Skip to main content
NCBI home page
BMJ Oncology logoLink to BMJ Oncology
. 2026 Sep 25;5(2):e001215. doi: 10.1136/bmjonc-2026-001215

Incidence of new-onset depression after colorectal cancer diagnosis and associated mortality: a population-based cohort study

Vicki Cheng 1,2, Eric C Sayre 3, Jonathan M Loree 4,5, Sharlene Gill 4,5, Rachel A Murphy 4,6, Mary A De Vera 1,2,7,✉
PMCID: PMC13636315  PMID: 42835580

Abstract

Objectives

To examine the incidence of and factors associated with new-onset depression following colorectal cancer (CRC) diagnosis and its association with all-cause and CRC-specific mortality.

Design

Population-based retrospective cohort study using linked administrative health databases.

Setting

British Columbia, Canada.

Participants

Individuals diagnosed with CRC from 2010 to 2017 without a history of physician-recorded depression diagnoses in the 5 years preceding the CRC diagnosis.

Main outcome measures

New-onset depression following CRC diagnosis was identified using International Classification of Diseases (ICD)-9 and ICD-10 diagnostic codes. Cumulative incidence and incidence rates of new-onset depression were estimated, and factors associated with new-onset depression were examined using Cox proportional hazards models. Depression was modelled as a time-varying exposure in mortality analyses, with Cox proportional hazards models used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and CRC-specific mortality.

Results

Among 13 986 patients with CRC (55.2% males, mean age 66.0), the 5-year cumulative incidence of new-onset depression among those without a history of depression was 6.63% following CRC diagnosis. Incidence rates were highest in the first year post-CRC diagnosis (3.54 per 100 person-years), indicating that new-onset depression was most common early after diagnosis. Factors associated with new-onset depression included female sex (HR 1.40 (95% CI 1.22 to 1.61)) and stage 4 disease (HR 1.77 (95% CI 1.34 to 2.33)). New-onset depression after CRC diagnosis was associated with 97% higher all-cause mortality (HR 1.97 (95% CI 1.74 to 2.23)) and 73% higher CRC-specific mortality (HR 1.73 (95% CI 1.48 to 2.03)).

Conclusions

The cumulative incidence of new-onset depression increased over time, with incidence rates highest in the first year following CRC diagnosis. New-onset depression after CRC diagnosis was associated with higher all-cause and CRC-specific mortality. Findings highlight the importance of early identification of patients at high risk for depression and consideration of longitudinal mental healthcare in CRC care.

Keywords: Colorectal cancer, Mortality, Epidemiology

WHAT IS ALREADY KNOWN ON THIS TOPIC

  • Although depression among people with colorectal cancer (CRC) has been well studied, less is known about how often it develops after a CRC diagnosis, who is most at risk, and how it may affect long-term health outcomes. Population-based longitudinal evidence examining new-onset depression specifically within the CRC population remains limited.

WHAT THIS STUDY ADDS

  • In this population-based cohort of 13 986 individuals with CRC, 6.63% developed new-onset depression within 5 years of CRC diagnosis, with incidence rates highest during the first year. Female sex and advanced cancer stage were associated with higher rates of new-onset depression, while a history of depression emerged as the strongest factor associated with new-onset depression. New-onset depression following CRC diagnosis was associated with higher all-cause and CRC-specific mortality.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • These findings support consideration of ongoing mental health assessment and care throughout CRC care and highlight the importance of identifying individuals at higher risk of depression who may benefit from targeted psychosocial support. Future research should evaluate strategies for depression screening and early psychosocial or psychiatric support among individuals with CRC, particularly those at higher risk.

Introduction

Colorectal cancer (CRC), characterised by the malignant growth of tumours in the colon or rectum, poses a significant global health burden, with approximately 1.9 million new cases and over 900 000 deaths annually in 2022.1 2 In Canada, approximately 1 in 16 males and 1 in 18 females are estimated to develop CRC during their lifetime.3 Beyond its physical consequences,4 5 CRC is associated with significant psychological and mental health impacts, contributing to an increased burden of mental disorders among individuals with CRC.6 The mental health impacts of CRC may stem from the diagnosis itself and the demands of cancer treatment, including surgery, chemotherapy and ostomy formation, as well as persistent symptoms such as bowel dysfunction, pain and sexual dysfunction.7–9 These challenges may be further compounded by concerns about recurrence, changes in body image, financial strain and social isolation.10 11

Depression is one of the most common and debilitating mental disorders affecting individuals with cancer.12–14 Beyond its impact on quality of life,14 depression may interfere with treatment adherence15 and has been associated with poorer long-term outcomes, including increased mortality.16 In the context of CRC, studies have demonstrated that patients are at a higher risk of developing depression and other mood disorders compared with the general population. Notably, a 2022 systematic review and meta-analysis by Cheng et al confirmed this association, showing that CRC was significantly associated with the onset of depression (pooled hazard ratio [HR] 1.78 (95% confidence interval [CI] 1.23 to 2.57)).17 Furthermore, although previous studies have characterised the prevalence of depression among individuals with CRC, few have examined the incidence of new-onset depression following CRC diagnosis.6 18 19

Several demographic, socioeconomic and clinical factors have also been associated with depression among individuals with cancer. Studies have reported associations between depression and factors such as sex, age, comorbidity burden, socioeconomic circumstances, disease duration and cancer stage.20–22 Depression may also be influenced by psychosocial factors, including social support and aspects of the healthcare experience.20 22 Therefore, identifying individuals at greater risk of developing depression following cancer diagnosis is important for informing timely identification and targeted mental health support. However, much of the existing evidence is based on cross-sectional studies of prevalent depressive symptoms across heterogeneous cancer populations, limiting understanding of factors associated with new-onset depression following CRC diagnosis.

