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Patterns of Postdiagnosis Depression Among Late-Stage Cancer Patients

Do Racial/Ethnic and Sex Disparities Exist?

Huo, Jinhai PhD, MD, MSPH*; Bian, Jiang PhD; Xie, Zhigang MPA*; Hong, Young-Rock MPH*; Wilkie, Diana J. PhD, RN, FAAN; Pereira, Deidre B. PhD§

American Journal of Clinical Oncology: August 2019 - Volume 42 - Issue 8 - p 675–681
doi: 10.1097/COC.0000000000000569
Original Articles: Supportive Care

Objectives: The incidence of depression after a late-stage cancer diagnosis is poorly understood and has not been the subject of intense investigation. We used population-based data to examine trends in postdiagnosis depression incidence among racial/ethnic and sexual groups.

Methods: We identified 123,066 patients diagnosed with late-stage breast, prostate, lung, or colorectal cancer from 2001 to 2013 in the Surveillance Epidemiology and End Results Medicare-linked database. The primary outcome was the incidence of postdiagnosis depression after a late-stage cancer diagnosis. Trend analysis was performed using the Cochran-Armitage test. Stratified incidence rates were calculated for the racial/ethnic and sexual groups.

Results: The incidence of depression after cancer diagnosis increased from 15.3% in 2001 to 24.1% in 2013, Ptrend<0.0001. About 50% of depression was reported in the first 3 months of stage IV cancer diagnosis. A total of 19,775 (20.0%) non-Hispanic whites, 1937 (15.9%) non-Hispanic blacks, and 657 (12.7%) Hispanics were diagnosed with depression during a mean follow-up of 2.7 months (interquartile range: 0.9 to 10.2 mo). The incidence of depression is significantly higher among females than males, 22.7% versus 16.3%, P<0.0001. In the multivariable logistic regression, non-Hispanic whites and females were still independent predictors of higher risk of postdiagnosis depression.

Conclusions: There are significant differences in the incidence of postdiagnosis depression among racial/ethnic and sexual groups in the United States. The consideration of racial/ethnic in depression prevention and diagnosis among cancer patients should be discussed as a matter of importance to ensure that there is no diagnosis bias among non-Hispanic blacks and Hispanics.

*Department of Health Services Research, Management and Policy

§Department of Clinical and Health Psychology, College of Public Health and Health Professions

Department of Health Outcomes & Biomedical Informatics, College of Medicine

Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL

The authors declare no conflicts of interest.

Reprints: Jinhai Huo, PhD, MD, MSPH, Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, HPNP 3111, P.O. Box 100195, Gainesville, FL 32610. E-mail:

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