Depression and risk of epithelial ovarian cancer: Results from two large prospective cohort studies

Gynecol Oncol. 2015 Dec;139(3):481-6. doi: 10.1016/j.ygyno.2015.10.004. Epub 2015 Oct 9.


Objectives: While emerging evidence supports a possible link between depression and ovarian cancer progression, no prospective studies have explored the association with ovarian cancer risk.

Methods: We prospectively followed 77,451 women from the Nurses' Health Study (1992-2010) and 106,452 women from the Nurses' Health Study II (1993-2011). Depression was defined as having one or more of the following: a 5-item Mental Health Index (MHI-5) score≤52, antidepressant use, or physician-diagnosed depression. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between depression and incident ovarian cancer.

Results: We documented 698 incident cases of epithelial ovarian cancer during follow-up. In multivariable analyses, depression assessed 2-4years before cancer diagnosis was associated with a modestly higher incidence of ovarian cancer (HR=1.30, 95% CI 1.05-1.60). Compared to women with persistent negative depression status, the adjusted HRs were 1.34 (95% CI 1.01-1.76) for women with persistent positive depression status and 1.28 (95% CI 0.88-1.85) for women with worsening depression status over follow-up. The association did not appear to vary by ovarian cancer risk factors or tumor characteristics.

Conclusions: Our findings suggest that depression may be associated with a modestly increased risk of ovarian cancer. Given the relatively high prevalence of depression in women, future work in larger prospective human studies is needed to confirm our results.

Keywords: Chronic stress; Depression; Etiology; Latency period; Ovarian cancer; Repeated measures.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use
  • Carcinoma, Ovarian Epithelial
  • Depression / drug therapy
  • Depression / epidemiology*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Health Surveys
  • Humans
  • Incidence
  • Middle Aged
  • Neoplasms, Glandular and Epithelial / epidemiology*
  • Neoplasms, Glandular and Epithelial / psychology
  • Ovarian Neoplasms / epidemiology*
  • Ovarian Neoplasms / psychology
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • United States / epidemiology


  • Antidepressive Agents