Incident depression after breast cancer among older Asian, Native Hawaiian, and Pacific Islander women.

Background: Longitudinal studies examining mental health outcomes among older (≥66 years) Asian, Native Hawaiian, and Pacific Islander (ANHPI) women diagnosed with breast cancer are limited. We evaluated incident depression after breast cancer among specific groups of older ANHPI compared with older non-Hispanic White (NHW) women. Predictors of depression and the risk of death following early onset of depression after breast cancer were also evaluated.

Methods: A cohort of 26 776 older ANHPI women in the United States diagnosed with breast cancer between 2000 and 2017 was identified from the SEER-Medicare linked claims. There were 6694 older ANHPI and 20 082 older NHW women diagnosed with breast cancer. Adjusted hazard ratios (HRs) were calculated with the Cox proportional hazards regression and 99% confidence intervals (CI) to evaluate incident depression and death among older ANHPI compared with age-matched NHW counterparts.

Results: Compared with older NHW women with breast cancer, older Japanese (HR = 0.43, 99% CI = 0.31 to 0.66), Chinese (HR = 0.46, 99% CI = 0.31 to 0.67), Filipino (HR = 0.43, 99% CI = 0.30 to 0.60), and Asian Indian/Pakistani women (HR = 0.49, 99% CI = 0.28 to 0.84) had a lower risk of depression overall and within 5 years of follow-up; lower risk persisted for Japanese and Chinese women >5 years. ANHPI breast cancer patients with early onset of depression had a higher risk of death (HR = 1.46, 99% CI = 1.30 to 1.65) compared to those without depression.

Conclusion: Compared with older NHW women, older ANHPI women had a lower incidence of depression, although disentangling the stigma surrounding depression by race and ethnicity remains challenging.