The Patterns and Risk Factors for Antidepressant Drug Prescription in Thyroid Cancer Patients and Survivors: Analysis Based on the Korean National Health Insurance Service Database

Abstract

Background:

Thyroid cancer is the most common endocrine malignancy and typically carries an excellent prognosis, especially in differentiated thyroid cancer (DTC). However, many survivors experience psychological challenges, including depression, which can significantly affect their long-term quality of life. While thyroid cancer treatment often involves surgery and hormone therapy, the relationship between treatment-related variables and new-onset depression remains poorly understood. Identifying clinical and treatment-related factors associated with depression is critical for improving postoperative survivorship care.

Methods:

We conducted a retrospective cohort study using data from the National Health Insurance Service–National Health Screening Cohort, which includes approximately 10% of the South Korean population aged 40–79 years. We included patients diagnosed with thyroid cancer (International Classification of Diseases version 10 [ICD-10] code C73) between 2002 and 2019 and excluded those with a prior diagnosis of depression or other cancers. Variables analyzed included treatment modality (active surveillance, lobectomy, total thyroidectomy [TT]), age, sex, income, smoking, alcohol consumption, physical activity, body mass index, blood pressure, presence of hypertension or diabetes, radioactive iodine (RAI) dose, and thyroid hormone replacement. The primary outcome was newly diagnosed depression, defined by a new prescription of antidepressants and corresponding diagnostic codes.

Results:

Among 6968 thyroid cancer patients included in the analysis, the risk of new-onset depression was significantly elevated in patients who underwent no treatment (hazard ratio [HR]: 1.33; 95% confidence interval [CI]: 1.06–1.66), lobectomy (HR: 1.30; 95% CI: 1.11–1.52), or TT (HR: 1.20; 95% CI: 1.09–1.32) compared with matched controls without thyroid cancer (all p < 0.05). There was no significant association between depression risk and cumulative RAI dose or levothyroxine dosage. Antidepressant prescription incidence was significantly higher within the first five years postdiagnosis but not beyond five years.

Conclusions:

Thyroid cancer diagnosis and treatment are associated with an increased risk of prescription of antidepressants in Korea.