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Depression as a Prognostic Factor for Breast Cancer Mortality

Received Aug. 28, 2001; revision received March 20, 2002; accepted April 16, 2002. From the Center of Preventive Medicine, Glostrup University Hospital, Glostrup, Denmark; the Institute of Public Health, University of Copenhagen, Copenhagen; the Psychiatric Hospital of Aarhus, Risskov, Denmark; and the Department of Oncology, Rigshospitalet University Hospital. Address reprint requests to Dr. Hjerl, Department of Psychiatry, Rigshospitalet University Hospital, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark; khjerl{at}dadlnet.dk (e-mail).

It is unclear if depression or depressive symptoms have an effect on mortality in breast cancer patients. In this population-based, nationwide, retrospective cohort study in Denmark, depression was defined as affective or anxiety disorders that necessitated psychiatric hospital admission. All the affective and anxiety disorders were divided and categorized into five ordinal diagnostic groups. Early-stage (N=10,382) and late-stage (N=10,211) breast cancer patients were analyzed separately with Cox's regression adjusted for well-documented somatic prognostic variables. The authors used survival analysis of data from three central registers and found that breast cancer patients with depression had a modestly but significantly higher risk of mortality depending on stage of breast cancer and time of depression. The same result was found after censoring unnatural causes of death such as accident, suicide, or homicide.

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