Depression following CRC diagnosis has also been linked to poorer long-term outcomes. A 2013 cohort study of 1227 individuals with CRC reported that those with depressive symptoms had a twofold risk of all-cause mortality.23 Similarly, a 2022 cohort study of 2602 individuals with CRC found that post-diagnosis depressive symptoms were independently associated with increased mortality (HR 1.47 (95% CI 1.21 to 1.80)).24 Recently, a 2025 meta-analysis of 65 cohort studies across cancer types, including CRC, further reported that depression after CRC diagnosis was associated with an 83% high risk of CRC-specific mortality, while highlighting substantial heterogeneity of depression assessment methods in previous literature, raising concerns about measurement bias.25 Indeed, several biological pathways may underlie the association between depression and poorer outcomes among individuals with CRC. Depression may influence biological processes such as inflammatory and neuroendocrine function,26 while also affecting engagement with cancer care, health behaviours and health outcomes, including physical activity and treatment adherence.27 28 These potential pathways may contribute to poorer health outcomes among individuals with CRC and therefore also highlight the importance of examining the relationship between new-onset depression and long-term outcomes, specifically mortality following CRC diagnosis.

To our knowledge, while a higher risk of depression among individuals with CRC compared with those without CRC has been established,17 several gaps remain in understanding new-onset depression within the CRC population. Existing evidence has largely focused on prevalent depression rather than new-onset depression, and few studies have comprehensively examined factors associated with new-onset depression in CRC or its association with subsequent all-cause and CRC-specific mortality in a population-based CRC cohort. We aimed to address these gaps by conducting a population-based cohort study among individuals with CRC to (1) estimate the incidence of new-onset depression, (2) identify sociodemographic, clinical and treatment-related factors associated with new-onset depression and (3) evaluate the association between new-onset depression and all-cause and CRC-specific mortality.

Methods

Study design, data source and source population

We conducted a population-based cohort study using administrative health data from Population Data British Columbia (BC), which captures longitudinal, de-identified individual-level data for the province of BC, Canada (5.68 million residents in 2025). The data sources accessed for this study included the Medical Services Plan (outpatient visits), Discharge Abstract Database (inpatient visits), Consolidation File (demographics) and Vital Statistics File (deaths) since 1985. We linked Population Data BC data to the BC Cancer Registry29 using Personal Health Numbers. The BC Cancer Registry29 captures information on cancer diagnosis (date of diagnosis, tumour type and site) and treatment (type and dates) since 1985 (online supplemental figure 1).

Supplementary data

bmjonc-5-2-s001.pdf (4.7MB, pdf)

The source population was derived from these data sources and included individuals diagnosed with CRC between 1 January 1985 and 31 December 2017. We identified individuals with CRC in the BC Cancer Registry using the International Classification of Diseases for Oncology (ICD-O), Third Edition codes: C18.3, C18.0, C18.2 (right colon); C18.6, C18.7, C18.5, C19 (left colon); C18.4 (transverse colon); C20, C21.8 (rectum) and C18.9, C18.1, C18.8 (unspecified). Individuals were further classified into two groups: early-age onset CRC (EAO-CRC; individuals diagnosed at age <50 years) and average-age onset CRC (AAO-CRC; individuals diagnosed at age ≥50 years) (online supplemental figure 1).

Study cohort

From the source population, we created a study cohort of individuals diagnosed with CRC from 1 January 2010 to 31 December 2017. The study period was defined by the earliest availability of stage data from the BC Cancer Registry (ie, from 2010 onwards) and the availability of administrative health data to 31 December 2017. Although the source population included individuals diagnosed with CRC from 1985 onwards, the analytic cohort was restricted to 2010–2017 to ensure availability of cancer stage and complete administrative health data throughout the study period. The primary analytic cohort consisted of individuals with CRC without a history of depression (ie, without a physician-recorded diagnosis of depression in the past 5 years) prior to CRC diagnosis; all primary analyses were conducted in this group. All analyses were repeated in an expanded cohort that included individuals with CRC with and without a history of depression, as sensitivity analyses (online supplemental figure 1). In this study, a history of depression was operationally defined as a physician-recorded diagnosis of depression within the 5 years preceding the CRC diagnosis.

Outcome ascertainment

New-onset depression was defined as the first depression diagnosis identified after the CRC diagnosis using a validated case definition among individuals without a history of depression in the 5 years before the CRC diagnosis. Depression was identified using previously validated case definitions: ≥1 inpatient visit (with ICD-10 codes, F20.4, F31.3–F31.5, F32.x, F33.x, F34.1, F41.2 and F43.2) or ≥2 outpatient visits (with ICD-9 codes, 296.2, 296.3, 296.5, 300.4, 309.x and 311.x) within a 1-year period.30 31 For individuals meeting the outpatient definition, the date of the second qualifying outpatient visit was considered the date of depression onset. This definition captures clinically diagnosed depression and related diagnoses identified through healthcare system contact (inpatient or outpatient care) and therefore reflects physician-recorded diagnoses requiring medical attention, rather than self-reported symptoms or medication use (eg, antidepressants) alone. Mortality outcomes included all-cause mortality and CRC-specific mortality, ascertained using the Vital Statistics database.

Covariate assessment

We included age, sex (ie, biological construct) from the Consolidation File, neighbourhood income quintile (area-based quintiles of Adjusted Income Per Person Equivalent), adjusted for household size, where quintile 1 represents the lowest income, residence (urban or rural) and comorbidities captured using the Charlson-Romano Comorbidity Index.32 Cancer site, cancer stage and treatment type (surgery, chemotherapy or radiation) were obtained from the BC Cancer Registry.

Statistical analysis

Incidence of new-onset depression

We examined the incidence of new-onset depression following CRC diagnosis using two approaches. First, incidence proportion (ie, risk) was calculated from the date of CRC diagnosis to successive time points (eg, 0–1, 0–2, 0–3, 0–4 and 0–5 years) to quantify the cumulative risk of depression over time. Second, time-specific incidence rates were estimated per 100 person-years within discrete follow-up intervals (eg, 0–1, 1–2, 2–3, 3–4 and 4–5 years). Person-time was accrued from the date of CRC diagnosis until the earliest occurrence of depression onset, death, loss to follow-up or the end of the study period (31 December 2017), whichever occurred first.

