The role of social position in anxiety and depressive symptoms among Danish cancer survivors

Background. Anxiety and depressive symptoms are common among cancer survivors. Studies of a possible association with social position have had divergent results. We examined these associations, social position being measured by education, in Danish cancer survivors approximately two years after diagnosis. Material and methods. People aged over 18, living in Denmark and registered for a first cancer in the Danish National Patient Registry between 1 May and 31 August 2010 were contacted; 4346 returned a questionnaire shortly after diagnosis, and 2568 were followed up in 2012. Age, sex and cancer site were derived from the registry; all other information was self-reported, with that on education from the 2010 questionnaire and responses to the Hospital Anxiety and Depression Scale from the 2012 questionnaire. General linear models were used, with adjustment for demographic factors, cancer-specific factors, and comorbidity. Results. The study population consisted of 1667 people (response rate, 51%). The mean symptom scores were 4.34 (SD 3.77) for anxiety and 2.94 (SD 3.25) for depression. People with medium and higher education had slightly higher anxiety symptom scores (mean difference(medium) = 0.41, 95% CI -0.07; 0.88, mean difference(higher) =0.19, 95% CI -0.27; 0.65). Depressive symptom scores were slightly elevated for people with medium education and reduced for those with higher education (mean difference(medium) =0.34, 95% CI -0.07; 0.75, mean difference(higher) = -0,11, 95% CI -0.50; 0.29). Female sex, smoking-related cancers and chemotherapy were significantly associated with higher scores for both anxiety and depressive symptoms, but somatic comorbidity and mental disorders at the time of treatment were most strongly, significantly associated with elevated anxiety and depressive symptom scores. Conclusion. No overall significant differences in anxiety or depressive symptom scores were found with length of education. Previous mental disorders and somatic comorbidity are the strongest indicators of higher levels of anxiety and depressive symptoms.