Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study

Aim: depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition at key points in the pathway enables timely referral to support. This study aimed to examine depression pre- and 5 years post-surgery to examine its prevalence and identify determinants.Methods: the ColoREctal Wellbeing (CREW) study is a prospective UK cohort involving 872 adults with non-metastatic CRC recruited before curative-intent surgery. Questionnaires completed pre-surgery, and 3, 9, 15, 24, 36, 48 and 60 months post-surgery, captured socio-demographics, assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present prevalence of clinically significant depression (CES-D≥20) over time and its predictors assessed pre-surgery and 2 years post-surgery.Results: pre-surgery, 21.0% of the cohort reported CES-D≥20 reducing to 14.7% 5 years post-surgery. Pre-surgery risk factors predicting subsequent depression: clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Post-surgery risk factors at 2 years predicting subsequent depression: clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health.Conclusions: depression is highly pervasive in people with CRC, exceeding general population prevalence across follow-up. Our findings emphasise the need to screen and treat depression across the pathway. Our novel data highlights key risk factors of later depression at important and opportune timepoints: pre-surgery and the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.