developed CMDs in reaction to the diagnosis of cancer, thus inflating the magnitude of the association, but in fact being a case of reverse causality [15]. In addition, some patients may have been referred to the mental health service because of cancer-related psychiatric symptoms (misdiagnosis). This could be true, for example, for CNS cancers [57], whose clinical onset may be initially masked by depression or anxiety syndromes. We did not have information on the temporal relationship between cancer and CMD onset. Collaborative care may have favored referrals from general practitioners to mental health services after cancer diagnosis [27]. However, there is unlikely to be a high proportion of patients referred by primary care services in our study. Specific psycho-oncologic and psychological services within the general hospital usually provide care for the majority of patients with primary cancer and secondary mental disorders, without referring them to a mental health setting [24]. Other individuals with CMDs receive care from general practitioners, private psychiatrists or—unfortunately—remain undiagnosed and untreated.
Second, we did not account for the competing risks of other causes of death (such as cardiovascular diseases or suicide) which may have precluded the occurrence of death from neoplasms among one of the two groups. Our cancer mortality estimates could thus be affected by this bias.
Third, we had no information on potential confounders such as other physical comorbidities, socio-economic conditions or environmental exposure (e.g., lifestyles, substance use etc.) that might also affect mortality among individuals with CMDs. Further studies are required to investigate this potential source of bias.
Finally, anxiety and depression disorders may co-occur; thus, the epidemiological correlation between anxiety and cancer mortality could be partly inflated by comorbid depression [58]. As we considered only the main psychiatric diagnosis, this cannot be completely ruled out.
Conclusions
Patients with CMDs have an excess mortality from cancer compared to the general population. Our study shows that both depressive and anxiety disorders are associated with an increased risk of death from a broad range of site-specific neoplasms. Further research is needed to investigate the relationship between the onset and the course of CMDs and cancer mortality, taking into account competing causes of death. There are many potential pathophysiological mechanisms underlying this association, which should also be analyzed. In the meantime, we highlight a need for closer cooperation between primary care physicians, mental health services, and oncology specialists. Patients with CMDs need increased clinical attention, focused cancer prevention initiatives, and careful monitoring to achieve early diagnosis and appropriate treatment.
Availability of data and material
Data of the study will be shared on reasonable request.
References
Steel Z, Marnane C, Iranpour C et al (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol 43:476–493. https://doi.org/10.1093/ije/dyu038
Whiteford HA, Degenhardt L, Rehm J et al (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382:1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6
Koyanagi A, Köhler-Forsberg O, Benros ME et al (2018) Mortality in unipolar depression preceding and following chronic somatic diseases. Acta Psychiatr Scand 138:500–508. https://doi.org/10.1111/acps.12899
Wang Y-H, Li J-Q, Shi J-F et al (2020) Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry 25:1487–1499. https://doi.org/10.1038/s41380-019-0595-x
Mitchell AJ, Chan M, Bhatti H et al (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12:160–174. https://doi.org/10.1016/S1470-2045(11)70002-X
Chen Y-H, Lin H-C (2011) Increased risk of cancer subsequent to severe depression—a nationwide population-based study. J Affect Disord 131:200–206. https://doi.org/10.1016/j.jad.2010.12.006
