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The heightened stress of having a spouse battling cancer may manifest in a clinical diagnosis of a new psychiatric disorder, a population-based cohort study found.

Looking at over 3 million people living in Denmark and Sweden, there was a higher incidence of first-onset psychiatric disorders among spouses of patients with cancer when compared with the spouses of patients without cancer (6.9% vs 5.6%), reported Qianwei Liu, MD, PhD, of the Karolinska Institutet in Stockholm, and colleagues.

This difference translated to a 14% higher risk during a median follow-up of more than 8 years (adjusted HR 1.14, 95% CI 1.13-1.16), with similarly elevated risks for developing depression, substance abuse disorder, and stress-related disorders (aHRs of 1.16-1.25), the group wrote in .

A particularly heightened risk among spouses was seen during the first year following a cancer diagnosis (aHR 1.30, 95% CI 1.25-1.34), driven primarily by a higher incidence in stress-related disorders and depression.

• Stress-related disorders: aHR 2.04 (95% CI 1.88-2.22)
• Depression: aHR 1.38 (95% CI 1.30-1.47)

"The greatest risk increase during the first year after cancer diagnosis was consistent with our previous finding that the risk of adverse health outcomes, e.g., psychiatric disorders, cardiovascular disease, and suicide, was highest during the first year after diagnosis among the patients with cancer themselves," the researchers pointed out.

Not surprisingly, spouses had a higher risk for developing a psychiatric disorder if their spouse had a cancer with a poorer prognosis, such as cancers of the esophagus, lung, or pancreas. For example, spouses of those with pancreatic cancer had a 41% increased psychiatric disorder risk. And spouses of those diagnosed with an advanced stage cancer had a 31% increased risk for a psychiatric disorder.

Likewise, if a spouse with cancer died during follow-up, the surviving spouse had a 29% increased psychiatric disorder risk. This was even more pronounced for male spouses following the death of the patient with cancer (aHR 1.48, 95% CI 1.44-1.52).

Spouses that had a preexisting psychiatric morbidity also saw a significantly higher risk for a hospital visit either for a recurrence of their condition or for another first-onset psychiatric disorder (aHR 1.23, 95% CI 1.20-1.25).

"These results support the need of clinical awareness to prevent potential mental illness among the spouses of patients with cancer, especially in these high-risk groups," Liu's group said.

Findings were based on data representing 546,321 spouses of patients with cancer compared with over 2.7 million unexposed spouses without a preexisting psychiatric morbidity. The median age of the cohort was 60. There was slightly more female than male spouses included (54% vs 46%).

Over the entire 8.4 years of median follow-up, spouses of patients with cancer had elevated risks for new diagnoses of depression, substance abuse, a stress-related disorder, and anxiety, when compared to spouses of patients without cancer, respectively:

• Depression: 2.9 vs 2.5 cases per 1,000 person-years (aHR 1.16, 95% CI 1.14-1.18)
• Substance abuse: 2.3 vs 1.9 cases per 1,000 person-years (aHR 1.20, 95% CI 1.17-1.22)
• Stress-related disorder: 1.1 vs 0.9 cases per 1,000 person-years (aHR 1.25, 95% CI 1.22-1.29)
• Anxiety: 1.0 vs 0.9 cases per 1,000 person-years (aHR 1.07, 95% CI 1.04-1.10)

While the risk of any new-onset diagnosis was highest during the first year, it remained elevated in the follow-up period beyond as well (aHR 1.13, 95% CI 1.12-1.14), the researchers noted.

Psychiatric diagnoses included disorders that required either inpatient or outpatient treatment, based on ICD codes. Interestingly, there was a slightly higher risk for an inpatient diagnosis of psychiatric disorders versus for an outpatient diagnosis (aHR 1.17 vs aHR 1.13, respectively).

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