Animal and human studies have reported an association between antidepressant (AD) medication use and breast cancer risk. A population-based case-control study was designed specifically to examine this association among women in Ontario, Canada.
The Ontario Cancer Registry (OCR) identified women diagnosed with primary breast cancer. Controls, randomly sampled from the female population of Ontario, were frequency matched by 5-year age groups. A mailed self-administered questionnaire included questions about lifetime use of AD and potential confounders. Multivariate logistic regression yielded odds ratio estimates.
'Ever' use of AD was reported by 14% (441/3077) cases versus 12% (372/2994) controls. The age-adjusted odds ratio (AOR) for 'ever' use was 1.17, (95% CI: 1.01, 1.36). An increased risk was also observed for selective serotonin reuptake inhibitors = 1.33 (95% CI: 1.07, 1.66), Sertraline = 1.58 (95% CI: 1.03, 2.41), and Paroxetine = 1.55 (95% CI: 1.00, 2.40). None of the 30 variables assessed for confounding altered the risk estimate by more than 10%. Multivariate adjustment including all possible breast cancer risk factors yielded an unchanged, but not significant, point estimate (MVOR = 1.2, 95% CI: 0.96, 1.51). No relationship was observed for duration or timing of AD use.
A modest association between 'ever' use of AD and breast cancer was found using the most parsimonious multivariate model. OR estimates did not change, but CI were widened and statistical significance lost, after adjustment for factors associated with breast cancer risk.
Comment In: Int J Epidemiol. 2003 Dec;32(6):966-714681257
To describe the lifetime prevalence of selected psychiatric disorders in Ontario women and to compare these estimates with use of mental health resources.
We obtained data from a survey of 3062 Ontario women, aged 25 to 74 years, who participated in the Women's Health Study. A 5-item scale assessed lifetime prevalence of 5 psychiatric disorders (anxiety, depression, posttraumatic stress disorder [PTSD], obsessive-compulsive disorder [OCD], and anorexia [AN] or bulimia [BN]). We assessed use of mental health services by comorbidity. We employed stratified random sampling to select study subjects. Prevalence estimates were weighted and 95%CIs were obtained using Taylor linearization techniques (1).
Nearly 30% of those surveyed reported at least 1 of the disorders studied. The most common were depression (27%) and anxiety (21%). Lifetime prevalence of PTSD, OCD, and AN or BN were 10.7%, 6.1%, and 3.9%, respectively. Successively younger birth cohorts displayed an increase in prevalence and a decrease in onset-age for all disorders. "Ever" use of mental health services was higher for women with 3 or more comorbid disorders (65%) than for those with no disorder (9.8%), or only 1 disorder (51.4%).
The results of this study highlight the need to conduct more research into the reasons for the low rates of professional service use, especially for women with high comorbidity. They also highlight the need to understand the phenomenon underlying the possibly increasing rates of disorders in younger birth cohorts, so that outreach strategies can be modified to accommodate differences in younger women.