Ko A, Kim K, Sik Son J et al (2019) Association of pre-existing depression with all-cause, cancer-related, and noncancer-related mortality among 5-year cancer survivors: a population-based cohort study. Sci Rep 9:18334. https://doi.org/10.1038/s41598-019-54677-y
Batty GD, Russ TC, Stamatakis E, Kivimäki M (2017) Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ 356:j108. https://doi.org/10.1136/bmj.j108
Wyman L, Crum RM, Celentano D (2012) Depressed mood and cause-specific mortality: a 40-year general community assessment. Ann Epidemiol 22:638–643. https://doi.org/10.1016/j.annepidem.2012.06.102
Ponizovsky AM, Haklai Z, Goldberger N (2018) Association between psychological distress and mortality: the case of Israel. J Epidemiol Community Health 72:726–732. https://doi.org/10.1136/jech-2017-210356
Lemogne C, Niedhammer I, Khlat M et al (2012) Gender differences in the association between depressive mood and mortality: a 12-year follow-up population-based study. J Affect Disord 136:267–275. https://doi.org/10.1016/j.jad.2011.11.041
Chang C-K, Hayes RD, Broadbent MTM et al (2014) A cohort study on mental disorders, stage of cancer at diagnosis and subsequent survival. BMJ Open 4:e004295. https://doi.org/10.1136/bmjopen-2013-004295
Ding T, Wang X, Fu A et al (2019) Anxiety and depression predict unfavorable survival in acute myeloid leukemia patients. Medicine (Baltimore) 98:e17314. https://doi.org/10.1097/MD.0000000000017314
Walker J, Magill N, Mulick A et al (2020) Different independent associations of depression and anxiety with survival in patients with cancer. J Psychosom Res 138:110218. https://doi.org/10.1016/j.jpsychores.2020.110218
Chen WC, Boreta L, Braunstein SE et al (2022) Association of mental health diagnosis with race and all-cause mortality after a cancer diagnosis: Large-scale analysis of electronic health record data. Cancer 128:344–352. https://doi.org/10.1002/cncr.33903
Chan CMH, Wan Ahmad WA, Yusof MMD et al (2015) Effects of depression and anxiety on mortality in a mixed cancer group: a longitudinal approach using standardised diagnostic interviews. Psychooncology 24:718–725. https://doi.org/10.1002/pon.3714
Onitilo AA, Nietert PJ, Egede LE (2006) Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry 28:396–402. https://doi.org/10.1016/j.genhosppsych.2006.05.006
Rantanen AT, Kallio MM, Korkeila JJA et al (2020) Relationship of non-melancholic and melancholic depressive symptoms with all-cause mortality: a prospective study in a primary care population. J Psychosom Res 133:110107. https://doi.org/10.1016/j.jpsychores.2020.110107
Das-Munshi J, Schofield P, Bhavsar V et al (2019) Ethnic density and other neighbourhood associations for mortality in severe mental illness: a retrospective cohort study with multi-level analysis from an urbanised and ethnically diverse location in the UK. Lancet Psychiatry 6:506–517. https://doi.org/10.1016/S2215-0366(19)30126-9
Zhu J, Fang F, Sjölander A et al (2017) First-onset mental disorders after cancer diagnosis and cancer-specific mortality: a nationwide cohort study. Ann Oncol 28:1964–1969. https://doi.org/10.1093/annonc/mdx265
Walker ER, McGee RE, Druss BG (2015) Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiat 72:334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502
Guan NC, Termorshuizen F, Laan W et al (2013) Cancer mortality in patients with psychiatric diagnoses: a higher hazard of cancer death does not lead to a higher cumulative risk of dying from cancer. Soc Psychiatry Psychiatr Epidemiol 48:1289–1295. https://doi.org/10.1007/s00127-012-0612-8
Hamer M, Chida Y, Molloy GJ (2009) Psychological distress and cancer mortality. J Psychosom Res 66:255–258. https://doi.org/10.1016/j.jpsychores.2008.11.002
