Elsevier

Journal of Affective Disorders

Volume 218, 15 August 2017, Pages 59-65
Journal of Affective Disorders

Research paper
Risk of mood disorders in patients with colorectal cancer

https://doi.org/10.1016/j.jad.2017.04.050Get rights and content

Highlights

  • Patients with CRC had a significantly higher risk of developing mood disorders.

  • This phenomenon was also observed for depression, bipolar disease and anxiety.

  • A follow-up time >1 year was more likely to have significantly increased risks.

  • Some treatments tended to have a lower risk of anxiety compared to the counterparts.

Abstract

Background

To assess the risk of mood disorders among patients with colorectal cancer (CRC), a population-based cohort study was performed using the Taiwanese National Health Insurance Research Database.

Methods

The study cohort included 27242 patients diagnosed with CRC between January 1, 2000 and December 31, 2010. Four insurants from the general population without CRC were frequency matched to each case by age, sex, and index year/month to create the control group. Cox's proportional hazard regression model with hazard ratios (HRs) and 95% confidence intervals (CIs) was conducted to estimate the impact of CRC on the risk of mood disorders.

Results

Patients with CRC exhibited a significantly higher risk of developing mood disorders (adjusted HR=3.05, 95% CI =2.89–3.20) compared with the control group. This phenomenon was also observed for each type of mood disorder (depression, bipolar disease and anxiety), as well as across different subgroups by patient characteristics. However, a follow-up time longer than 1 year was more likely to have significantly increased risks, and we unexpectedly found that some treatments in CRC patients tended to have a decreased risk of anxiety compared to their counterparts.

Conclusion

The findings of this population-based cohort study suggest that patients with CRC are at a higher risk of mood disorders, especially when follow-up time is longer than 1 year, but various treatments may inversely affect this association.

Introduction

Cancer has been the leading cause of mortality among the general population in Taiwan since 1982 (Cancer Statistics Annual Report: Taiwan Cancer Registry). The incidence of cancer is rising continuously as the population rapidly ages and it constitutes an enormous burden in Taiwan. Colorectal cancer (CRC) remained the most common type of cancer in Taiwan for the eighth consecutive year. The average incidence rate from 2002 to 2012 was increased by 4.3% and 1.4% annually for colon cancer and rectal cancer, respectively (Chiang et al., 2016). The age-adjusted incidence rates for colon and rectal cancer were 37.72 and 22.84 per 100,000 people in 2012 (Chiang et al., 2016).

Mood disorders are a category of illnesses that includes major depressive disorder and bipolar disorder. A major depressive disorder is frequent in the general population and the Global Burden of Disease 2010 study identified depressive disorders as a leading cause of burden (Ferrari et al., 2013). Liao et al. found a low prevalence (1.2%) of major depressive disorder in Taiwanese adults and suggested that the pattern of low help-seeking behavior and profound functional impairment indicates much room for improvement in the early detection and intervention of major depression in this population (Liao et al., 2012). Bipolar disorder, formerly called manic depression, causes extreme mood swings ranging from a manic to a depressive state. Both depression and bipolar disorders are commonly associated with anxiety disorders (Preti et al., 2016, Mystakidou et al., 2005). An anxiety disorder is a feeling of nervousness, apprehension, fear, or worry. It is a chronic disorder and highly prevalent in the adult population. The prevalence of lifetime anxiety among the general population was around 5% in western countries in 2002 (Grant et al., 2005, Wittchen et al., 1994). In Taiwan, Hwu et al. found that the life time prevalence of anxiety differed considerably according to geographic sampling area, ranging from 3.7% to 10.5% (Hwu et al., 1989). Anxiety has a detrimental impact on health outcomes, such as increased risk of respiratory resistance in asthma and coronary heart disease (Roest et al., 2010, Ritz et al., 2000).

Depression, anxiety, and bipolar disorders are not uncommon among patients diagnosed with cancer (Nikbakhsh et al., 2014, Linden et al., 2012, Jadoon et al., 2010). In fact, it has been suggested that ongoing medical and psychosocial effects of cancer as well as its related treatments may lead to long-term psychological morbidity in cancer survivors (Khan et al., 2010, Aziz, 2002). Emotional distress was thought as the sixth vital sign in cancer care (Bultz and Carlson, 2005). Several individual cancer sites have been explored to evaluate the risk of subsequent depression and anxiety (Schwarz et al., 2008, Watson et al., 2005, Lintz et al., 2003, Aukst Margetić et al., 2013, Tavoli et al., 2007). However, only a limited number of papers focused on the issue of mood disorder risk among patients with CRC (Kurtz et al., 2002a, Kurtz et al., 2002b, Sehlo and Al Ahwal, 2013, Stommel et al., 2004). Considering that CRC is the most common cancer seen in Taiwan, with a relatively better prognosis compared to lung and liver cancers (high incidence in Taiwan), it would be interesting to know the psychosocial sequelae of CRC patients. In this study, we tried to determine whether CRC is a risk factor in the development of mood disorders, with the possible association that it's a temporary phenomenon or longer lasting, and if the cancer-related treatments aggravate the risks of mood disorders.

Section snippets

Data source

Taiwan Bureau of National Health Insurance (BNHI) established a single-payer National Health Insurance (NHI) program on March 1, 1995 and covers nearly all (99%) 23.7 million residents of Taiwan (Database NHIR). The Taiwan National Health Insurance Research Database (NHIRD) contains the de-identified medical claims records, compiled by the Taiwan National Health Research Institutes (NHRI). The details of the NHI program and NHIRD were well written in previous studies (Chou et al., 2016, Lin et

Results

The study subjects were composed of 27242 patients in the CRC cohort and 108046 persons in the non-CRC cohort. The mean age of the CRC cohort was 64.2 years and that of the non-CRC cohort was 63.5 years, with approximately 51% of the patients aged ≥65 years and most were men (approximately 61%) (Table 1). Most of the occupations in both cohorts were white-collar jobs (45.5% vs 43.4%), and the cohorts preferred to reside in urbanized areas (51.1% vs 56.1%). The CRC cohort and non-CRC cohort had

Discussion

The main finding of our large population-based cohort study was that Taiwanese patients with CRC had a significantly increased risk of developing mood disorders compared to the control group of people without CRC. The higher risks were consistent across different subgroups by patient socio-demographic characteristics. We unexpectedly disclosed that the significantly increased risks were more prominent in the group with follow-up time longer than 1 year and some types of cancer-related treatment

Disclosure statement

Li-Min Sun, Ji-An Liang, Cheng-Li Lin, Sean Sun, and Chia-Hung Kao declare that they have no conflict of interest.

Novelty and impact statements

Patients with colorectal cancer exhibited a significantly higher risk of developing mood disorders (depression, bipolar disease and anxiety) (adjusted HR =3.05, 95% CI =2.89–3.20) compared with the control group. However, a follow-up time longer than 1 year was more likely to have significantly increased risks, and we unexpectedly found that some treatments in colorectal cancer patients tended to have a lower risk of anxiety compared to their counterparts.

Acknowledgments

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004); China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM10501010037); NRPB Stroke Clinical Trial Consortium (MOST105-2325-B-039-003); Tseng-Lien Lin Foundation, Taichung, Taiwan; Taiwan Brain Disease Foundation, Taipei, Taiwan; Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and Health, and welfare

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