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