Grassi L, Watson M, Federation IPOS, of Psycho-Oncology Societies’ co-authors, (2012) Psychosocial care in cancer: an overview of psychosocial programmes and national cancer plans of countries within the International Federation of Psycho-Oncology Societies. Psychooncology 21:1027–1033. https://doi.org/10.1002/pon.3154
Meggiolaro E, De Padova S, Ruffilli F, Bertelli T, Bragagni M, Prati S, Pisotti L, Massa I, Foca F, Tamberi S, De Giorgi U, Zerbinati L, Grassi L (2021) From Distress screening to uptake: an italian multicenter study of cancer patients. Cancers. https://doi.org/10.3390/cancers13153761
Formoso G, Marino M, Guberti M, Grilli RG (2022) End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy. BMJ Open 12:e057437. https://doi.org/10.1136/bmjopen-2021-057437
Berardi D, Ferrannini L, Menchetti M, Vaggi M (2014) Primary care psychiatry in Italy. J Nerv Ment Dis 202:460–463. https://doi.org/10.1097/NMD.0000000000000145
Berardi D, Stivanello E, Chierzi F et al (2021) Mortality in mental health patients of the Emilia-Romagna region of Italy: A registry-based study. Psychiatry Res 296:113702. https://doi.org/10.1016/j.psychres.2020.113702
Grassi L, Stivanello E, Belvederi Murri M et al (2021) Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy. Psychooncology 30:2039–2051. https://doi.org/10.1002/pon.5805
World Health Organization (2015) International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. World Health Organization, Geneva
Pratt LA, Druss BG, Manderscheid RW, Walker ER (2016) Excess mortality due to depression and anxiety in the United States: results from a nationally representative survey. Gen Hosp Psychiatry 39:39–45. https://doi.org/10.1016/j.genhosppsych.2015.12.003
Moise N, Khodneva Y, jannat-khah D, et al (2018) Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: The REGARDS study. BMJ Open 8:e017385. https://doi.org/10.1136/bmjopen-2017-017385
Batty GD, McIntosh AM, Russ TC et al (2016) Psychological distress, neuroticism, and cause-specific mortality: early prospective evidence from UK Biobank. J Epidemiol Community Health 70:1136–1139. https://doi.org/10.1136/jech-2016-207267
Goodwin GM (2015) The overlap between anxiety, depression, and obsessive-compulsive disorder. Dialogues Clin Neurosci 17:249–260
Zhu G-L, Xu C, Yang K et al (2022) Causal relationship between genetically predicted depression and cancer risk: a two-sample bi-directional mendelian randomization. BMC Cancer 22:353. https://doi.org/10.1186/s12885-022-09457-9
Ren Q, Luo F, Ge S, Chen P (2022) Major depression disorder may causally associate with the increased breast cancer risk: Evidence from two-sample mendelian randomization analyses. Cancer Med. https://doi.org/10.1002/cam4.5043
Otonari J, Ikezaki H, Furusyo N, Sudo N (2021) Do neuroticism and extraversion personality traits influence disease-specific risk factors for mortality from cancer and cardiovascular disease in a Japanese population? J Psychosom Res 144:110422. https://doi.org/10.1016/j.jpsychores.2021.110422
Ying L, Chen S, Li L, Pan Z (2021) The impact of personality on the risk and survival of breast cancer: a Mendelian randomization analysis. Psychol Med. https://doi.org/10.1017/S0033291721001562
Galan D, Perry BI, Warrier V et al (2022) Applying Mendelian randomization to appraise causality in relationships between smoking, depression and inflammation. Sci Rep 12:15041. https://doi.org/10.1038/s41598-022-19214-4
Bortolato B, Hyphantis TN, Valpione S et al (2017) Depression in cancer: The many biobehavioral pathways driving tumor progression. Cancer Treat Rev 52:58–70. https://doi.org/10.1016/j.ctrv.2016.11.004
Wang X, Wang N, Zhong L et al (2020) Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Mol Psychiatry 25:3186–3197. https://doi.org/10.1038/s41380-020-00865-6
Grassi L, Riba M (2020) Cancer and severe mental illness: Bi-directional problems and potential solutions. Psychooncology 29:1445–1451. https://doi.org/10.1002/pon.5534
