Cancer diagnosis and the increase in depressive symptoms among patients and their families: a nationwide cross-sectional and cohort analysis based on the China health and retirement longitudinal study

<h2>Abstract</h2><h3>Background</h3> This study aims to assess the mental health effects of a cancer diagnosis on the patients and their family members. <h3>Methods</h3> Data from the China Health and Retirement Longitudinal Study (CHARLS) spanning from 2011 to 2020 were utilized. The study compared depressive symptom scores, as measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10), among cancer patients, non-cancer individuals with cancer family members, and individuals without cancer or cancer family members. A longitudinal analysis was also performed to track changes in depressive symptom scores for patients and their non-cancer family members before and after a cancer diagnosis within the CHARLS database. <h3>Findings</h3> The study included 19,364 individuals and 256 cancer patients, along with 246 non-cancer individuals with cancer family members in both cross-sectional and cohort analyses. In the 2020 CHARLS database, a total of 19,364 participants were analyzed, with a median age of 63.0 years [interquartile range (IQR) 55.0 - 70.0]. 9,079 individuals (46.9%) were male. Among them, 491 individuals were diagnosed with cancer, with 169 (34.4%) having depressive symptoms (CESD score above 10). Among the 407 non-cancer individuals with cancer family members, 130 (31.9%) had depressive symptoms. Among the 18,466 individuals without cancer or cancer family members, 5,778 (31.3%) had depressive symptoms. The study found a significant association between cancer and depression in individuals (P<0.001). A within-subject longitudinal cohort analysis was conducted on 256 cancer patients who had CESD-10 score data prior to their cancer diagnosis, showing a median score of 6 (IQR 3-13) before diagnosis and 9 (IQR 5-15) after diagnosis, P=0.0001, indicating a significant increase in depressive symptoms post-diagnosis. The 246 non-cancer family members of these patients also participated in this longitudinal study, with a median CESD-10 score of 6 (IQR 3-11) before the family member's cancer diagnosis and 8 (IQR 4-13) after, P=0.007. The prevalence of depressive symptoms significantly increased following a family member's cancer diagnosis. <h3>Interpretation</h3> The diagnosis of cancer significantly worsens depressive symptoms in both patients and their family members. It is imperative to focus on and implement measures to improve the mental health status of cancer patients and their families.