Increased risk of mental health problems after cancer during adolescence: A register-based cohort study

Int J Cancer. 2020 Dec 15;147(12):3349-3360. doi: 10.1002/ijc.33154. Epub 2020 Jul 3.

Abstract

In this nationwide, register-based study, we estimated the risk of mental health problems in 2822 individuals diagnosed with cancer in adolescence (13-19 years). Mental health problems were assessed by psychiatric diagnoses and/or prescribed psychotropic drugs. Cox proportional hazards models estimated hazard ratio (HR) for a psychiatric diagnosis and prescription of psychotropic drug compared to a matched comparison group (n = 28 220). Estimates were adjusted for calendar period and parent characteristics (eg, history of psychiatric diagnosis, education, country of birth). We found an increased risk of a psychiatric diagnosis during the first 5 years after the cancer diagnosis (females: HR 1.23, 95% CI, 1.06-1.44; males: HR 1.32, 95% CI, 1.11-1.56), and at >5 years after diagnosis (females: HR 1.31, 95% CI, 1.09-1.58, males: HR 1.45, 95% CI, 1.18-1.77). The risk of being prescribed antidepressant (females: HR 1.54, 95% CI, 1.30-1.84, males: HR 2.06, 95% CI, 1.66-2.55), antipsychotic (females: HR 2.28, 95% CI, 1.56-3.34, males: HR 3.07, 95% CI, 2.13-4.42), anxiolytic (females: HR 1.95, 95% CI, 1.64-2.31, males: HR 4.02, 95% CI, 3.34-4.84) and sedative drugs (females: HR 2.24, 95% CI, 1.84-2.72, males: HR 3.91, 95% CI, 3.23-4.73) were higher than for comparisons during the first 5 years after diagnosis. Median age at first psychiatric diagnosis and first prescribed psychotropic drug were 18 years. In conclusion, cancer during adolescence is associated with increased risk of mental health problems that may develop in close proximity to treatment. The findings emphasize the need for comprehensive care during treatment and follow-up.

Keywords: adolescence; cancer; mental health problems; psychiatric diagnoses; psychotropic drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Anxiety Agents / therapeutic use*
  • Antidepressive Agents / therapeutic use*
  • Antipsychotic Agents / therapeutic use*
  • Cohort Studies
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Humans
  • Male
  • Mental Disorders / drug therapy
  • Mental Disorders / epidemiology*
  • Mental Disorders / etiology
  • Mental Health
  • Neoplasms / psychology*
  • Registries
  • Sex Characteristics
  • Sweden / epidemiology

Substances

  • Anti-Anxiety Agents
  • Antidepressive Agents
  • Antipsychotic Agents