School of Health Sciences, University of Southampton, Southampton, UK.
College of Human and Health Sciences, Swansea University, Swansea, UK.
Colorectal Dis. 2021 Dec;23(12):3234-3250. doi: 10.1111/codi.15949. Epub 2021 Nov 25.
Depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition of depression at key points in the pathway enables timely referral to support. This study aimed to examine depression before and 5 years after surgery to examine its prevalence and identify determinants.
The ColoREctal Wellbeing (CREW) study is a prospective UK cohort study involving 872 adults with nonmetastatic CRC recruited before surgery with curative intent. Questionnaires completed before surgery and 3, 9, 15, 24, 36, 48 and 60 months after surgery captured socio-demographics and assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present the prevalence of clinically significant depression (CES-D ≥ 20) over time and its predictors assessed before and 2 years after surgery.
Before surgery, 21.0% of the cohort reported CES-D ≥ 20 reducing to 14.7% 5 years after surgery. Presurgery risk factors predicting subsequent depression were clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Postsurgery risk factors at 2 years predicting subsequent depression were clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health.
Depression is highly pervasive in people with CRC, exceeding prevalence in the general population across follow-up. Our findings emphasize the need to screen and treat depression across the pathway. Our novel data highlight key risk factors of later depression at important and opportune time points: before surgery and at the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.
结直肠癌（CRC）患者经历的抑郁是影响生活质量的重要临床问题。在途径的关键点识别抑郁，可及时转介以获得支持。本研究旨在检查手术前后 5 年的抑郁情况，以检查其患病率并确定其决定因素。
ColoREctal Wellbeing（CREW）研究是一项前瞻性英国队列研究，涉及 872 名非转移性 CRC 成人患者，他们在手术前具有治愈意向，并接受了前瞻性研究。在手术前、术后 3、9、15、24、36、48 和 60 个月完成的问卷，捕获了社会人口统计学资料，并评估了抑郁（流行病学研究中心抑郁量表，CES-D）和其他心理社会因素。还收集了临床细节。我们呈现了随时间推移的临床显著抑郁（CES-D≥20）的患病率及其在手术前和 2 年后评估的预测因素。
手术前，队列中有 21.0%的患者报告 CES-D≥20，术后 5 年降至 14.7%。预测随后抑郁的术前危险因素包括临床显著抑郁和焦虑、既往心理健康服务使用、自我效能低下、健康状况不佳、接受新辅助治疗和社会支持不足。术后 2 年预测随后抑郁的危险因素包括临床显著抑郁、负性情绪、认知功能障碍、适应类型和健康状况不佳。
CRC 患者的抑郁发生率非常高，在整个随访过程中超过了一般人群的患病率。我们的研究结果强调了在整个途径中筛查和治疗抑郁的必要性。我们的新数据强调了在重要和适当的时间点发生后期抑郁的关键风险因素：手术前和常规监测结束时。早期识别和及时转介到适当的支持是改善长期心理结局的关键。