Incidence estimates were calculated in the primary analytic cohort of individuals with CRC without a history of depression and repeated in sensitivity analyses that included individuals with CRC with and without a history of depression. Subgroup analyses were conducted by age at diagnosis (EAO-CRC vs AAO-CRC), sex (male/female) and cancer stage.

Factors associated with new-onset depression

Time-to-event analyses using Cox proportional hazards models were performed to evaluate variables associated with time to new-onset depression following CRC diagnosis. Cox models account for variable follow-up time and censoring and appropriately model the time to depression onset. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated, with statistical significance defined as p<0.05. The primary multivariable model included age, sex, neighbourhood income quintile, residence, comorbidities, cancer site, cancer stage and treatment type. Analyses were conducted in the primary analytic cohort and repeated in sensitivity analyses. Subgroup analyses further examined estimates by age at CRC diagnosis, sex and cancer stage.

Association between new-onset depression and mortality

Cox proportional hazards models were conducted to estimate the association between new-onset depression and mortality following CRC diagnosis. Depression was treated as a time-varying exposure such that individuals contributed person-time without depression from CRC diagnosis until the first recorded depression diagnosis and person-time with depression thereafter. This approach allows exposure status to change over follow-up, such that individuals contribute person-time to both exposure groups (eg, depression/no depression), thereby avoiding immortal time bias and ensuring that depression onset precedes assessment of mortality risk. For all-cause mortality, deaths from any cause were treated as events using standard Cox models. For CRC-specific mortality, Fine and Gray subdistribution hazard models were used to account for competing risks,33 with non-cancer deaths treated as competing events. The primary multivariable models were adjusted for age, sex, neighbourhood income quintile, residence, comorbidities, cancer site, cancer stage and treatment type. Primary analyses were conducted in the primary analytic cohort and repeated in sensitivity analyses, where we adjusted for depression history. Subgroup analyses were conducted by age at diagnosis, sex and cancer stage. All analyses were conducted using SAS statistical software V.9.4.

Study conduct

Access to data provided by the Data Stewards is subject to approval but can be requested for research projects through the Data Stewards or their designated service providers. The following data sets were used in this study: Medical Services Plan, Discharge Abstract Database, Consolidation File, Vital Statistics File and BC Cancer Registry. You can find further information regarding these data sets by visiting the PopData project webpage (https://my.popdata.bc.ca/project_listings/18-088/collection_approval_dates). All inferences, opinions and conclusions drawn in this publication are those of the author(s) and do not reflect the opinions or policies of the Data Steward(s).

Patient and public involvement

Patients or the public were not involved in the design, conduct, reporting or dissemination plans of our research.

Results

Characteristics of the study cohort are summarised in table 1. Our study cohort included 13 986 individuals with CRC, including those with and without a history of depression (55.2% males, mean age: 66.0 years, standard deviation [SD]: 11.5). Among these, 1135 have EAO-CRC (55.1% males, mean age: 42.2 years, SD: 6.3) and 12 851 have AAO-CRC (55.3% males, mean age: 68.1 years, SD: 9.3). Overall, 10.0% of individuals with CRC had a history of depression, including 12.2% among EAO-CRC and 9.8% among AAO-CRC.

Table 1.

Characteristics of individuals with CRC (all), EAO-CRC (aged <50 years) and AAO-CRC (aged ≥50 years), with and without a history of depression

Characteristic CRC (n=13 986) EAO-CRC (n=1135) AAO-CRC (n=12 851)
Follow-up time
 Overall
  Median time (years) 2.8 3.0 2.7
 Alive, n (%) 9504 (68.0) 808 (71.2) 8696 (67.7)
  Median time (years) 3.8 3.8 3.6
 Died, n (%) 4482 (32.0) 327 (28.8) 4155 (32.3)
  Median time (years) 1.7 1.5 1.2
Demographic factors
 Age, mean (SD) 66.0 (11.5) 42.2 (6.3) 68.1 (9.3)
 Sex, n (%)
  Male 7727 (55.2) 625 (55.1) 7102 (55.3)
  Female 6259 (44.8) 510 (44.9) 5749 (44.7)
 Neighbourhood income quintile, n (%)
  Quintile 1 2954 (21.1) 228 (20.1) 2726 (21.2)
  Quintile 2 2777 (19.9) 221 (19.5) 2556 (19.9)
  Quintile 3 2793 (20.0) 232 (20.4) 2561 (19.9)
  Quintile 4 2795 (20.0) 249 (21.9) 2546 (19.8)
  Quintile 5 2667 (19.0) 205 (18.1) 2462 (19.2)
 Residence, n (%)
  Urban 12 010 (85.9) 1013 (89.3) 10 997 (85.6)
  Rural 1976 (14.1) 122 (10.8) 1854 (14.4)
Comorbidities
 Charlson-Romano Comorbidity Index*, mean (SD) 1.1 (2.4) 1.2 (2.5) 1.1 (2.4)
 Inflammatory bowel disease, n (%) 360 (2.6) 81 (7.1) 279 (2.2)
History of depression†
 Depression, n (%)
  Yes 1393 (10.0) 138 (12.2) 1255 (9.8)
 No (primary analytic cohort) 12 593 (90.0) 997 (87.8) 11 596 (90.2)
CRC characteristics
 Site, n (%)
  Left colon 5797 (41.5) 459 (40.4) 5338 (41.5)
  Rectum 4599 (32.9) 475 (41.9) 4124 (32.1)
  Right colon 2419 (17.3) 115 (10.1) 2304 (17.9)
  Transverse colon 845 (6.0) 64 (5.6) 781 (6.1)
  Unspecified 326 (2.3) 22 (1.9) 304 (2.4)
 Stage‡, n (%)
  1 3030 (21.7) 163 (14.4) 2867 (22.3)
  2 3493 (25.0) 238 (21.0) 3255 (25.3)
  3 4536 (32.4) 435 (38.3) 4101 (31.9)
  4 2927 (20.9) 299 (26.3) 2628 (20.5)
 Treatment, n (%)
  Surgery 7635 (54.6) 764 (67.3) 6871 (53.5)
  Chemotherapy 7620 (54.5) 831 (73.2) 6789 (52.8)
  Radiation 3679 (26.3) 425 (37.4) 3254 (25.3)
Open in a new tab

Descriptive statistics were determined in the year prior to the CRC diagnosis date.

