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Meta-Analysis
. 2023 Oct 15;129(20):3287-3299.
doi: 10.1002/cncr.34853. Epub 2023 Aug 7.

Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis

Lonneke A van Tuijl  1   2 , Maartje Basten  3 , Kuan-Yu Pan  4   5   6 , Roel Vermeulen  7 , Lützen Portengen  7 , Alexander de Graeff  8 , Joost Dekker  4   5 , Mirjam I Geerlings  3   9   10   11 , Adriaan Hoogendoorn  4   12 , Femke Lamers  4   5 , Adri C Voogd  13   14 , Jessica Abell  15 , Philip Awadalla  16   17   18 , Aartjan T F Beekman  4 , Ottar Bjerkeset  19   20 , Andy Boyd  21 , Yunsong Cui  22 , Philipp Frank  15 , Henrike Galenkamp  23 , Bert Garssen  1 , Sean Hellingman  24 , Martijn Huisman  25   26 , Anke Huss  7 , Trynke R de Jong  27 , Melanie R Keats  28 , Almar A L Kok  4   25 , Steinar Krokstad  29   30 , Flora E van Leeuwen  31 , Annemarie I Luik  32 , Nolwenn Noisel  33 , N Charlotte Onland-Moret  3 , Yves Payette  33 , Brenda W J H Penninx  4 , Ina Rissanen  3 , Annelieke M Roest  34 , Rikje Ruiter  32   35 , Robert A Schoevers  36 , David Soave  16   24 , Mandy Spaan  31 , Andrew Steptoe  15 , Karien Stronks  23   37 , Erik R Sund  19   29   30 , Ellen Sweeney  22 , Emma L Twait  3   9   10 , Alison Teyhan  21 , W M Monique Verschuren  3   38 , Kimberly D van der Willik  31   32 , Judith G M Rosmalen  36   39 , Adelita V Ranchor  1
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Free article
Meta-Analysis

Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis

Lonneke A van Tuijl et al. Cancer. .
Free article

Abstract

Background: Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium.

Methods: The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2).

Results: No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23).

Conclusions: Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. PREREGISTRATION NUMBER: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157677.

Keywords: anxiety; cancer; depression; meta-analysis; risk.

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