Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
Health Insurance Research Institute, National Health Insurance Service, Wonju 26464, Korea.
Int J Environ Res Public Health. 2022 Jul 15;19(14):8615. doi: 10.3390/ijerph19148615.
The purpose of this study is to determine the effect of cancer survivorship stage and health-related behaviors on the risk of developing mental health problems (depressive and anxiety disorders) in women who have experienced cancers that affect women (breast cancer, cervical cancer, ovarian cancer, endometrial cancer). Using the healthcare utilization and medical checkup data from 2010 to 2020 provided by the National Health Insurance Service, the occurrence of mental health problems since 2020 was tracked for 36,801 women diagnosed with cancer. The occurrence of mental health problems was defined as the cases in which the disease code was assigned to anxiety disorders (F40F44, F48) and depressive disorders (F3234, F41.2, F92) as presented in ICD-10. To evaluate the effect of cancer survivorship stage and health-related behaviors on the development of mental health problems, the hazard ratio (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. During the follow-up period of 5.6 years, anxiety disorder occurred in 14,698 (39.9%), and by cancer type, breast cancer survivors accounted for the most at 1.02 per 1000 person-years. The risk of anxiety disorders increased in those who experienced cervical cancer (AHR, 1.08, 95% CI, 1.03-1.13) and those in the acute survivorship stage (AHR, 1.38, 95% CI, 1.22-1.55). In terms of health-related behaviors, the risk of developing anxiety disorder was shown to be reduced in drinkers (AHR, 0.91, 95% CI, 0.87-0.96), former smokers (AHR, 0.86, 95% CI, 0.77-0.97), and current smokers (AHR, 0.80, 95% CI, 0.71-0.90). During the follow-up period of 5.6 years, depressive disorder occurred in 6168(16.8%), and by cancer type, ovarian cancer survivors accounted for the most at 1.30 per 1000 person-years. The risk of developing depressive disorders was highest in those who experienced ovarian cancer (AHR, 1.40, 95% CI, 1.27-1.53) and those in the acute survivorship stage (AHR, 2.99, 95% CI, 2.60-3.42). For health-related behaviors, the risk of developing depressive disorders was increased in former smokers (AHR, 1.32, 95% CI, 1.14-1.54), current smokers (AHR, 1.21, 95% CI, 1.04-1.41), and those with insufficient physical activity (AHR, 1.09, 95% CI, 1.02-1.15). It has been confirmed that cancer type, cancer survivorship stage, and health-related behaviors, such as smoking, drinking, and physical activity, are significantly related to the risk of mental health problems. Thus, it is necessary to develop strategies to cope with mental health problems at the individual and national levels and to develop interventions to promote a more active lifestyle.
本研究旨在确定癌症生存阶段和与健康相关的行为对经历影响女性的癌症（乳腺癌、宫颈癌、卵巢癌、子宫内膜癌）后出现心理健康问题（抑郁和焦虑障碍）风险的影响。利用国家健康保险服务提供的 2010 年至 2020 年的医疗保健利用和体检数据，对 2020 年以来的 36801 名确诊癌症的女性进行了心理健康问题发生情况的跟踪。心理健康问题的发生被定义为疾病代码被分配给焦虑障碍（F40F44、F48）和抑郁障碍（F3234、F41.2、F92）的病例。为了评估癌症生存阶段和与健康相关的行为对心理健康问题发展的影响，使用 Cox 比例风险模型计算了危害比（HR）和 95%置信区间（CI）。在 5.6 年的随访期间，发生了 14698 例（39.9%）焦虑障碍，按癌症类型划分，乳腺癌幸存者占比最高，为每 1000 人年 1.02 例。经历宫颈癌（AHR，1.08，95%CI，1.03-1.13）和急性生存阶段（AHR，1.38，95%CI，1.22-1.55）的女性，发生焦虑障碍的风险增加。在健康相关行为方面，饮酒者（AHR，0.91，95%CI，0.87-0.96）、前吸烟者（AHR，0.86，95%CI，0.77-0.97）和当前吸烟者（AHR，0.80，95%CI，0.71-0.90）发生焦虑障碍的风险降低。在 5.6 年的随访期间，发生了 6168 例（16.8%）抑郁障碍，按癌症类型划分，卵巢癌幸存者占比最高，为每 1000 人年 1.30 例。经历卵巢癌（AHR，1.40，95%CI，1.27-1.53）和急性生存阶段（AHR，2.99，95%CI，2.60-3.42）的女性发生抑郁障碍的风险最高。对于健康相关的行为，前吸烟者（AHR，1.32，95%CI，1.14-1.54）、当前吸烟者（AHR，1.21，95%CI，1.04-1.41）和体力活动不足者（AHR，1.09，95%CI，1.02-1.15）发生抑郁障碍的风险增加。已证实癌症类型、癌症生存阶段以及吸烟、饮酒和体力活动等与健康相关的行为与心理健康问题的风险显著相关。因此，有必要制定个人和国家层面应对心理健康问题的策略，并制定促进更积极生活方式的干预措施。
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