Risk of Depressive or Anxiety Disorders in Commercially Insured Patients with Non-Hodgkin Lymphoma (NHL) in the US: A Retrospective Analysis
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Background: Non-Hodgkin Lymphoma (NHL) is one of the most common cancers in the United States, with an expected incidence of 72,000 new cases in 2017. Compared to rapidly fatal cancers, such as lung or pancreatic, NHL is associated with a relatively high 5-year survival of 70%. Prior epidemiological studies suggest that NHL patients may experience higher rates of depressive or anxiety disorders, and have an associated unmet mental health need. Objective: To estimate the incidence of depressive and anxiety disorders in patients newly diagnosed with NHL compared to matched, cancer-free controls in the US commercially insured population. Methods: A retrospective cohort analysis was conducted using MarketScan® claims data from 2008 to 2015. Patients with NHL were identified by ICD-9 code and matched on a 1:1 ratio to cancer-free controls using propensity scores generated from age, region, and Charlson comorbidity index (CCI) score. Incidence rate ratios and hazard ratios were estimated using Poisson regression and Cox proportional hazards models. The odds of experiencing a depressive or anxiety disorder within one year of diagnosis was also estimated using logistic regression. Results: A total of 24,055 NHL patients were identified and matched to cancer-free controls, with a total study population of 48,110. NHL patients had a 36% higher instantaneous risk of experiencing a depressive or anxiety disorder, 31% higher risk of only a depressive disorder, and 39% higher risk of only an anxiety disorder, compared to cancer-free controls (p < 0.00005). Within one year of diagnosis, NHL patients had 122% higher odds of experiencing any type of depressive or anxiety disorder, 112% higher odds of experiencing a depressive disorder, and 127% higher odds of experiencing an anxiety disorder. Conclusion: Diagnosis with NHL is associated with a significantly higher risk of experiencing depressive or anxiety disorders compared to cancer-free controls, which may indicate an important clinical need within this patient population.