Incidence of Major Depression, Suicidal Ideation, and Mental Health Treatment Amongst Cancer Survivors

PURPOSE/OBJECTIVE(S)

Receiving a cancer diagnosis and undergoing subsequent treatments can result in a significant psychological burden for cancer patients. However, there is conflicting literature on the incidence of major depression in cancer patients compared to patients without cancer. The purpose of this study was to investigate and further clarify the incidence of major depression, associated treatments, and suicidal ideation in cancer survivors compared to a non-cancer cohort.

MATERIALS/METHODS

This is a retrospective, population-based study using survey responses from the National Survey on Drug Use and Health collected from January 2015 to December 2019. Survey data sets were queried for all respondents aged 18 years or older who provided a cancer history. Patients with a reported history of cancer ("cancer survivors") were further stratified by whether they reported a "recent" cancer diagnosis within the past 12 months. Survey responses were then evaluated for recent diagnoses of and treatments for major depressive disorder and suicidal ideation. Rates were compared between cancer survivors and participants without cancer using the Pearson χ2 test and multivariable logistic regression models, respectively.

RESULTS

Among the 212,411 survey respondents identified, 7,635 (3.6%) reported a cancer history, with 1,486 (0.7%) reporting a recent cancer history. The incidence of major depression was not different between cancer survivors and participants without cancer (9.3% vs. 9.2%; p = 0.762), though the incidence was slightly higher amongst recent cancer survivors (10.0% vs. 9.2%; p = 0.259). Among patients diagnosed with major depression, cancer survivors were significantly more likely to receive treatment for depression (78.6% vs. 60.3%, p<0.001), with 72.6% discussing depressive symptoms with a medical professional and 64.3% receiving prescription medication. Suicidal ideation was significantly lower among cancer survivors (5.1% vs. 6.2%, p<0.001) including recent survivors (5.0% vs. 6.2%, p<0.001). Suicidal ideation was higher in patients with underlying major depression in both cancer survivors and participants without cancer (30.6% vs. 35.6%, p = 0.015). On logistic regression, respondents with underlying depression receiving treatment were more likely to have suicidal ideation (OR: 1.49; p<0.001) while having a cancer diagnosis did not correlate with suicidal ideation (OR: 0.87; p = 0.869).

CONCLUSION

There was no significant overall difference in the incidences of major depression between cancer survivors and patients without cancer. However, one consideration is the under-diagnosis depression among cancer survivors. Symptoms of depression may be overlooked and mistakenly attributed to appropriate grief from a cancer diagnosis. Among patients diagnosed with major depression, cancer survivors were more likely to receive treatment for depression. These results highlight the importance of early depression assessment and treatment for cancer survivors.

The role of T cells in rheumatoid arthritis

The most striking arguments in favor of a T cell dependent nature of RA are the strong association of the disease with selected class II HLA haplotypes (the "shared epitope" hypothesis) and the fact that, in experimental animal models such as adjuvant arthritis, the disease can be transferred by isolated T cell lines. It is true that T cell activation at the site of inflammation is not excessive. However, there is now unequivocal evidence for focal synthesis of IL-2 and IFN-gamma in the RA synovial membrane and one may realise that a limited but specific T cell activation may be sufficient to induce or perpetuate the immune process. This same argument may explain the lack of clear TCR restriction at the sites of inflammation. Until now, no antigen has been demonstrated to initiate and/or perpetuate RA. Different antigens though have been incriminated in the pathogenesis of RA, including cartilage antigens (collagen, proteoglycans, chondrocyte antigens), heat shock proteins or exogenous (viral/bacterial) antigens. Unless one can pick up the right antigen and clone the relevant T cells, it will be very hard to directly prove a T cell-dependent nature of the disease.

