Identifying gender-specific treatment targets for depression in cancer survivors: Evidence from NHANES

Depression is a prevalent and heterogeneous symptom among cancer survivors, yet gender-specific differences in symptom patterns remain underexplored. This study aims to characterize gender-specific depressive-symptom networks in cancer survivors and identify optimal intervention targets via computer-simulated interventions.

In this cross-sectional study of 2141 cancer survivors from seven National Health and Nutrition Examination Survey (NHANES) cycles, we compared Patient Health Questionnaire-9 (PHQ-9) scores by gender. We used Gaussian graphical models to identify core symptoms, applied Bayesian network analysis to map symptom activation pathways, and conducted computer-simulated interventions to pinpoint gender-specific treatment targets.

Overall, the average PHQ-9 scores were relatively low, suggesting very mild reported depressive symptoms. In men's networks, three central nodes, specifically "depressed mood", "anhedonia", and "psychomotor changes" emerged. "Worthlessness" was identified as the primary driver of "suicidal ideation", with "worthlessness" and "fatigue" as the potential intervention targets. In women's networks, "depressed mood" served as the only core symptom driving "concentration difficulties", with "depressed mood" and "psychomotor changes" as the potential intervention targets.

Distinct gender-specific differences in core depressive emerged in cancer survivors' symptom networks. These findings provide direction for targeted psychosocial interventions in oncology care.