Association between Depressive Symptoms and the Risk of Cancer in Middle-Aged and Older Chinese Adults：a population-based cohort study

IMPORTANCE Depressive symptoms may heighten the risk of cancer, however, little evidence is available on the association of depressive symptoms and cancer in China. OBJECTIVE To evaluate the association between depressive symptoms and risk of cancer among middle-aged and older Chinese adults. DESIGN, SETTING, AND PARTICIPANTS This study was based on data collected by the China Health and Retirement Longitudinal Study (CHARLS). Our cohort included 7,090 middle-aged and older Chinese adults with no cancer diagnosis at baseline. Information on depressive symptoms and cancer were collected at four waves of CHARLS investigations conducted in 2011, 2013, 2015, 2018 and 2020, respectively. EXPOSURE Depressive symptoms were assessed using the Chinese version of the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Participants scoring ≥12 on CES-D at all four waves of investigations were classified as persistent depressive. MAIN OUTCOMES AND MEASURE Follow-up ended when the participant reported a physician diagnosis of cancer or death or when the study period ended (September 30, 2023). RESULTS Of the 7,090 individuals, 3,672 (51.8%) were female and 5,687(80.2%) were 45-60 years old. During the seven years of follow-up, 156 new cancer cases were identified. Persistent depressive symptoms were independently associated with an increased risk of cancer (adjusted HR: 2.27; 95%CI: 1.5-3.45) after adjusting for potential confounding factors. The association between persistent depressive symptoms and cancer was not moderated by sociodemographic characteristics. CONCLUSIONS AND RELEVANCE The presence of depressive symptoms was significantly associated with the risk of cancer among middle-aged and older Chinese adults. Future risk management and preventive services of cancer should consider incorporating screening and providing psychosocial therapies for the elder population to identify and ameliorate depressive symptoms.