T cell receptor V beta usage in rheumatoid nodules: marked oligoclonality among IL-2 expanded lymphocytes

Rheumatoid arthritis is an autoimmune disease which is characterized by chronic polyarthritis and joint destruction as well as by extra-articular manifestations, typically including the appearance of rheumatoid nodules. Although the pathogenesis of the disease is unknown, substantial evidence suggests that it is T cell-mediated. In contrast to experimental models, the disease-mediating T cells in the human situation have never been isolated or identified. We expanded T lymphocytes from human rheumatoid nodules by IL-2 stimulation and observed a marked oligoclonality among these expanded lymphocytes. This tendency towards oligoclonality was not seen in IL-2-expanded lymphocytes from peripheral blood. We hypothesize that this oligoclonal expansion reflects a clonally restricted in situ preactivation of lymphocytes and that precisely these preactivated cells are involved in the pathogenesis of the rheumatic process.

DNA topoisomerase activities in concanavalin A-stimulated lymphocytes

Topoisomerase activities have been measured in nuclear extracts of concanavalin A-stimulated lymphocytes. In parallel with the wave of DNA synthesis, type II topoisomerase activity was considerably increased. After 72 h treatment, this activity was stimulated approx. 20-fold over the activity in untreated cells. In contrast, type I topoisomerase was poorly stimulated after 24 h treatment, and 4-5-fold after 72 h. These findings, together with our previous results on regenerating rat liver, suggest a major role of topoisomerase II in DNA replication.

The National Evaluation of School Nutrition Programs: program impact on anthropometric measures

This report describes the anthropometric analysis component of the National Evaluation of School Nutrition Programs. It addresses two research questions: First, is there a relationship between participation in the school nutrition programs and students' height, weight, and triceps fatfold, and, second, are the impacts of program participation on height, weight, and triceps fatfold different for students with different characteristics? The anthropometric analyses suggest that long-term participation in the School Lunch Program has no relationship to height but does have a small relationship to the weight of school-aged children. This is at least partly due to an increase in body fat. Program impacts do not differ for students with different income and ethnic characteristics; however, impacts are greater for older children than for younger children. The School Breakfast Program has no relationship with students' height and only weak relationships with students' weight and triceps fatfold. The Breakfast Program tends slightly to move participants toward the middle of the weight distribution and away from the extremes. Although there are statistically significant increases in weight and triceps fatfold thickness associated with participation in the School Lunch Program, they are small compared with effects of the child's sex, height, and ethnic background. Other variables, such as parents' height and weight, parents' education and family income, also have greater impacts on weight and triceps fatfold measurements than participation in the School Nutrition Programs.

The National Evaluation of School Nutrition Programs: program impact on dietary intake

This article describes the dietary analysis component of the National Evaluation of School Nutrition Programs. It addresses two research questions: 1) do participants and nonparticipants in the school nutrition programs have different calorie and nutrient intakes for 24 h, breakfast, and/or lunch and 2) if there are differences in the nutritional quality or total quantity of food consumed? Students who participate in the School Lunch Program get more than nonparticipants of almost all nutrients that were examined, both at lunch and during 24 h. The superior lunch and 24-h intakes of Lunch Program participants are due to the higher nutritional quality of the School Lunch compared with lunches that nonparticipants eat. The most important impact of the School Breakfast is that when the program is available, it increases the likelihood that children will eat breakfast, and children who eat breakfast have significantly higher intakes of nutrients than children who skip breakfast. The School Breakfast provides more calcium, phosphorus, protein, and magnesium than a non-US Department of Agriculture breakfast, but less vitamin A, vitamin B6, niacin, thiamin, and iron. The positive impacts of calcium and phosphorus carry over 24 h, while the negative impacts for vitamin A, vitamin B6, niacin, thiamin, and iron are made up during the remainder of the day. Although strong conclusions cannot be drawn about the impact of the Milk Program, milk is an important component of all US Department of Agriculture school nutrition programs and makes a major contribution to student dietary intake. Its presence in the meal patterns probably accounts for some of the greater nutrient intakes associated with participation in the School Lunch Program and most of the greater intakes associated with participation in the School Breakfast Program.