Impact of Depression and/or Anxiety on Mortality in Women with Gynecologic Cancers: A Nationwide Retrospective Cohort Study

Abstract

Objective: This study aimed to investigate the impact of depression and anxiety disorders on mortality in women diagnosed with gynecologic cancers, utilizing nationwide retrospective cohort data.

Methods: Data from the Korean National Health Insurance Service (NHIS) database, covering women diagnosed with cervical, endometrial, or ovarian cancers between 2007 and 2014, were analyzed. Women diagnosed with depression or anxiety disorders within one year after cancer diagnosis were identified and compared with a control group comprising patients with gynecologic cancers who did not develop either disorder during the same post-diagnosis period. Mortality was evaluated as the primary outcome.

Results: Of 85,327 women analyzed, 784 (0.9%) were diagnosed with depression or anxiety disorders. Patients with depression or anxiety exhibited significantly higher mortality (38.4% vs. 29.9%; p < 0.001). Multivariate analysis indicated that depression significantly increased mortality risk (OR 1.46, 95% CI 1.27-1.66), whereas anxiety alone showed no significant effect (OR 0.97, 95% CI 0.74-1.27). Combined depression and anxiety showed the highest mortality risk (OR 1.47, 95% CI 1.31-1.65).

Conclusions: Depression and anxiety disorders are significant predictors of increased mortality in women with gynecologic cancers, emphasizing the necessity for integrated mental health assessment and interventions in oncologic care to improve both survival and quality of life.

Keywords: Korean National Health Insurance Service (NHIS); anxiety disorders; depression; gynecologic cancers.

Figure 1

Data cleansing flow chart.

Figure 2

Adjusted odds ratios for mortality by clinical and psychological factors. Values represent unadjusted all-cause mortality. Standardization by age or cancer stage was not possible due to data limitations. Variables marked with an asterisk (*) are statistically significant. The symbol (↑) denotes that the risk of mortality increases incrementally with each additional year of age.