*All comorbidities except for cancer.

†A diagnosis of depression in the last 5 years prior to the CRC diagnosis date.

‡Stage data available from 2010 onwards.

AAO-CRC, average-age onset CRC; CRC, colorectal cancer ; EAO-CRC, early-age onset CRC.

Incidence of new-onset depression

Figure 1 shows the incidence proportion of new-onset depression among individuals with CRC without a history of depression, overall and stratified by age at diagnosis (figure 1A), sex (figure 1B) and stage (figure 1C). Within the first year after CRC diagnosis, 3.20% of individuals without a history of depression developed new-onset depression, with the cumulative risk increasing to 5.45% by 3 years and 6.63% by 5 years (figure 1A). In sensitivity analyses, including individuals with and without a history of depression, 5.52% of individuals developed new-onset depression within the first year after CRC diagnosis, with the cumulative risk increasing to 8.52% by 3 years and 9.48% by 5 years (online supplemental figure 2A).

Figure 1.

Bar charts show rising depression incidence proportions over 5 years post-CRC diagnosis. EAO-CRC reaches nearly 10%, exceeding AAO-CRC and overall CRC. Females consistently exceed males. Stage 3 shows the highest incidence among all stages.

Open in a new tab

Incidence proportion of new-onset depression after CRC diagnosis among individuals with CRC without a history of depression, stratified by (A) age at diagnosis; (B) sex and (C) stage (1–4). AAO-CRC, average-age onset CRC; CRC, colorectal cancer; EAO-CRC, early-age onset CRC.

Figure 2 shows incidence rates of new-onset depression among individuals with CRC without a history of depression, overall and stratified by age at diagnosis (figure 2A), sex (figure 2B) and stage (figure 2C). Within the first year after CRC diagnosis, the incidence rate was 3.54 per 100 person-years, then stabilised at 1.22 per 100 person-years by 5 years (figure 2A). In sensitivity analyses including individuals with and without a history of depression, the incidence rate was 6.43 per 100 person-years within the first year after CRC diagnosis, then decreased to 1.57 per 100 person-years by 5 years (online supplemental figure 3A).

Figure 2.

Line graphs show depression incidence per 100 person-years over 5 years post-CRC diagnosis. EAO-CRC starts highest near 5.5, Stage 4 peaks near 4.7, and females slightly exceed males initially.

Open in a new tab

Incidence rate of new-onset depression after CRC diagnosis among individuals with CRC without a history of depression, stratified by (A) age at diagnosis; (B) sex and (C) stage (1–4). AAO-CRC, average-age onset CRC; CRC, colorectal cancer; EAO-CRC, early-age onset CRC.

Factors associated with new-onset depression

Figure 3 presents adjusted HRs and 95% CIs from the primary multivariable Cox model evaluating factors associated with new-onset depression following CRC diagnosis. In this model, female sex (HR 1.40 (95% CI 1.22 to 1.61)) and increasing cancer stage (stage 2 HR 1.34 (95% CI 1.08 to 1.68); stage 3 HR 1.51 (95% CI 1.19 to 1.92); stage 4 HR 1.77 (95% CI 1.34 to 2.33)) were associated with higher hazards of new-onset depression. In subgroup analyses, factors associated with new-onset depression varied across age, sex and stage strata (online supplemental figures 4–8). In sensitivity analyses, including individuals with and without a history of depression, a history of depression was strongly associated with an eightfold higher hazard of new-onset depression (HR 8.06 (95% CI 7.21 to 9.00)) and was statistically significant across all models (online supplemental figures 9–14).

Figure 3.

Forest plot showing hazard ratios for new-onset depression after colorectal cancer diagnosis. Female sex and advanced cancer stages 2, 3, and 4 show significant associations.

Open in a new tab

Factors associated with new-onset depression after colorectal cancer (CRC) diagnosis among all individuals with CRC without a history of depression.

Association between new-onset depression and mortality

All-cause mortality

Figure 4A presents adjusted HRs and 95% CIs from the primary multivariable Cox model evaluating the association between new-onset depression and all-cause mortality following CRC diagnosis. In the model, new-onset depression was associated with a 97% higher hazard of all-cause mortality among individuals with CRC without a history of depression (HR 1.97 (95% CI 1.74 to 2.23)), after adjusting for demographic, clinical and treatment-related factors. In subgroup analyses, the association between new-onset depression and all-cause mortality was also observed within age, sex and stage strata (online supplemental figures 15–19). In sensitivity analyses, including individuals with and without a history of depression, new-onset depression remained significantly associated with all-cause mortality (HR 1.63 (95% CI 1.46 to 1.81)). A history of depression was also associated with an increased hazard of all-cause mortality (HR 1.20 (95% CI 1.09 to 1.33)) (online supplemental figures 20–25).

Figure 4.

Forest plots show new-onset depression hazard ratios near 1.97 for all-cause and 1.73 for CRC-specific mortality. Advanced cancer stage 4 shows the highest hazard ratios.

Open in a new tab

Association between new-onset depression and (A) all-cause mortality and (B) colorectal cancer (CRC)-specific mortality among all individuals with CRC without a history of depression. A time x stage interaction term (not displayed in figure) was included to account for non-proportional hazards.

