Hypothetical interventional effect of health behaviors for improving depression symptoms among patients diagnosed...

Depressive symptoms are frequently reported among patients undergoing treatment for malignancies and among cancer survivors. However, treatment options for depression in this population remain limited due to significant side effects and suboptimal efficacy. These challenges underscore the urgent need for safe, well-tolerated, and effective strategies to alleviate depressive symptoms in individuals affected by cancer. Therefore, we aimed to evaluate the hypothetical interventional effects of seven lifestyle factors on alleviating depressive symptoms in individuals currently or previously diagnosed with cancer.

The cross-sectional study used the National Health and Nutrition Examination Survey data (NHANES) on US patients diagnosed with cancer. Lifestyle was collected through questionnaires and physical examination, including diet habit, physical activity, smoking status, alcohol consumption, sleep length, and waist circumference. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Associations between lifestyle and depressive symptoms were assessed using inverse probability-weighted linear models. The g-formula approach was used to explore the effects of hypothetical intervention strategies to alleviate depression.

The association analysis included 19,021 participants. In the hypothetical intervention analysis, 1,931 individuals diagnosed with cancer were included, with a mean age of 65.13 ± 13.76 years, and 924 (47.9%) of them were males. For different hypothetical intervention strategies, the reductions of PHQ-9 score were 1.117 (95% CI, 1.112, 1.122) under the smallest waistline, 0.878 (0.868, 0.888) under the 7-8 h sleeping duration, 0.743 (95% CI, 0.742, 0.744) under the highest mediterranean diet (MED) index, 0.690 (95% CI, 0.690, 0.690) under the alcohol cessation, 0.683 (95% CI, 0.683, 0.684) under the best Dietary Approaches to Stop Hypertension (DASH) Index, 0.650 (95% CI, 0.624, 0.676) under the highest physical activity equivalent, 0.378 (95% CI, 0.378, 0.378) under the cessation of smoking, and 0.125 (95% CI, 0.123, 0.128) under the best HEI-2015 Index (Healthy Eating Index-2015) ranked from highest to lowest.

Lifestyle interventions can reduce depressive symptoms in patients diagnosed with cancer in the United States. Appropriate dietary patterns and exercise can be selected based on the needs and characteristics of the patient. Smoking and alcohol cessation, reducing waist circumference and adequate sleep duration are also feasible interventions.