Educational level and the risk of depression after prostate cancer

Abstract

Background: The risk of depression is inversely associated with socioeconomic position in the general population; however, studies on the association in cancer populations are limited. The aim was to investigate if shorter education was associated with a higher risk of depression following prostate cancer diagnosis. Material and methods: This is a cohort study among participants in the Danish prospective Diet, Cancer and Health (DCH) study including 2337 men diagnosed with prostate cancer between 1997 and 2014. Primary outcome was indication of moderate to severe depression, defined as either a first hospital contact for depression or first use of antidepressants. The main indicator of socioeconomic position was education categorized into short (<9 years of education), medium (9-12 years) and long (>12 years). We retrieved information on education, depression and cohabitation status from Danish National Registries. Information on stage, primary treatment, lifestyle and anthropometry was obtained from medical records and questionnaires. Data were analyzed using Cox proportional hazards models adjusted for possible confounders and mediators. Results: The hazard of first depression was 1.86-fold higher (95% CI, 1.36-2.54) in prostate cancer patients with short education compared to those with long education. Adjustment for stage and primary treatment did not change the HRs, while adding comorbidity and lifestyle factors resulted in an HR of 1.65 (95% CI, 1.19-2.29). Men with medium education had a non-statistically significant 1.23-fold higher hazard of depression (95% CI, 0.95-1.59) than men with long education in the fully adjusted model. Educational differences were present in the cumulative incidence of first depression among cancer-free DCH study participants, but the level of first depression was substantially lower in this population than in prostate cancer patients. Conclusions: We found indication of social inequality in depression following prostate cancer. Patients and particularly men with short education might benefit from psychosocial intervention and support.

Risk of Depression After Radical Prostatectomy—A Nationwide Registry-based Study

“…We found an increased risk of depression in men with low income; this aligns with a previous study revealing an inverse association between socioeconomic position and the risk of depression [25], and this association has also been noted for other cancers [26]. The underlying mechanisms of this association are suggested to include mediation through psychiatric risk factors such as the lack of social support and fewer resources to develop positive strategies to cope with stress.…”

Depression, hope and social support among older people with cancer: a comparison of Muslim Palestinian and Jewish Israeli cancer patients

“…It should also be noted that 78% of the Jewish patients had 12 years of education or more in comparison to only 22% of the Muslim patients. Education is considered a resource which can, to some extent, protect against depression in general and among cancer patients in particular [34].…”

Changes in lifestyle among prostate cancer survivors: A nationwide population‐based study

“…Previous research indicate that social support may have positive effects on the psychological wellbeing of patients and that men with lower socioeconomic status might suffer more from a prostate cancer diagnosis. 6,7,27 In our population neither social support in terms of marital status nor socioeconomic status affected whether the men made and sustained a lifestyle change. This might be related to that the vast majority of the men in our study were married and already retired from work.…”