Associations between DSM-IV mental disorders and subsequent self-reported diagnosis of cancer

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Abstract

Objective

The associations between mental disorders and cancer remain unclear. It is also unknown whether any associations vary according to life stage or gender. This paper examines these research questions using data from the World Mental Health Survey Initiative.

Methods

The World Health Organization Composite International Diagnostic Interview retrospectively assessed the lifetime prevalence of 16 DSM-IV mental disorders in face-to-face household population surveys in nineteen countries (n = 52,095). Cancer was indicated by self-report of diagnosis. Smoking was assessed in questions about current and past tobacco use. Survival analyses estimated associations between first onset of mental disorders and subsequently reported cancer.

Results

After adjustment for comorbidity, panic disorder, specific phobia and alcohol abuse were associated with a subsequently self-reported diagnosis of cancer. There was an association between number of mental disorders and the likelihood of reporting a cancer diagnosis following the onset of the mental disorder.

This suggests that the associations between mental disorders and cancer risk may be generalised, rather than specific to a particular disorder. Depression is more strongly associated with self-reported cancers diagnosed early in life and in women. PTSD is also associated with cancers diagnosed early in life.

Conclusion

This study reports the magnitude of the associations between mental disorders and a self-reported diagnosis of cancer and provides information about the relevance of comorbidity, gender and the impact at different stages of life. The findings point to a link between the two conditions and lend support to arguments for early identification and treatment of mental disorders.

Introduction

The high prevalence of treatable mental disorders and their relatively early age of onset [1] means that any possible associations between mental disorders and cancer may merit investigation. There are several mechanisms through which mental disorder may facilitate the occurrence of cancer. The physical sequelae of stress and the symptoms of mental disorder are associated with physiological changes which can promote cancer [2]. Mental disorders are associated with poor health behaviours which increase cancer risk [3]. In addition, mental disorders may impact upon screening uptake and subsequent intervention [4].

Population studies of stress, mental disorders and subsequent cancer have yielded conflicting results. Some studies have demonstrated that stress and anxiety disorders are related [5], [6], [7]. Other studies suggest that people with diagnosed mental disorders are no more likely than the general population to have a diagnosis of cancer [5], [8], [9]. However, these studies focus on clinical populations and exclude people who have not received a formal psychiatric diagnosis. Additionally, in these studies mental disorders are treated as a single category, despite varying characteristics and levels of severity.

The aims of this study were to examine the association of first onset of a range of mental disorders with subsequent onset of cancer, with and without adjustment for mental disorder comorbidity using the World Mental Health (WMH) surveys dataset. Second, to assess whether an increasing number of mental disorders are associated with an increased likelihood of reporting cancer. Third, to assess whether associations vary by gender, or across the life course. These variables were examined in relation to the time of the onset of the mental disorder and the reported time of the cancer diagnosis.

Section snippets

Samples and procedures

This study uses data from 19 World Mental Health (WMH) surveys (see Table 1). A stratified multi-stage clustered area probability sampling strategy was used to select adult respondents (18 years +) in most countries. Most of the surveys were based on nationally representative household samples whilst Colombia, Mexico and Shenzhen were based on nationally representative household samples in urbanised areas. Interviews were undertaken face-to-face by trained lay interviewers.

Internal subsampling

Descriptive characteristics

Characteristics of the contributing surveys and prevalence of cancer are shown in Table 1. A total of 1499 respondents reported a diagnosis of cancer.

Type and number of mental disorders as predictors of cancer diagnosis

The first column of Table 2 shows the results from bivariate models in which each mental disorder was modelled as a separate predictor of subsequent cancer, without taking mental disorder comorbidity into account. In these models all mood disorders, panic disorder, specific phobia, PTSD, OCD, IED, binge eating disorder, alcohol abuse, alcohol

Discussion

This study has a number of limitations. The data on mental disorders is based on retrospective recall of symptoms and, for mental disorders, this is associated with underestimates and errors in estimating onset [15]. The data on cancer is also based on recall and self report rather than clinical data. The validity of self reported cancer diagnosis and the accuracy of timing of onset data may also be questioned; however data on the accuracy of self reported cancer demonstrate acceptable levels

Conflict of interest

The authors have no competing interests to report.

Acknowledgments

The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb. We thank

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