CRC-specific mortality

Figure 4B presents adjusted HRs and 95% CIs from the primary multivariable Cox model evaluating the association between new-onset depression and CRC-specific mortality following CRC diagnosis. In the model, new-onset depression was associated with a 73% higher hazard of CRC-specific mortality among individuals with CRC without a history of depression (HR 1.73 (95% CI 1.48 to 2.03)), after adjusting for demographic, clinical and treatment-related factors. In subgroup analyses, the association between new-onset depression and CRC-specific mortality was also observed within age, sex and stage strata (online supplemental figures 26–30). In sensitivity analyses, including individuals with and without a history of depression, the association between new-onset depression and CRC-specific mortality remained significant (HR 1.51 (95% CI 1.31 to 1.73)). A history of depression was not associated with increased CRC-specific mortality (HR 1.06 (95% CI 0.93 to 1.21)) (online supplemental figures 31–36).

Discussion

In this population-based cohort of 13 986 individuals with CRC, 6.63% of individuals with CRC without a history of depression developed new-onset depression within 5 years of CRC, with incidence rates highest in the first year (3.54 per 100 person-years). Female sex and increasing cancer stage were associated with developing depression, with a history of depression showing the strongest association across analyses. Importantly, new-onset depression after a CRC diagnosis was independently associated with worse long-term outcomes, nearly doubling the risk of all-cause mortality and a 73% higher risk of CRC-specific mortality. Together, these findings suggest that depression is a clinically important concern among individuals with CRC, with implications extending beyond quality of life to adverse long-term outcomes.

Given prior evidence of elevated depression risk among individuals with CRC compared with those without CRC,17 34 focusing specifically on new-onset depression within the CRC population allows us to move beyond between-group comparisons and precisely characterise when and among whom depression emerges following a CRC diagnosis. A recent 2026 population-based cohort study by Springer et al. found that individuals with cancer had more than two times the risk of developing an incident mental disorder compared with cancer-free individuals (HR 2.30 (95% CI 2.30 to 2.30)), with incidence rates and relative risks highest during the first year after cancer diagnosis.35 Our findings similarly demonstrate that the incidence of new-onset depression was highest in the first year following CRC diagnosis, extending this broader evidence by characterising the timing of depression specifically within the CRC population. Furthermore, examining new-onset depression also helps characterise the timing of depression following CRC diagnosis and throughout subsequent care. Although the overall pattern of increasing cumulative incidence was similar across stages, stage 4 disease had a relatively high incidence rate of new-onset depression early after diagnosis but a lower cumulative incidence by 5 years compared with stages 2–3. This may partly reflect the higher mortality among individuals with stage 4 disease, as those who die before receiving a depression diagnosis cannot subsequently experience an incident depression event. The clinical context of depression may also differ by stage, with depression in stage 1–3 disease potentially reflecting treatment burden and post-treatment adjustment, whereas in stage 4 disease it may be driven by ongoing therapy and a poorer prognosis. Moreover, prior qualitative and observational research similarly reports persistent psychological distress after CRC treatment, extending into the follow-up and beyond phase of care (ie, survivorship).11 36 Indeed, patients often begin seeking mental health support months to years after treatment ends, highlighting the prolonged psychological burden of CRC.11 37–39 Consistent with this, clinical guidelines, including the Pan-Canadian Guideline on Screening, Assessment and Care of Psychosocial Distress in Adults With Cancer, recommend that ‘all patients with cancer and cancer survivors be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care’.40

We also provide longitudinal evidence on who may be most at risk of depression following CRC diagnosis. While prior research has identified female sex,41–44 younger age,44 comorbidities41–43 and advanced stage45 as factors associated with depression in individuals with CRC, much of this evidence is based on cross-sectional designs. Using longitudinal, population-based data, our study demonstrates temporal relationships between CRC diagnosis and subsequent depression. Across all analyses, female sex and advanced stage remained significantly associated with higher incident depression, with a history of depression being the strongest factor, increasing risk more than eightfold (HR 8.06 (95% CI 7.21 to 9.00)). These findings identify clinically relevant high-risk subgroups (eg, female individuals, advanced cancer stage and prior depression) for whom enhanced monitoring and early mental health screening or intervention may be especially warranted.

With respect to the association between depression and mortality, our findings differ from some previous studies. A prospective cohort study of 2396 postmenopausal women with CRC by Liang et al found no significant association between prediagnosis depression and either all-cause or CRC-specific mortality after adjustment.46 In contrast, in our sensitivity analysis, including individuals with a history of depression, prior depression was associated with higher all-cause mortality (HR 1.20 (95% CI 1.09 to 1.33)) but not CRC-specific mortality (HR 1.06 (95% CI 0.93 to 1.21)). Differences in study populations (eg, postmenopausal women with CRC vs a broader CRC population) and in the definition and measurement of depression may partly explain these discrepant findings, as depression in Liang et al’s study was assessed using depressive symptoms and antidepressant use46, whereas our study defined depression using physician-recorded diagnoses. In contrast, a 2024 systematic review and meta-analysis found that depression was associated with all-cause mortality (pooled HR 1.62 (95% CI 1.27 to 2.06)) but not CRC-specific mortality (pooled HR 1.16 (95% CI 0.91 to 1.48)) in multivariable analyses.47 Differences in depression definitions, follow-up duration and study populations may contribute to the heterogeneity in findings for CRC-specific mortality across the existing literature.

Despite these differences, our findings are consistent with several other studies linking depression to poorer long-term outcomes among individuals with CRC. In 2021, Walker et al16 observed a 47% higher hazard of all-cause mortality in patients with CRC with major depression (HR 1.47 (95% CI 1.11 to 1.94)), and Mols et al23 reported nearly a twofold higher risk among CRC survivors with depressive symptoms (HR 2.07 (95% CI 1.56 to 2.74)). Consistent with these findings, we observed that among individuals without a history of depression, new-onset depression after CRC was associated with a 97% higher risk of all-cause mortality (HR 1.97 (95% CI 1.74 to 2.23)) and a 73% higher risk of CRC-specific mortality (HR 1.73 (95% CI 1.48 to 2.03)). Furthermore, a recent 2025 meta-analysis of 13 CRC studies reported that depression was associated with an 83% higher risk of CRC-specific mortality (pooled HR 1.83 (95% CI 1.47 to 2.28)),25 although substantial heterogeneity was noted (I²=93%), reflecting variation in depression definitions, study designs and populations. Our study addresses these limitations by using a longitudinal population-based cohort, validated administrative case definitions of depression and a design that establishes temporality between depression onset and mortality. Importantly, by restricting analyses to individuals without a history of depression, we specifically examine the association of new-onset depression following CRC diagnosis—an approach not examined in previous studies.

