Associations between multimorbidity and depression among breast cancer survivors within the UK Biobank cohort: a cross-sectional study

Abstract

Background Advances in the early detection of cancer and its treatment have resulted in an increasing number of people living with and beyond breast cancer. Multimorbidity is also becoming more common in this population as more people live longer with breast cancer and experience late effects of cancer treatment. Breast cancer survivors have heightened risk of depression, but to what extent multimorbidity affects the mental health of this population is less clear. This study aims to investigate the association between multimorbidity and depression among women living with and beyond breast cancer in the UK Biobank cohort. Methods Data from UK Biobank (recruitment during 2006 to 2010, aged 40–70 years) were used to identify 8438 women with a previous diagnosis of breast cancer via linked cancer registries in England, Scotland and Wales. The lifetime number of chronic conditions was self-reported and multimorbidity defined as 0, 1, 2, 3, 4 or 5+. The Patient Health Questionnaire (PHQ-2) was used to define participants that were likely to have depression based on their symptom reporting at baseline. Logistic regression models were used to analyse the associations between multimorbidity and depression, accounting for a number of potential sociodemographic confounding variables (including age, ethnicity, socioeconomic deprivation, education level and marital status) and characteristics related to the cancer (number of years since diagnosis and recurrence/secondary cancer). Results Multimorbidity was common among breast cancer survivors, with 32.9% of women experiencing one and 30.1% experiencing two or more chronic health conditions. Hypertension (25.8%), painful conditions (18.3%), and asthma (11.6%) were the three most common co-morbid conditions. 5.3% of participants had current depression. A strong, dose-response relationship was found between multimorbidity and the likelihood of depression (OR = 2.09, 95% CI: 1.56–2.79 for two conditions and OR = 6.06, 95% CI: 3.63–10.14 for five or more conditions). Conclusions Multimorbidity and depression were strongly associated among female UK Biobank participants with a previous breast cancer diagnosis. This association became increasingly pronounced as the number of chronic comorbid conditions increased. As more people survive cancer for longer, increasing recognition and support for multimorbidity and its impact on mental health is needed.

A Psychological Nursing Intervention for Patients with Breast Cancer on Inflammatory factors, Negative emotions and Quality of Life

“…Moreover, psychological distress (symptoms of depression and anxiety) has been associated with poorer physical function and high mortality risk (17). Approximately 38% of the breast cancer patients in the study were diagnosed with depression and 32% of them with anxiety based on PHQ2 (18) and GAD2 (19) questionnaires.…”

Association between single and multiple cardiometabolic diseases and depression: A cross-sectional study of 391,083 participants from the UK biobank

“…Participants who had ever seen a psychiatrist for nerves, anxiety, tension, or depression were thought to fulfill this criterion. Thirdly, we widened the definition of depression phenotypes by including the measurement of two-item Patient Health Questionnaire (PHQ-2) ( 18 ). At recruitment, participants were asked the frequency of depressed mood and unenthusiasm/disinterest in last 2 weeks.…”

Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population

“… 21 , 22 Many studies have reported that comorbidity and multimorbidity at the time of cancer diagnosis, and measured by the Charlson Comorbidity Index (CCI), 10 , 23 , 24 or simple count of some strictly selected comorbid conditions and their relationships with psychological distress among breast cancer patients. 4 , 8 , 10 , 17 , 23 , 25 - 29 However, the influence of individual comorbid conditions on mental health may vary, the CCI includes only 19 chronic physical conditions (without psychiatric conditions) and it has been validated to predict mortality, but maybe not associated with poor mental health. 10 Few studies to date have investigated multimorbidity including broad chronic conditions and their associations with breast cancer outcomes.…”

“… 10 Few studies to date have investigated multimorbidity including broad chronic conditions and their associations with breast cancer outcomes. 8 , 10 , 23 , 26 - 30 Some studies have been limited to older populations (ie, ages ≥60, ≥65, or ≥70 years), 10 , 15 , 31 cancer registry-based studies, 4 , 17 , 23 or survey studies without detail data on comprehensive comorbidities. 11 , 25 , 26 , 29 , 31 Very limited data are available on the associations of the presence of multimorbidity with mental health.…”

“… 11 , 25 , 26 , 29 , 31 Very limited data are available on the associations of the presence of multimorbidity with mental health. 17 , 18 The objectives of the current study were to quantify the prevalence of specific comorbid conditions and multimorbidity among patients with newly diagnosed breast cancer and examine the associations between multimorbidity and anxiety and depression using a large US administrative healthcare claims database.…”