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Depression, smoking, and lung cancer risk over 24 years among women

Published online by Cambridge University Press:  03 December 2020

Claudia Trudel-Fitzgerald Open the ORCID record for Claudia Trudel-Fitzgerald [Opens in a new window] ,
Emily S. Zevon ,
Ichiro Kawachi ,
Reginald D. Tucker-Seeley  and
Laura D. Kubzansky
Claudia Trudel-Fitzgerald*
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
Emily S. Zevon
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
Ichiro Kawachi
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
Reginald D. Tucker-Seeley
Affiliation:
Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, USA
Laura D. Kubzansky
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
*
Author for correspondence: Dr Claudia Trudel-Fitzgerald, E-mail: [email protected]
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Abstract

Background

Studies evaluating depression's role in lung cancer risk revealed contradictory findings, partly because of the small number of cases, short follow-up periods, and failure to account for key covariates including smoking exposure. We investigated the association of depressive symptoms with lung cancer risk in a large prospective cohort over 24 years while considering the role of smoking.

Methods

Women from the Nurses' Health Study completed measures of depressive symptoms, sociodemographics, and other factors including smoking in 1992 (N = 42 913). Depressive symptoms were also queried in 1996 and 2000, whereas regular antidepressant use and physician-diagnosed depression were collected starting in 1996. Multivariable Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of lung cancer risk until 2016.

Results

We identified 1009 cases of lung cancer. Women with the highest v. lowest level of depressive symptoms had an increased lung cancer risk (HRsociodemographics-adjusted = 1.62, 95% CI 1.34–1.95; HRfully-adjusted = 1.25, 95% CI 1.04–1.51). In a test of mediation, lifetime pack-years of smoking accounted for 38% of the overall association between depressive symptoms and disease risk. When stratifying by smoking status, the elevated risk was evident among former smokers but not current or never smokers; however, the interaction term suggested no meaningful differences across groups (p = 0.29). Results were similar or stronger when considering time-updated depression status (using depressive symptoms, physician diagnosis, and regular antidepressant use) and chronicity of depressive symptoms.

Conclusions

These findings suggest that greater depressive symptoms may contribute to lung cancer incidence, directly and indirectly via smoking habits, which accounted for over a third of the association.

Keywords

Antidepressantcancerdepressionlung cancersmoking
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 13 , October 2022 , pp. 2510 - 2519
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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