The observed association between depression after CRC diagnosis and mortality also suggests that greater attention to early and proactive mental health assessment within CRC care may be warranted. From a behavioural and clinical mechanistic perspective, this is important given that depression has been associated with a range of health behaviours and treatment adherence among individuals with cancer.27 28 Prior research has reported associations between depression and poorer recovery, lower adherence to chemotherapy and other treatments,48 longer hospital stays49 and behaviours such as physical inactivity and poor dietary intake.50–52 Patients with depression are also more likely to experience social isolation and diminished social supports, which have also been associated with poorer health outcomes.53 54 Therefore, routine monitoring early in the CRC care continuum should be considered to identify emerging depressive symptoms and facilitate timely access to appropriate mental health support.

While our population-based study provides robust and clinically relevant insights into depression risk across the CRC care trajectory, limitations must be acknowledged. First, our administrative health data do not capture depression severity or patient-reported outcomes; our measures reflect physician-diagnosed depression identified through healthcare contact (inpatient or outpatient). Therefore, milder or untreated depressive symptoms not resulting in healthcare contact are not captured, which may lead to underestimation of the true incidence of depression and could affect the observed associations if more severe cases disproportionately drive mortality risk. Similarly, as antidepressants are prescribed for a range of conditions beyond depression, individuals treated with antidepressant medications used for reasons other than a physician-recorded diagnosis of depression would not be captured. Furthermore, our study period was restricted to 2010–2017 to ensure consistent availability of cancer stage information from our administrative data, which may limit the generalisability of our findings to individuals diagnosed with CRC in earlier periods. As this study was conducted using linked administrative health databases from BC, our findings may be generalisable to individuals receiving healthcare within BC and similar publicly funded healthcare systems but may not be fully applicable to settings with different healthcare financing and delivery models. Additionally, despite adjustment for multiple demographic and clinical factors, residual confounding may remain, given that our administrative health databases do not capture variables related to social determinants of health, lifestyle factors (eg, smoking, alcohol use and physical activity) and other psychosocial variables (eg, social support, stigma). Future studies incorporating patient-reported outcomes and psychosocial measures could better characterise depression trajectories and their impact on outcomes. Furthermore, intervention studies evaluating targeted screening or supportive care models—particularly for high-risk groups, such as those with a history of depression—are needed to inform more proactive and effective mental healthcare in overall CRC care.

Conclusions

Our population-based cohort study characterised the timing and factors associated with new-onset depression following CRC diagnosis and its implications for mortality. Notably, 6.63% of individuals with CRC without a history of depression developed new-onset depression within 5 years of CRC diagnosis, with incidence rates highest in the first year after diagnosis (3.54 per 100 person-years). Female sex, increasing cancer stage and—most strongly—a history of depression were factors associated with new-onset depression following CRC diagnosis. New-onset depression was also associated with substantially higher all-cause mortality, including a 97% increased risk among individuals with CRC without prior depression. These findings highlight the importance of early identification of individuals at higher risk for depression and the consideration of longitudinal mental healthcare for individuals throughout CRC care.

Footnotes

Contributors: VC: conceptualisation, methodology, formal analysis, investigation, visualisation, writing—draft, writing—review and editing and project administration. ECS: formal analysis and writing—review and editing. JML: writing—review and editing. SG: writing—review and editing. RAM: writing—review and editing. MADeV: conceptualisation, methodology, writing—original draft, writing—review and editing, project administration and supervision. MADeV (corresponding author) is the guarantor.

Funding: This work was supported by a project grant from the Canadian Institutes of Health Research (funding reference number: PJT-159467); the Canadian Graduate Research Scholarship Doctoral Award from the Canadian Institutes of Health Research and the Tier 2 Canada Research Chair. The authors were not paid to write this article by a pharmaceutical company or other agency. The authors were not precluded from accessing data in the study and accept responsibility for submitting the article for publication.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, conduct, reporting, dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Data are available upon reasonable request.

Data availability statement

Access to data provided by the Data Stewards is subject to approval but can be requested for research projects through the Data Stewards or their designated service providers. The following data sets were used in this study: Medical Services Plan, Discharge Abstract Database, Consolidation File, Vital Statistics File, and British Columbia Cancer Registry. You can find further information regarding these data sets by visiting the PopData project webpage at: https://my.popdata.bc.ca/project_listings/18-088/collection_approval_dates. All inferences, opinions, and conclusions drawn in this publication are those of the author(s), and do not reflect the opinions or policies of the Data Steward(s).

Ethics statements

Patient consent for publication

Not applicable.

Ethics approval

This study was approved by the University of British Columbia Behavioural Research Ethics Board (H17-03530).

