Retrospektive Analysen zu unipolarer Depression unter besonderer Berücksichtigung des Alters und somatischer Komorbiditäten
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Philipps-Universität Marburg
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Abstract
The aim of this work was to investigate the relationship between depression and comorbid somatic
health risks, whose impacts are known to be exacerbated by depression. To illustrate this relationship,
three studies were conducted with the following aims
i) Investigate whether age at depression diagnosis has an impact on anti-depressant
medication prescribed by physicians
ii) Assess whether the risk and incidence of common cancers is increased in patients with
depression
iii) Differentiate the risk conferred by depression from the risk associated with other
comorbid psychiatric disorders on the risk of cancer, illustrated with the case of gastrointestinal
(GI) cancers
This dissertation is based on these three publications published in the Journal of Psychiatric Research,
Brain Sciences, and Journal of Cancer Research and Clinical Oncology. All three analyses used
secondary data from the Disease AnalyzerTM (DA) database (IQVIA).
In the first study published in 2021 as “Age effects on treatment patterns in 138,097 patients
with unipolar depression followed in general practices in Germany“ in the Journal of Psychiatric
Research we investigated within a retrospective cohort analysis whether treatment prescribed varied
with age at depression diagnosis. A cohort of 13,553 patients with depression diagnosed first-time
between January 2015 and December 2018 within the DA database was selected, to allow for at least
12 months follow-up after depression diagnosis at the time of data extraction. Patients aged over 18
years were grouped by age (18-30, 31-65 and >65 years) and Odds Ratio (OR) for specific treatment
types assessed between the groups matched by gender and insurance type, with OR adjusted for by
gender, insurance type, treatment site and Charlson-Comorbidity-Index. Less than half of patients in
each group received treatment, with patients aged 65 or older most likely to receive medication
(48.3%) compared to 31–65-year-olds (42.4%) or 18–30-year-olds (34.8%). Older patients showed an
increased probability (OR: 1.3 [1.26–1.34 95% CI], p < 0.0001) for tri- and tetra-cyclic medication, while
younger patients showed an increased probability for SSRIs and SNRIs (OR: 1.23 [1.16–1.30 95% CI], p
<0.0001).
The second study published in 2023 as “Depression is associated with an increased risk of
subsequent cancer diagnosis: a retrospective cohort study with 235,404 patients“ in Brain Sciences
aimed at assessing whether cancer risk was affected by depression diagnosis. We compared 117,702
patients with a depression diagnosis documented in the DA database between January 2015 and
December 2018 with a comparator group of 117,702 patients 1:1 matched based on index year, age,
gender, visit frequency, and treating site, allowing for a minimum follow-up of three years at time of
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data extraction. Depression patients with previous bipolar disorder (F31), mania (F30) or schizophrenia
(F20–29) and cancer before index date were excluded, while from the comparator group any patients
with any previous psychiatric disorder or cancer were excluded. 4.9% of patients with depression
compared to 4.1% without depression received at least one cancer diagnosis over 3.9 years median
follow-up. The depression group showed an 18% increase in risk for a cancer diagnosis overall, with
largest increased risk in lung cancer (HR: 1.39 [1.21–1.60], p < 0.0001), cancers of the gastro-intestinaltract
(HR: 1.30 [1.15–1.46], p < 0.0001), breast (HR: 1.23 [1.12–1.35], p < 0.0001) and urinary (HR: 1.23
[1.06–1.43],p < 0.01). Similarly, the incidence of cancer diagnosis overall increased by 22% for
depressed patients. IRs showed no difference across cancer types.
The third study published in 2023 as “Psychiatric disorder and its association with
gastrointestinal cancer: a retrospective cohort study with 45,842 patients in Germany” in the Journal
of Cancer Research and Clinical Oncology investigated whether there was an association between
psychiatric illness and cancer, and whether the association differed by type of psychiatric illness. Cases
were selected from the DA database if a first GI-cancer diagnosis occurred between 2015 and 2020.
Comparators with no diagnosis of cancer at any time were matched 1:1 using nearest neighbour
matching based on propensity scores calculated from age, sex, visit frequency and total observation
time. The final study cohort of 44,582 patients aged ≥18 years with sex documented was assessed for
presence or absence of psychiatric disease before the index date (first cancer diagnosis or random visit
between 2015 and 2020). 46.8% of patients with GI-cancer had a psychiatric diagnosis before the index
date, as did 45.6% of patients without cancer. Depression was the most common psychiatric diagnosis
(21%), followed by psychosomatic disorder (13-16%) and PTSD (9%). Patients in both groups received
previous psychiatric treatment (22-23%). There was no association between previous psychiatric
diagnosis overall, as well as for previous diagnoses of depression, PTSD, anxiety, schizophrenia, or
ADHD with cancer risk, as the ORs approached or straddled 1.0. Only the association between
psychosomatic disorder and risk for GI-cancer was significant at the adjusted α-level (OR: 0.85, 0.81-
0.90 95%CL, p<0.0001). The results were consistent regardless of whether the model was adjusted
only for relevant somatic comorbidities, or also by previous psychiatric treatment.
In conclusion, this body of work was able to show age of patients at depression diagnosis impacted
the type of anti-depressant treatment prescribed. We further showed depression increased the risk
for cancer over a 4-year observation period, with different strengths of association depending on the
type of cancer examined. We were not able to replicate this finding in a cohort of cancer patients with
previous depression, however we were able to show psychosomatic disorder conferred a reduced risk
of GI cancer in an 8-year pre-index observation period. This association was not altered when taking
previous psychiatric treatments into account, which are known to impact the risk of cancer. We
demonstrate that depression treatment is impacted by somatic health risks such as age, and
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depression in turn impacts the risk of certain types of cancer. Further research is required to
understand the relationship between depression and cancers, considering also psychiatric and somatic
comorbidities and different cancer types.
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Metadata
Contributors
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Dates
Created: 2024Issued: 2024-03-12Updated: 2024-03-12
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
depression, cancerVersorgungsforschungKrebsDepressionreal world data
DFG-subjects
Depression Krebs Versorgungsforschung
DDC-Numbers
610
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Mössinger, Hannah: Retrospektive Analysen zu unipolarer Depression unter besonderer Berücksichtigung des Alters und somatischer Komorbiditäten. : Philipps-Universität Marburg 2024-03-12. DOI: https://doi.org/10.17192/z2024.0136.
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This item has been published with the following license: In Copyright