Ambulatory Mental Health Visits and Use of Psychotropic Medicines by Cancer Survivors Spouses PUNEKAR
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Ambulatory Mental Health Visits and Use of Psychotropic Medicines by Cancer Survivors Spouses PUNEKAR

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  • Great implications—but are these tied to findings?

Ambulatory Mental Health Visits and Use of Psychotropic Medicines by Cancer Survivors Spouses PUNEKAR Presentation Transcript

  • 1. Rajeshwari S. Punekar, Ph.D., M.P.H Scott & White Healthcare Temple, TX
  • 2.  Cancer diagnosis has negative psychological impact on cancer survivors and their family members1,2,3. Lower mental health status of cancer survivors’ spouses 4,5,6,7. Few studies examining use of mental health services and prescribed psychotropic medicines among cancer survivors’ spouses 8
  • 3.  To describe the utilization patterns of mental health services and psychotropic medications among cancer survivors’ spouses. To compare use of mental health services and psychotropic medications between cancer survivors’ spouses and spouses of non- cancer individuals.
  • 4. 1999-2008 2001-2009 NHIS-MEPS link files 2001-2009 NHIS MEPS-HCSpouses- 1,592 Spouses-226
  • 5.  Ambulatory mental health visits =the total annual number of mental health visits made to outpatient department, or physician’s office. Use of psychotropic medicines =the total annual number of psychotropic medication prescriptions. Survey design adjusted Logistic regression model
  • 6. Characteristics Age 25-64 Age 65+ Cancer Non-cancer Cancer Non-cancer (N=0.2 (N=2 million) (N=0.3 (N=12 million) million) million) % % % %Ambulatory mental health 12 8 10 8 visits a Psychotropic medicines Antidepressants 16 13 17 14 Antipsychotics 2 1 4 2Anxiolytics, hypnotics and 8 5 8 7 sedatives a CNS stimulants 0 1 1 0 Total a 20 16 23 20 a Spouses of cancer and non-cancer individuals, ages 25-64, are significantly different at p=0.05 level b Spouses of cancer and non-cancer individuals, 65 and above, are significantly different at p=0.05 level
  • 7. Predictors Ambulatory mental health Prescribed psychotropic visits medicines 25-64 65+ 25-64 65+ OR OR OR ORCancer survivor 1.49* 1.21 1.16 1.03Time since diagnosed withcancer (TSD)TSD is less than 1 year 1.97* 0.49 2.25 0.29TSD between 1 year and 5 1.22 0.55 1.56 0.56yearsTSD between 6 years and 1.81 1.25 1.13 0.8010 yearsTSD between 11 years and 1.64 1.16 1.67 1.1820 yearsCancer sitesBreast cancer 1.58 0.52 1.85 1.02Gynecological cancer 2.49 1.04 2.00 0.52Lung cancer 0.67 0.64 0.24 0.81Prostate cancer 0.81 0.56 0.79 0.80Other cancer 0.51 0.76 0.44 1.27 Colorectal cancer survivors who have been diagnosed with cancer for more than 21 years is the reference group. * significantly different at p=0.05 level
  • 8.  Higher percentage of younger age cancer survivors’ spouses use ambulatory mental health services and psychotropic medicines Cancer diagnosis within a year is a significant predictor of ambulatory mental health services utilization. Cancer diagnosis and cancer-related factors are not significant predictors for using prescribed psychotropic medicines.
  • 9.  No information about the stage of cancer and the type of treatment. No information about the mental health status of cancer survivors and their spouses prior to cancer diagnosis Smaller sample sizes for patients with less prevalent cancer sites such as brain and bone cancers Use of psychotherapeutic medications and mental health visits is self-reported
  • 10.  Identify mental health issues in cancer survivors’ spouses and refer them to appropriate psycho-oncology therapy. Cancer survivors’ spouses should be made aware of psychological challenges involved with cancer diagnosis. Encourage cancer survivors’ spouses to pursue pharmacotherapy to overcome their mental health issues.
  • 11. Future studies: Use of mental health services and prescribed psychotropic medicines among VA cancer patients Cancer patients and provider communications about mental health issues and barriers to access mental health services
  • 12. 1. Badger, T., Braden, C., Mishel, M., & Longman, A. (2004). Depression burden, psychological adjustment, and quality of life in women with breast cancer: Patterns over time. Research in Nursing & Health, 27(1), 19-28.2. Ben, E., & Valerie, C. (2004). The psychological impact of a cancer diagnosis on families: The influence of family functioning and patients illness characteristics on depression and anxiety. Psycho-Oncology, 13(8), 562-576.3. Ferrario, S., Zotti, A., Massara, G., & Nuvolone, G. (2003). A comparative assessment of psychological and psychosocial characteristics of cancer patients and their caregivers. Psycho-Oncology, 12(1), 1-7.4. Ganz, P. A. (2002). Adult Cancer Survivors: Understanding Late Effects Of Cancer And Its Treatment: National Cancer Policy Board.5. Edwards, B., & Clarke, V. (2004). The psychological impact of a cancer diagnosis on families: The influence of family functioning and patients illness characteristics on depression and anxiety. Psycho-Oncology, 13(8), 562-576.6. Ezer, H. (2003). Predictors of adaptation in wives during the initial psychosocial phase of prostate cancer. Unpublished Ph.D., Universite de Montreal (Canada), Canada.7. Wagner, C., Bigatti, S., & Storniolo, A. (2006). Quality of life of husbands of women with breast cancer. Psycho-Oncology, 15(2), 109-120.8. Vanderwerker, L., Laff, R., Kadan-Lottick, N., McColl, S., & Prigerson, H. (2005). Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol, 23, 6899-6907.