Chronic Diseases

Alan B. Zonderman National Institutes of Health

Psychological depression has been identified as one of several emotional conditions that may influence immunological and hormonal functioning ( Katz et al., 1970; Seligman, 1975; Solomon & Amkraut, 1983). Depression has been proposed as an important source of vulnerability leading to morbidity or mortality ( Greene, 1966; LeShan, 1959), and its association with cancer has been the focus of several studies and reviews ( Bieliauskas & Garron, 1982; Fox, 1978; 1983).

The major evidence for the association of depression with cancer mortality was provided by Shekelle and his colleagues ( Persky, Kempthorne-Rawson, & Shekelle, 1987; Shekelle et al., 1981). In 17-and 20-year follow-ups of a random sample of 2,020 men employed by the Western Electric Company, they found a two-fold increase in the risk for cancer death associated with scores on the MMPI Depression scale. Although not statistically significant, they also found an association between noncancer death and scores on the MMPI Depression scale. These results are particularly notable because depression remained a significant independent predictor of cancer mortality even after statistical adjustment for the influences of age, cigarette smoking, alcohol intake, family history of cancer, and occupational status.

On the other hand, Dattore, Shontz, and Coyne ( 1980) found that men who subsequently developed any type of cancer had significantly lower initial MMPI Depression scores. They rejected the notion that depression is a form of cancer- proneness. In a large-scale prospective cohort study of 8,932 women over a 10- 14 year follow-up period, Hahn and Petitti ( 1988) failed to find an association between MMPI Depression scores and breast cancer in women who were initially free of cancer. Even among women who at entry had severe depression (MMPI- D ≥ 70), no difference was found in the risk for developing breast cancer.

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