Frequency and network analysis of depressive symptoms in patients with cancer compared to the general population

•Use of sum scores of depressive symptoms may be problematic in oncological settings.•Network analysis represents an emerging alternative.•Depressive symptoms were more common in patients than in the general population.•There were significant differences in interrelationships for four symptom pairs.•Depression symptoms were less closely interrelated in patients with cancer. The use of sum scores of depressive symptoms has been increasingly criticized and may be particularly problematic in oncological settings. Frameworks analyzing individual symptoms and their interrelationships such as network analysis represent an emerging alternative. We aimed to assess frequencies and interrelationships of 9 DSM-5 symptom criteria of major depression reported in the PHQ-9 questionnaire by 4020 patients with cancer and 4020 controls from the general population. We estimated unregularized Gaussian graphical models for both samples and compared network structures as well as predictability and centrality of individual symptoms. Depressive symptoms were more frequent, but less strongly intercorrelated in patients with cancer than in the general population. The overall network structure differed significantly between samples (correlation of adjacency matrices: rho=0.73, largest between-group difference in any edge weight: 0.20, p