College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
College of Medical, Veterinary and Life Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
BMC Cancer. 2021 May 31;21(1):650. doi: 10.1186/s12885-021-08409-z.
Advances in the early detection of cancer and its treatment have resulted in an increasing number of people living with and beyond breast cancer. Multimorbidity is also becoming more common in this population as more people live longer with breast cancer and experience late effects of cancer treatment. Breast cancer survivors have heightened risk of depression, but to what extent multimorbidity affects the mental health of this population is less clear. This study aims to investigate the association between multimorbidity and depression among women living with and beyond breast cancer in the UK Biobank cohort.
Data from UK Biobank (recruitment during 2006 to 2010, aged 40-70 years) were used to identify 8438 women with a previous diagnosis of breast cancer via linked cancer registries in England, Scotland and Wales. The lifetime number of chronic conditions was self-reported and multimorbidity defined as 0, 1, 2, 3, 4 or 5+. The Patient Health Questionnaire (PHQ-2) was used to define participants that were likely to have depression based on their symptom reporting at baseline. Logistic regression models were used to analyse the associations between multimorbidity and depression, accounting for a number of potential sociodemographic confounding variables (including age, ethnicity, socioeconomic deprivation, education level and marital status) and characteristics related to the cancer (number of years since diagnosis and recurrence/secondary cancer).
Multimorbidity was common among breast cancer survivors, with 32.9% of women experiencing one and 30.1% experiencing two or more chronic health conditions. Hypertension (25.8%), painful conditions (18.3%), and asthma (11.6%) were the three most common co-morbid conditions. 5.3% of participants had current depression. A strong, dose-response relationship was found between multimorbidity and the likelihood of depression (OR = 2.09, 95% CI: 1.56-2.79 for two conditions and OR = 6.06, 95% CI: 3.63-10.14 for five or more conditions).
Multimorbidity and depression were strongly associated among female UK Biobank participants with a previous breast cancer diagnosis. This association became increasingly pronounced as the number of chronic comorbid conditions increased. As more people survive cancer for longer, increasing recognition and support for multimorbidity and its impact on mental health is needed.
癌症的早期检测和治疗的进步导致越来越多的人患有乳腺癌并幸存下来。由于更多的人患有乳腺癌并经历癌症治疗的晚期影响而寿命更长，因此多病共存在这一人群中也变得更为常见。乳腺癌幸存者患抑郁症的风险较高，但多病共存在多大程度上影响这一人群的心理健康尚不清楚。本研究旨在调查英国生物银行队列中患有和幸存乳腺癌的女性中多病共存与抑郁之间的关联。
使用英国生物银行（2006 年至 2010 年招募，年龄 40-70 岁）的数据，通过英格兰、苏格兰和威尔士的癌症登记处确定了 8438 名患有乳腺癌的女性。通过自我报告确定了一生中的慢性疾病数量，将多病共存定义为 0、1、2、3、4 或 5+。使用患者健康问卷（PHQ-2）根据基线时的症状报告确定可能患有抑郁症的参与者。使用逻辑回归模型分析了多病共存与抑郁之间的关联，同时考虑了一些潜在的社会人口统计学混杂变量（包括年龄、种族、社会经济剥夺、教育水平和婚姻状况）和与癌症相关的特征（诊断后年限和复发/继发性癌症）。
乳腺癌幸存者中多病共存很常见，有 32.9%的女性患有一种，30.1%的女性患有两种或两种以上慢性健康状况。高血压（25.8%）、疼痛状况（18.3%）和哮喘（11.6%）是三种最常见的合并疾病。有 5.3%的参与者患有当前的抑郁症。发现多病共存与抑郁的可能性之间存在很强的剂量反应关系（两种疾病的 OR=2.09，95%CI：1.56-2.79，五种或更多疾病的 OR=6.06，95%CI：3.63-10.14）。
在英国生物银行患有乳腺癌诊断的参与者中，多病共存与抑郁密切相关。随着慢性共病数量的增加，这种关联变得越来越明显。随着越来越多的人因癌症而存活更长时间，需要提高对多病共存及其对心理健康影响的认识和支持。
