Depression in breast cancer patients who have undergone mastectomy: A national cohort study

Abstract

Objective: The objective of this study was to compare the incidence of post-operative depression in breast cancer patients who have undergone mastectomy with the incidence of post-operative depression in non-breast cancer participants (controls).

Methods: Using data from the Korean Health Insurance Review and Assessment Service (HIRA), we selected 2,130 patients with breast cancer who have undergone mastectomy for this national cohort study and matched these patients 1:4 with 8,520 control participants according to age, sex, income, region, and pre-operative depression. The incidence of post-operative depression was measured from mastectomy year to post-op year 10. The Mann-Whitney U test was used for data analysis, and the false-discovery rate was applied to determine statistical significance (P < 0.05).

Results: The incidence of depression was higher in the breast cancer with mastectomy group than in the control group up to 3 years after mastectomy). However, there was no difference in the incidence of depression between the breast cancer with mastectomy group and the control group after post-op 4 years. The incidence of depression was higher in the breast cancer with mastectomy group than in the control group up to 2 years after mastectomy, and there was no difference in the incidence of depression between the two groups after post-op 3 years in middle-aged and older adults (≥ 40 years old). In young adults (≤ 39 years old), the incidence of depression was significantly higher in the breast cancer with mastectomy group than in the control group in mastectomy year.

Conclusion: Patients undergoing mastectomy for breast cancer experience depression more frequently than healthy people. However, patients overcome their depressive mood symptoms during the postoperative period. Young adults overcome their symptoms more quickly than middle-aged and older adults.

Fig 1. Schematic illustration of the participant selection process of the present study.

The indicated number of breast cancer patients who underwent mastectomies from 2003 to 2012 were selected from a total of 1,025,340 patients (n = 2,141). After removal of unmatched participants, male participants, and participants younger than 15 years old, 2,130 participants were ultimately included in the study. These participants were matched 1:4 with 8,520 control participants.

Fig 2. Schematic illustration of participant depression histories according to the time elapsed since mastectomy for breast cancer.