Psychological distress in adult patients with colorectal cancer: roles of biological age and neighborhood deprivation

INTRODUCTION: Depression and anxiety are common in adults with colorectal cancer (CRC), especially during chemotherapy, yet underlying biosocial mechanisms remain unclear. We examined whether biological age predicts these symptoms and whether neighborhood deprivation amplifies risk. METHODS: This secondary de-identified EHR analysis (2017-2023) included adults (≥18) with stage II-III CRC receiving chemotherapy (N = 958). Biological age was measured using nine blood biomarkers (i.e., Levine Clinical Biological Age). Depression and anxiety were assessed using PHQ-9 and GAD-7 tools. The Area Deprivation Index (ADI) was used to quantify neighborhood deprivation. Multivariable linear regression examined associations between biological aging and psychological symptoms over 6 months, with Benjamini-Hochberg adjustment (q-values) for multiple testing. RESULTS: Mean biological age was 65.9 years at baseline and increased by 3 years during chemotherapy. Participants reported moderate depression and anxiety symptoms at baseline. In adjusted analyses, increases in biological age were associated with worsening depressive symptoms (B = 0.18, q = 0.048), while higher baseline biological age was associated with greater baseline depressive symptom severity (B = 0.31, q = 0.008). Neighborhood deprivation strengthened associations between biological aging and depressive symptoms at baseline and over time, including changes in biological age and age acceleration (all q ≤ 0.049). CONCLUSIONS: Blood biomarker-based biological age may indicate elevated risk of psychological distress in CRC, particularly in socioeconomically deprived neighborhoods. Integrating biological age and geospatial context may improve high-risk patient identification and guide targeted mental health care.