The association between Major Depressive Disorder and premature death risk in hematologic and solid cancer: a longitudinal cohort study

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  • Federica Sancassiani
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Elena Massa
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Carla Pibia
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Giulia Perda
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Laura Boe
    Department of Medical Sciences and Public Health, University of Cagliari, Italy , Italy.
  • Elena Fantozzi
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Giulia Cossu
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Giovanni Caocci
    Hematology and CTMO, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy.
  • Olga Mulas
    Hematology e CTMO, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy.
  • Emanuela Morelli
    Hematology and CTMO, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy.
  • Jutta Lindert
    University of Applied Sciences Emden/Leer, Emden, Germany.
  • Eleonora Lai
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Antonio Egidio Nardi
    Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil.
  • Mario Scartozzi
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Giorgio La Nasa
    Department of Medical Sciences and Public Health, University of Cagliari; Hematology and CTMO, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy.
  • Mauro Giovanni Carta
    Department of Medical Sciences and Public Health, University of Cagliari, Italy.


Background: the aim was to verify the association between Major Depressive Disorders (MDD) and the risk of premature death in people with oncological diseases, and to collect evidence about the causality of a possible association from a longitudinal perspective.

Design and Methods
: it is a cohort study lasting 9 months, involving people with solid or hematologic cancers. The assessment was conducted by an ad hoc form to collect socio-demographic and clinical-oncological data, the PHQ-9 to screen MDD (cut-off ≥10) and the SF-12 to evaluate HRQoL. Relative Risk (RR) of early death between MDD exposed and not-exposed and Kaplan-Meier survival were carried out.
Results: people exposed to MDD during the follow-up were 107/263 (40.7%). Among them, 36 deceased during the observation period. Overtime, having MDD and death’ occurrence showed a strong association (RR=2.15; 95% CI (1.10-4.20); χ²=5.224, p=0.0022), confirmed by Kaplan-Meier survival analysis (χ²=4.357, p=0.037). Among people who died, there was not any association between MDD, age, gender, HRQoL, cancer stage and site.

: the study confirms the association between MDD and early death in people with cancer. The absence of any association between the onset of MDD and advanced stage of cancer may suggest that it could be due to the consequences of MDD in worsening the clinical conditions related to cancer. The findings point out the relevance of MDD’ early detention among people with cancer.


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