References

  • 1.Canadian Cancer Society . What is colorectal cancer? 2026. Available: https://cancer.ca/en/cancer-information/cancer-types/colorectal/what-is-colorectal-cancer
  • 2.Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74:229–63. 10.3322/caac.21834 [DOI] [PubMed] [Google Scholar]
  • 3.Canadian Cancer Soceity . Colorectal cancer statistics. 2026. Available: https://cancer.ca/en/cancer-information/cancer-types/colorectal/statistics
  • 4.Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw 2009;7:883–93. 10.6004/jnccn.2009.0058 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Khoo AM-G, Lau J, Loh X-S, et al. Understanding the psychosocial impact of colorectal cancer on young-onset patients: A scoping review. Cancer Med 2022;11:1688–700. 10.1002/cam4.4575 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Peng YN, Huang ML, Kao CH. Prevalence of Depression and Anxiety in Colorectal Cancer Patients: A Literature Review. Int J Environ Res Public Health 2019;16:411. 10.3390/ijerph16030411 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Saunders CH, Goldwag JL, Read JT, et al. “Because Everybody is so Different”: a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021;11:e043245. 10.1136/bmjopen-2020-043245 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Rune KT, Ardern J, Davis C. Experiences of colorectal cancer patients in Australia: a qualitative study on specialised nursing and supportive care. Support Care Cancer 2026;34:140. 10.1007/s00520-026-10333-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Haber L, Allen A, Rune KT. Sexual quality of life following a cancer diagnosis: a qualitative study. Support Care Cancer 2023;31:125. 10.1007/s00520-022-07459-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Oveisi N, Cheng V, Taylor D, et al. “Cancer changes everything, but it makes you wonder-am I still enough?” serial focus groups with adolescent and young adult cancer patients to understand experiences with cancer and sexual and reproductive health. BMC Cancer 2025;25:1253. 10.1186/s12885-025-14561-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Cheng V, McTaggart-Cowan H, Loree JM, et al. Mental health in people living with and beyond colorectal cancer: A patient-oriented constructivist grounded theory. Cancer Med 2024;13:e70203. 10.1002/cam4.70203 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Grassi L, Caruso R, Riba MB, et al. Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline. ESMO Open 2023;8:101155. 10.1016/j.esmoop.2023.101155 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Getie A, Ayalneh M, Bimerew M. Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses. BMC Psychiatry 2025;25:156. 10.1186/s12888-025-06599-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Alwhaibi M, AlRuthia Y, Sales I. The Impact of Depression and Anxiety on Adult Cancer Patients’ Health-Related Quality of Life. J Clin Med 2023;12:2196. 10.3390/jcm12062196 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2015;152:239–46. 10.1007/s10549-015-3471-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Walker J, Mulick A, Magill N, et al. Major Depression and Survival in People With Cancer. Psychosom Med 2021;83:410–6. 10.1097/PSY.0000000000000942 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Cheng V, Oveisi N, McTaggart-Cowan H, et al. Colorectal Cancer and Onset of Anxiety and Depression: A Systematic Review and Meta-Analysis. Curr Oncol 2022;29:8751–66. 10.3390/curroncol29110689 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Calman L, Turner J, Fenlon D, et al. Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study. Colorectal Dis 2021;23:3234–50. 10.1111/codi.15949 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Mols F, Schoormans D, de Hingh I, et al. Symptoms of anxiety and depression among colorectal cancer survivors from the population-based, longitudinal PROFILES Registry: Prevalence, predictors, and impact on quality of life. Cancer 2018;124:2621–8. 10.1002/cncr.31369 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Arvanitou E, Nikoloudi M, Tsoukalas N, et al. Factors associated with anxiety and depression in cancer patients: Demographic factors and the role of demoralization and satisfaction with care. Psychooncology 2023;32:712–20. 10.1002/pon.6115 [DOI] [PubMed] [Google Scholar]
  • 21.Chen X, Ye C, Liu L, et al. Factors associated with depressive symptoms among cancer patients: a nationwide cross-sectional study. BMC Public Health 2024;24:1443. 10.1186/s12889-024-18898-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Alkubati SA, Halboup AM, Zoromba MA, et al. Prevalence and determinants of depression and its association with social support among cancer patients: implications for enhancing oncology care. BMC Psychol 2025;13:232. 10.1186/s40359-025-02584-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Mols F, Husson O, Roukema J-A, et al. Depressive symptoms are a risk factor for all-cause mortality: results from a prospective population-based study among 3,080 cancer survivors from the PROFILES registry. J Cancer Surviv 2013;7:484–92. 10.1007/s11764-013-0286-6 [DOI] [PubMed] [Google Scholar]
  • 24.Varela-Moreno E, Rivas-Ruiz F, Padilla-Ruiz M, et al. Influence of depression on survival of colorectal cancer patients drawn from a large prospective cohort. Psychooncology 2022;31:1762–73. 10.1002/pon.6018 [DOI] [PubMed] [Google Scholar]
  • 25.Ungvari Z, Fekete M, Buda A, et al. Depression increases cancer mortality by 23-83%: a meta-analysis of 65 studies across five major cancer types. Geroscience 2026;48:293–309. 10.1007/s11357-025-01676-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Qiu W, Cai X, Zheng C, et al. Update on the Relationship Between Depression and Neuroendocrine Metabolism. Front Neurosci 2021;15:728810. 10.3389/fnins.2021.728810 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000;160:2101–7. 10.1001/archinte.160.14.2101 [DOI] [PubMed] [Google Scholar]
  • 28.Jeong S, Kim EJ. Effect of depression and empowerment on medication adherence in patients with breast cancer: a descriptive survey. BMC Nurs 2025;24:47. 10.1186/s12912-024-02680-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Population Data BC . BC cancer registry data (2019). V2. Data extract. BC cancer. 2019. Available: http://www.popdata.bc.ca/data
  • 30.Doktorchik C, Patten S, Eastwood C, et al. Validation of a case definition for depression in administrative data against primary chart data as a reference standard. BMC Psychiatry 2019;19:9. 10.1186/s12888-018-1990-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Pena-Gralle APB, Talbot D, Trudel X, et al. Validation of case definitions of depression derived from administrative data against the CIDI-SF as reference standard: results from the PROspective Québec (PROQ) study. BMC Psychiatry 2021;21:491. 10.1186/s12888-021-03501-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993;46:1075–9. 10.1016/0895-4356(93)90103-8 [DOI] [PubMed] [Google Scholar]