Matcham F, Carroll A, Chung N et al (2017) Smoking and common mental disorders in patients with chronic conditions: An analysis of data collected via a web-based screening system. Gen Hosp Psychiatry 45:12–18. https://doi.org/10.1016/j.genhosppsych.2016.11.006
Cattaruzza MS, Maisonneuve P, Boyle P (1996) Epidemiology of laryngeal cancer. Eur J Cancer B Oral Oncol 32B:293–305. https://doi.org/10.1016/0964-1955(96)00002-4
van Osch FHM, Jochems SHJ, van Schooten FJ et al (2016) Significant role of lifetime cigarette smoking in worsening bladder cancer and upper tract urothelial carcinoma prognosis: a meta-analysis. J Urol 195:872–879. https://doi.org/10.1016/j.juro.2015.10.139
Schweren LJS, Larsson H, Vinke PC et al (2021) Diet quality, stress and common mental health problems: A cohort study of 121,008 adults. Clin Nutr 40:901–906. https://doi.org/10.1016/j.clnu.2020.06.016
Boden JM, Fergusson DM (2011) Alcohol and depression. Addiction 106:906–914. https://doi.org/10.1111/j.1360-0443.2010.03351.x
Bagnardi V, Rota M, Botteri E et al (2013) Light alcohol drinking and cancer: a meta-analysis. Ann Oncol 24:301–308. https://doi.org/10.1093/annonc/mds337
Sharpe CR, Collet J-P, Belzile E et al (2002) The effects of tricyclic antidepressants on breast cancer risk. Br J Cancer 86:92–97. https://doi.org/10.1038/sj.bjc.6600013
Harlow BL, Cramer DW, Baron JA et al (1998) Psychotropic medication use and risk of epithelial ovarian cancer. Cancer Epidemiol Biomarkers Prev 7:697–702
Solmi M, Firth J, Miola A et al (2020) Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people. Lancet Psychiatry 7:52–63. https://doi.org/10.1016/S2215-0366(19)30414-6
Grassi L, Riba MB (2021) Disparities and inequalities in cancer care and outcomes in patients with severe mental illness: call to action. Psychooncology 30:1997–2001. https://doi.org/10.1002/pon.5853
Prasad SM, Eggener SE, Lipsitz SR et al (2014) Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer. JCO 32:2471–2478. https://doi.org/10.1200/JCO.2013.51.1048
Goodwin JS, Zhang DD, Ostir GV (2004) Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. J Am Geriatr Soc 52:106–111. https://doi.org/10.1111/j.1532-5415.2004.52018.x
Manning M, Bettencourt BA (2011) Depression and medication adherence among breast cancer survivors: Bridging the gap with the theory of planned behaviour. Null 26:1173–1187. https://doi.org/10.1080/08870446.2010.542815
Markovitz LC, Drysdale NJ, Bettencourt BA (2017) The relationship between risk factors and medication adherence among breast cancer survivors: What explanatory role might depression play? Psychooncology 26:2294–2299. https://doi.org/10.1002/pon.4362
Goldacre MJ, Kurina LM, Wotton CJ et al (2005) Schizophrenia and cancer: an epidemiological study. Br J Psychiatry 187:334–338. https://doi.org/10.1192/bjp.187.4.334
Miloyan B, Bulley A, Bandeen-Roche K et al (2016) Anxiety disorders and all-cause mortality: systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 51:1467–1475. https://doi.org/10.1007/s00127-016-1284-6
Acknowledgements
The authors thank Clara Pope for English editing.
Funding
Open access funding provided by Alma Mater Studiorum - Università di Bologna within the CRUI-CARE Agreement. No funding was received to assist with the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
DB, FC, and ES conceived and designed the study. AS acquired the data. Analyses were performed by ES, MAM, and PM. The first draft of the manuscript was written by FC and ES. DB and MM supervised the study. MBM created the figures. All authors critically commented on previous version of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Chierzi, F., Stivanello, E., Musti, M.A. et al. Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 58, 309–318 (2023). https://doi.org/10.1007/s00127-022-02376-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-022-02376-x