Post-Diagnosis Depressive Symptoms and Survival in the Colon Cancer Patterns of Care in Chicago Study

Background Depressive symptoms are common among colorectal cancer survivors and may influence prognosis through behavioral and biological pathways. However, evidence linking post-diagnosis depression to cancer-specific survival remains inconsistent, and many studies rely on heterogeneous depression measures or focus primarily on all-cause mortality. This study examines whether depressive symptoms after diagnosis are associated with colon cancer–specific mortality in a racially and socioeconomically diverse cohort. Methods We analyzed data from the Colon Cancer Patterns of Care in Chicago (CCPCC) study, a multi-site cohort of colon cancer patients diagnosed between 2011 and 2014 and recruited from nine healthcare institutions in the Chicago metropolitan area. Depressive symptoms were assessed during a baseline interview using the Patient Health Questionnaire-8 (PHQ-8) and dichotomized using the validated clinical cutoff (≥10). The outcome was colon cancer–specific mortality determined through linkage with the National Death Index through 2018. Kaplan–Meier methods were used to estimate survival distributions. Multivariable Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for demographic, socioeconomic, and clinical covariates. Results Among 355 colon cancer patients, 17.7% had clinically significant depressive symptoms. In the final multivariable model (n = 308; 84 colon cancer–specific deaths), post-diagnosis depressive symptoms were not associated with colon cancer–specific mortality (HR = 1.03, 95% CI: 0.55–1.93). Depressive symptoms were more prevalent among patients with lower education, lower income, and greater comorbidity burden. Kaplan–Meier analyses showed no significant difference in survival by depressive symptom status. Conclusions Post-diagnosis depressive symptoms were not independently associated with colon cancer–specific survival in this urban cohort after adjustment for socioeconomic and clinical factors. Implications While depression screening remains essential for improving quality of life and addressing psychosocial disparities among cancer survivors, its direct impact on cancer-specific mortality may be limited. Future studies with repeated depression assessments and larger cohorts are needed to clarify potential pathways linking mental health and cancer outcomes.

Author dc:creator

• Olivia Xinyi Shen (24400004)

• Epidemiology
• cancer epidemiology
• mental health
• public health

Statement dc:rights

• In Copyright
• Open Access after 2028-05-01

DOI dc:identifier

https://doi.org/10.25417/uic.32995064.v1

OAI identifier oai:identifier

oai:figshare.com:article/32995064