Association of Depressive Symptoms with Cancer Risk in Middle-Aged and Older Chinese Adults: A Longitudinal Cohort Study

Aims: . Although, the association between depression and cancer has already been very well studied, but studies about depressive symptoms and cancer development are scarce and inconclusive among Chinese adults. We aimed to investigate whether the severity of depressive symptoms is associated with total and site-specific cancer risk in a nationally representative sample of middle-aged and older Chinese adults. Methods: . This study was based on the China Health and Retirement Longitudinal Study (CHARLS), which was initiated in 2011 and followed up to 2018. We included 11,974 individuals aged 45 years or older with complete information about depressive symptoms and no history of cancer at baseline. Depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale (CES-D). Incident cancer cases were documented in the biennial self-reported questionnaires. The multivariable Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results: . Of 11,794 individuals included in the analysis, 51.72% were women. After a median follow-up of 7.0 years, 265 incident cancer cases were identified. Overall, there was a significant positive association between CES-D score and cancer risk (HR 1.02, 95%CI 1.00-1.05, P =0.03). Severe depressive symptoms were associated with a 75% increased cancer risk (HR 1.75, 95%CI 1.10-2.78). Such associations were evident among women rather than men. In the cancer-specific analysis, the association of severe depressive symptoms and cancer risk was more pronounced for female hormone-related cancers (HR 5.58; 95% CI 2.70-11.54). Conclusions: . The findings imply that individuals with severe depressive symptoms could be considered as high-risk population in cancer screening programs.