The role of depression in adherence to colorectal cancer screening guidelines

Cancer is the second leading cause of death in the United States with an incidence rate of approximately 442.3 out of 100 000. In 2021, colorectal cancer (CRC) was responsible for more than 52 000 deaths. Screening is a preventive practice that can detect CRC early. More than 70% of adults aged 45 years or older get screened at least once, yet far fewer follow recommended screening guidelines. Depression is associated with an increased risk of CRC and CRC-related mortality and a reduction in regular CRC screening, making it a significant psychosocial barrier to preventive screening. This cross-sectional study examined factors associated with adherence to CRC screening recommendations, particularly among individuals with a self-reported depression diagnosis.

Utilizing a representative national sample (n = 204  539) from the 2023 Behavioral Risk Factor Surveillance System (adults aged≥50), we assessed the effects of depression and key variables associated with depression and CRC screening on the likelihood of adherence. Our model included interactions between depression and race/ethnicity, education, and income among other variables.

African Americans (AA) with depression were 60% less likely to meet recommendations than AA without depression (odds ratio = 0.40, 99% confidence interval = 0.29, 0.55).

The results suggest a critical need for health care practitioners to assess patient mental health, especially among AA patients, who are at higher risk of developing CRC despite an overall higher likelihood of being screened. Targeting the highest risk individuals, particularly those with depression, may reduce costs for public health campaigns targeting CRC screening.