Mortality Risks Associated with Depression in Men with Prostate Cancer

Authors

Casey Crump
Pär Stattin
James D Brooks
Jan Sundquist
Weiva Sieh
Kristina Sundquist

Language

English

Publication Date

12-1-2024

Journal

European Urology Oncology

DOI

10.1016/j.euo.2024.03.012

PMID

38575410

PMCID

PMC11838044

PubMedCentral® Posted Date

12-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: Men diagnosed with prostate cancer (PC) have an increased risk of depression; however, it is unclear to what extent depression affects long-term survival. A better understanding of such effects is needed to improve long-term care and outcomes for men with PC.

Objective: To determine the associations between major depression and mortality in a national cohort of men with PC.

Design, setting, and participants: A national cohort study was conducted of all 180 189 men diagnosed with PC in Sweden during 1998-2017. Subsequent diagnoses of major depression were ascertained from nationwide outpatient and inpatient records through 2018.

Outcome measurements and statistical analysis: Deaths were identified from nationwide records through 2018. Cox regression was used to compute hazard ratios (HRs) for all-cause mortality associated with major depression, adjusting for sociodemographic factors and comorbidities. Subanalyses assessed differences by PC treatment during 2005-2017. PC-specific mortality was examined using competing risks models.

Results and limitations: In 1.3 million person-years of follow-up, 16 134 (9%) men with PC were diagnosed with major depression and 65 643 (36%) men died. After adjusting for sociodemographic factors and comorbidities, major depression was associated with significantly higher all-cause mortality in men with high-risk PC (HR, 1.50; 95% confidence interval [CI], 1.44-1.55) or low- or intermediate-risk PC (1.64; 1.56-1.71). These risks were elevated regardless of PC treatment or age at PC diagnosis, except for youngest men (< 55 yr) in whom the risks were nonsignificant. Major depression was also associated with increased PC-specific mortality in men with either high-risk PC (HR, 1.35; 95% CI, 1.28-1.43) or low- or intermediate-risk PC (1.42; 1.27-1.59). This study was limited to Sweden and will need replication in other countries when feasible.

Conclusions: In this national cohort of men with PC, major depression was associated with ∼50% higher all-cause mortality. Men with PC need timely detection and treatment of depression to support their long-term outcomes and survival.

Patient summary: In this report, we examined the effects of depression on survival in men with prostate cancer. We found that among all men with prostate cancer, those who developed depression had a 50% higher risk of dying than those without depression. Men with prostate cancer need close monitoring for the detection and treatment of depression to improve their long-term health outcomes.

Keywords

Humans, Male, Prostatic Neoplasms, Aged, Middle Aged, Sweden, Cohort Studies, Major Depressive Disorder, Depression, Risk Factors, cancer survivors, depression, major depressive disorder, mortality, premature mortality, prostate cancer, prostatic neoplasms

Published Open-Access

yes

Recommended Citation

Crump, Casey; Stattin, Pär; Brooks, James D; et al., "Mortality Risks Associated with Depression in Men with Prostate Cancer" (2024). Faculty, Staff and Student Publications. 2067.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/2067