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Subsequent depression in patients with lip and head and neck cancer: a population-based primary care analysis
Lisa Lotta Cirkel1, Bernd Wöstmann1,2, Karel Kostev3
1Department of Cariology, Periodontology, and Endodontology, Dental Clinic, Justus Liebig University Giessen, Giessen, Germany.
Background:
Lip and head and neck cancer is associated with a significant psychological burden. However, there is a lack of evidence from German primary care regarding the association between lip and head and neck cancer and subsequent depression. Our study aimed to determine the association between lip and head and neck cancer diagnosis and subsequent depression diagnosis.
Methods:
Using the German Disease Analyzer database (IQVIA), we conducted a retrospective cohort study of adults (≥ 18 years) with incident lip and head and neck cancer (ICD-10 C00-C06) initially documented in general practices between 2005 and 2023. Individuals with prior mental health conditions were excluded. Lip and head and neck cancer patients were propensity-score matched (1:10) to cancer-free individuals. Incident depression diagnosis within five years after the index date was the primary outcome, analyzed using Kaplan-Meier curves and conditional Cox regression.
Results:
The study included 1,852 patients with lip and head and neck cancer and 18,520 matched non-cancer individuals. Lip and head and neck cancer was associated with a higher incidence of subsequently diagnosed depression (hazard ratio (HR) = 1.62; 95% confidence interval (CI) 1.40-1.87). Tongue cancer was found to be the tumor site most consistently associated with subsequent depression across all subgroups (HR = 2.05; 95% CI 1.65-2.53); base-of-tongue cancer (C01) and tongue cancer (C02) showed independently consistent associations when analyzed separately (HR = 2.10 and HR = 2.01, respectively). Stronger associations were observed among adults aged 60 years or younger and men. Patients with distant metastasis showed a particularly strong association with subsequent depression (HR = 2.59; 95% CI 1.85-3.63).
Conclusions:
Patients with lip and head and neck cancer, particularly those with tongue cancer, younger individuals, and patients with metastases, showed a significantly higher incidence of subsequent depression. These results highlight the importance of systematic mental health screening and targeted psychosocial support in routine oncological and primary care settings to enhance patient outcomes.
