Effect of depression before breast cancer diagnosis on mortality among postmenopausal women

• Published in: Cancer Vol. 123; no. 16; pp. 3107 - 3115
• Main Authors: Liang, Xiaoyun, Margolis, Karen L., Hendryx, Michael, Reeves, Katherine, Wassertheil‐Smoller, Sylvia, Weitlauf, Julie, Danhauer, Suzanne C., Chlebowski, Rowan T., Caan, Bette, Qi, Lihong, Lane, Dorothy, Lavasani, Sayeh, Luo, Juhua
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.08.2017
• Subjects: Aged; Antidepressive Agents - therapeutic use; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Cancer; Cause of Death; Cohort Studies; Comorbidity; Confidence intervals; Cox proportional hazards regression model; Death; depression; Depression - drug therapy; Depression - epidemiology; Depressive Disorder - drug therapy; Depressive Disorder - epidemiology; Diagnosis; Female; Hazards; Health risk assessment; Health risks; Humans; Mammography; Medical diagnosis; Mental depression; Mental disorders; Mental health; Middle Aged; Mortality; Multivariate Analysis; Neoplasm Staging; Oncology; Post-menopause; postmenopausal women; Postmenopause; Proportional Hazards Models; Prospective Studies; Regional development; Statistical analysis; Studies; Womens health; Cox proportional hazards regression model; mortality; breast cancer; depression; postmenopausal women
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.30688

BACKGROUND Few previous studies investigating depression before the diagnosis of breast cancer and breast cancer–specific mortality have examined depression measured at more than 1 time point. This study investigated the effect of depression (combining depressive symptoms alone with antidepressant use) measured at 2 time points before the diagnosis of breast cancer on all‐cause mortality and breast cancer–specific mortality among older postmenopausal women. METHODS A large prospective cohort, the Women's Health Initiative, was used. The study included 3095 women with incident breast cancer who had measures of depressive symptoms and antidepressant use before their diagnosis at the baseline and at year 3. Multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs) between depression at the baseline, depression at year 3, and combinations of depression at these time points and all‐cause mortality and breast cancer–specific mortality. RESULTS Depression at year 3 before a breast cancer diagnosis was associated with higher all‐cause mortality after adjustments for multiple covariates (HR, 1.35; 95% confidence interval [CI], 1.02‐1.78). There was no statistically significant association of baseline depression and all‐cause mortality or breast cancer–specific mortality whether or not depression was also present at year 3. In women with late‐stage (regional‐ or distant‐stage) breast cancer, newly developed depression at year 3 was significantly associated with both all‐cause mortality (HR, 2.00; 95% CI, 1.13‐3.56) and breast cancer–specific mortality (HR, 2.42; 95% CI, 1.24‐4.70). CONCLUSIONS Women with newly developed depression before the diagnosis of breast cancer had a modestly but significantly increased risk for death from any cause and for death from breast cancer at a late stage. Cancer 2017;123:3107–15. © 2017 American Cancer Society. Women with newly developed depression before the diagnosis of breast cancer have a modestly but significantly increased risk for death from any cause and for death from breast cancer if they are diagnosed at a late stage. The results also highlight the importance of prevention efforts to supporting mental health and preventing the initial emergence of depression among older women.