  • 33.Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94:496–509. 10.1080/01621459.1999.10474144 [DOI] [Google Scholar]
  • 34.Howren A, Sayre EC, Cheng V, et al. Risk of Anxiety and Depression after Diagnosis of Young-Onset Colorectal Cancer: A Population-Based Cohort Study. Curr Oncol 2022;29:3072–81. 10.3390/curroncol29050249 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Springer F, Thomsen MK, Biccler J, et al. Incident mental disorders following cancer: analysis of real-world psychiatric outcomes in a nationwide population-based cohort study in Denmark across three decades. Br J Cancer 2026;135:445–52. 10.1038/s41416-026-03460-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Zebrack B. Cancer survivorship-a framework for quality cancer care. J Natl Cancer Inst 2024;116:352–5. 10.1093/jnci/djad266 [DOI] [PubMed] [Google Scholar]
  • 37.Andreu Y, Martinez P, Soto-Rubio A, et al. Colorectal cancer survival: prevalence of psychosocial distress and unmet supportive care needs. Support Care Cancer 2022;30:1483–91. 10.1007/s00520-021-06513-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Cheng V, Sayre EC, Cheng V, et al. Mental healthcare utilisation among individuals with colorectal cancer: population-based cohort studies. BMJ Oncol 2025;4:e000690. 10.1136/bmjonc-2024-000690 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Luo X, Xu H, Zhang Y, et al. Identifying the unmet needs of post-treatment colorectal cancer survivors: A critical literature review. Eur J Oncol Nurs 2024;70:102570. 10.1016/j.ejon.2024.102570 [DOI] [PubMed] [Google Scholar]
  • 40.Andersen BL, DeRubeis RJ, Berman BS, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 2014;32:1605–19. 10.1200/JCO.2013.52.4611 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Kurtz ME, Kurtz JC, Stommel M, et al. Predictors of depressive symptomatology of geriatric patients with colorectal cancer: a longitudinal view. Support Care Cancer 2002;10:494–501. 10.1007/s00520-001-0338-8 [DOI] [PubMed] [Google Scholar]
  • 42.Clark CJ, Fino NF, Liang JH, et al. Depressive symptoms in older long-term colorectal cancer survivors: a population-based analysis using the SEER-Medicare healthcare outcomes survey. Support Care Cancer 2016;24:3907–14. 10.1007/s00520-016-3227-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Braamse AMJ, van Turenhout ST, Terhaar Sive Droste JS, et al. Factors associated with anxiety and depressive symptoms in colorectal cancer survivors. Eur J Gastroenterol Hepatol 2016;28:831–5. 10.1097/MEG.0000000000000615 [DOI] [PubMed] [Google Scholar]
  • 44.Powell-Chandler A, Boyce K, James O, et al. Psychological sequelae of colonic resections. Colorectal Dis 2020;22:945–51. 10.1111/codi.14986 [DOI] [PubMed] [Google Scholar]
  • 45.Xia S, Sun M, Liu X. Major depression but not minor to intermediate depression correlates with unfavorable prognosis in surgical colorectal cancer patients underwent adjuvant chemotherapy. Psychol Health Med 2020;25:309–18. 10.1080/13548506.2019.1643032 [DOI] [PubMed] [Google Scholar]
  • 46.Liang X, Hendryx M, Qi L, et al. Association between prediagnosis depression and mortality among postmenopausal women with colorectal cancer. PLoS One 2020;15:e0244728. 10.1371/journal.pone.0244728 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Xia S, Zhu Y, Luo L, et al. Prognostic value of depression and anxiety on colorectal cancer-related mortality: a systematic review and meta-analysis based on univariate and multivariate data. Int J Colorectal Dis 2024;39:45. 10.1007/s00384-024-04619-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Colleoni M, Mandala M, Peruzzotti G, et al. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet 2000;356:1326–7. 10.1016/S0140-6736(00)02821-X [DOI] [PubMed] [Google Scholar]
  • 49.McDermott CL, Bansal A, Ramsey SD, et al. Depression and Health Care Utilization at End of Life Among Older Adults With Advanced Non-Small-Cell Lung Cancer. J Pain Symptom Manage 2018;56:699–708. 10.1016/j.jpainsymman.2018.08.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Westin T, Jansson A, Zenckert C, et al. Mental depression is associated with malnutrition in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 1988;114:1449–53. 10.1001/archotol.1988.01860240099032 [DOI] [PubMed] [Google Scholar]
  • 51.Institute of Medicine Committee on Psychosocial Services to Cancer Patients/Families in a Community S . The national academies collection: reports funded by National Institutes of Health. In: Adler NE, Page AEK, eds. Cancer care for the whole patient: meeting psychosocial health needs. Washington: National Academies Press (US), National Academy of Sciences, 2008. [Google Scholar]
  • 52.Trudel-Fitzgerald C, Tworoger SS, Poole EM, et al. Psychological symptoms and subsequent healthy lifestyle after a colorectal cancer diagnosis. Health Psychol 2018;37:207–17. 10.1037/hea0000571 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Wang C, Qiu X, Yang X, et al. Factors Influencing Social Isolation among Cancer Patients: A Systematic Review. Healthcare (Basel) 2024;12:1042. 10.3390/healthcare12101042 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Liu B, Wu X, Shi L, et al. Correlations of social isolation and anxiety and depression symptoms among patients with breast cancer of Heilongjiang province in China: The mediating role of social support. Nurs Open 2021;8:1981–9. 10.1002/nop2.876 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary data

bmjonc-5-2-s001.pdf (4.7MB, pdf)

Data Availability Statement

Data are available upon reasonable request.

Access to data provided by the Data Stewards is subject to approval but can be requested for research projects through the Data Stewards or their designated service providers. The following data sets were used in this study: Medical Services Plan, Discharge Abstract Database, Consolidation File, Vital Statistics File, and British Columbia Cancer Registry. You can find further information regarding these data sets by visiting the PopData project webpage at: https://my.popdata.bc.ca/project_listings/18-088/collection_approval_dates. All inferences, opinions, and conclusions drawn in this publication are those of the author(s), and do not reflect the opinions or policies of the Data Steward(s).

Articles from BMJ Oncology are provided here courtesy of BMJ Publishing Group

RESOURCES