Risk of major depressive disorder in Japanese cancer patients: A matched cohort study using employer-based health insurance claims data

Objective Patients with cancer are at high risk of depression. However, the risk of major depressive disorder (MDD) after cancer diagnosis has not been studied in a population setting in Japan. This cohort study used a Japanese medical claims database to examine time to MDD in cancer patients and the risk of MDD (hazard ratio; HR) compared with matched cancer-free controls. Methods Primary endpoint was time to MDD (starting 6 months before cancer diagnosis) in adult (18-74 years) cancer patients; secondary endpoint was time to MDD (6 months before to 12 months after cancer diagnosis) in a matched cohort of cancer patients and cancer-free controls. Multivariate analyses were performed to determine HRs for all cancers and for each cancer site. Results Of 35 008 cancer patients (mean age, 53.3 years), 2201 (6.3%) were diagnosed with MDD within 66 months. Matched cancer patients (n = 30 372) had an elevated risk of MDD compared with cancer-free controls (n = 303 720; HR [95% confidence interval] 2.96 [2.77-3.16]). MDD risk was highest in patients with multiple cancers, pancreatic cancer, and brain cancer. Compared with middle-aged patients, risk was higher in patients <40 years old and lower in patients >= 65 years old; risk tended to be higher in women than in men. Conclusions Compared with cancer-free individuals, Japanese patients with cancer, mostly <65 years old, had an almost threefold higher risk of developing MDD within 12 months of cancer diagnosis. Physicians should watch for MDD in cancer patients and treat when necessary.