Depressive Symptoms and Gynecological Cancer Risk in Women: An Updated Population-Based Study
Abstract
Background: Depression is common among women and has been linked to chronic diseases, including cancer. The association between depressive symptoms and gynecological cancer risk remains unclear. This study investigated these associations in adult women. Methods: This cross-sectional study included 15,407 adult women from the 2009–2010, 2011–2012, 2013–2014, 2015–2016, January 2017–March 2020, and August 2021–August 2023 cycles of the National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Gynecological cancers, including cervical, ovarian, and endometrial cancers, were identified based on self-reported physician diagnoses. Survey-weighted logistic regression models were used to estimate odds ratios and 95% confidence intervals. Restricted cubic spline analyses and subgroup analyses were further performed to evaluate potential nonlinear associations and effect modification. Results: Among participants, 372 had gynecological cancers (187 cervical, 68 ovarian, 130 endometrial). Women with cancers had higher PHQ-9 scores. Each 1-point increase in PHQ-9 was associated with overall gynecological cancer risk (OR=1.04, 95% CI 1.01–1.07, P=0.013). The strongest cancer-specific association was observed for endometrial cancer (OR=1.05, 95% CI 1.00–1.11, P=0.042; severe depression OR=4.31, 95% CI 1.41–13.16, P=0.010). The association with ovarian cancer was weaker (OR=1.06, 95% CI 1.00–1.11, P=0.047), with limited dose-response evidence. No independent association was found for cervical cancer (OR=1.02, 95% CI 0.98–1.06, P=0.399). Spline analyses showed no nonlinear effects, and demographic factors, such as ethnicity, may influence associations. Conclusions: Depressive symptoms were associated with higher odds of prevalent gynecological cancer, with the strongest association observed for endometrial cancer. Associations with ovarian cancer were less stable, and cervical cancer showed no independent relationship. These findings highlight the relevance of mental health in women’s cancer risk and the need for longitudinal studies. Given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects.