Mental health status, and the use of mental health services and psychotherapeutic medicines among U.S. cancer survivors and their spouses A Dissertation in Health Policy and Administration And Demography by Rajeshwari S. Punekar
Increase in number of cancer survivors
Development of a cancer survivor advocacy community
Emphasis on understanding the Quality of Life (QOL) of cancer survivors and their family members
Current literature lacks information on the mental health status and the utilization of mental health services and prescribed psychotherapeutic medications for the whole U.S. oncology population § .
§ Oncology Population refers to U.S. cancer survivors and their spouses
To describe mental health status, mental health service utilization, and psychotherapeutic medicine utilization among U.S. cancer survivors and their spouses.
To compare mental health status, mental health service utilization, and psychotherapeutic medicine utilization between the oncology population and the general population.
To identify the predictors of mental health status, mental health service utilization, and psychotherapeutic medicine utilization within the oncology population.
First study to produce the national estimates of mental health status, psychological distress, depression, and psychotherapeutic medicines utilization for U.S. cancer survivors and their spouses
First study to compare psychotherapeutic medicines utilization between the oncology population and the general population
First study to explore psychotherapeutic medicines utilization patterns among cancer survivors’ spouses
Conceptual Framework General Health
Mental Health Status
Communication within a family
Diagnosis or history of cancer
Stage of cancer
Age at diagnosis
Time since diagnosis
Type of treatment
Use of Mental Health Services and Psychotherapeutic Medicines
Mental Health Status
Mixed results regarding the mental health status of cancer survivors.
Bradley, Rose, Lutgendorf, Costanzo, & Anderson, 2006; and Ferrario, Zotti, Massara, & Nuvolone, 2003 report that both short-term and long term cancer survivors have higher anxiety and depression levels than the general population.
Keating, Nørredam, Landrum, Huskamp, & Meara, 2005; Mols et al., 2006; Bardwell et al., 2004; and Parker, Baile, Moor, & Cohen, 2003 report that cancer survivors have similar or better mental health status than the general population.
Ferrario, Zotti, Massara, & Nuvolone, 2003; Wagner, Bigatti, & Storniolo, 2006; Cochrane, Goering, & Rogers, 1997; Pruchno & Potashnik, 1989 show that the spouses of cancer survivors more depressed and have more psychological distress and anxiety compared to the spouses of non-cancer adults
Mental Health Services Utilization
Hewitt & Rowland, 2002 and Earle, Neville, & Fletcher, 2007 show that cancer survivors use more mental health services compared to the general population.
Investigations into the mental health service utilization among spouses of cancer survivors are very rare.
Psychotherapeutic Medicines Utilization
Derogatis et al., 1979; Goldberg & Mor, 1985; Stiefel, Kornblith, & Holland, 1990; and Cullivan, Crown, & Walsh, 1998
Examined the prescription patterns of psychotropic medicines among hospitalized cancer patients
Compared it with the prescription rates of psychotropic medicines in the general population, which were derived from other research studies.
Concluded that cancer survivors use more psychotropic medicines compared to the general population.
Investigations into the utilization of psychotropic medicines among spouses of cancer survivors are almost non-existent.
Medical Expenditure Panel Survey- Household Component (MEPS-HC)
A nationally representative household survey with an overlapping panel design.
The household component of the MEPS (MEPS-HC) is drawn from the previous year's NHIS sample.
Individuals with a history or diagnosis of cancer are identified through cancer-related health care utilization events, which are identified with the help of the clinical classification condition codes.
Information about demographics, socio-economic characteristics, health status, and health care utilization.
National Health Interview Survey (NHIS)
A cross-sectional multistage household interview survey.
The study sample restricted to the sample adult population.
Individuals with a history or diagnosis of cancer are identified by asking individuals, “Has a doctor or other health providers told you that you have a cancer or malignancy of any kind?”
Information about cancer sites, age when diagnosed with cancer, and time since diagnosed with cancer.
Data 1999-2005 NHIS Cancer cases- 1,957 Spouses- 826 2001-2006 MEPS-HC Cancer cases- 679 Spouses- 300 2001-2006 NHIS-MEPS link files
Mental health status
Mental component scores (MCS-12) of the SF-12
Kessler Index (K6)
Patient Health Questionnaire-2
Mental health service utilization
Total annual number of events for mental health disorders
Psychotropic medicine utilization
Total annual number of psychotropic medicine prescriptions.
MEPS Person-level Survey Weights
Adjustment factor 1f = Σ i weight if / weight 1f
Survey Design Adjustment
Descriptive Analysis Individuals a Cancer and non-cancer individuals, below ages of 65 years, are significantly different at p=0.05 level b Cancer and non-cancer individuals, 65 and older, are significantly different at p=0.05 level 12 15 10 17 Psychotherapeutic Medicines Use a,b 10 10 11 16 Mental Health Services Use a 7 9 5 10 Depression a % % % % 5 4 4 6 Non-Specific Psychological Distress (K6) Scores a 52 52 51 49 Mental Component Scores of SF-12 a Non-cancer Cancer Non-cancer Cancer 65 and older 25-64 Outcomes
Descriptive Analysis Spouses a Cancer and non-cancer individuals, below ages of 65 years, are significantly different at p=0.05 level b Cancer and non-cancer individuals, 65 and older, are significantly different at p=0.05 level 18 23 16 27 Psychotherapeutic Medicines Use a,b 7 10 9 12 Mental Health Services Use 6 10 4 7 Depression a,b % % % % 3 3 3 4 Non-Specific Psychological Distress (K6) Scores a 53 53 52 50 Mental Component Scores of SF-12 a Non-cancer Cancer Non-cancer Cancer 65 and older 25-64 Outcomes
Mental health status
Mental health services use
Psychotherapeutic medications use
Time since diagnosed with cancer
Regression coefficients and Odds Ratios (OR) for the outcome of interests in full sample * Significant at p=0.05 level 1.31* 1.34* 1.23* 1.33* Psychotherapeutic medicines utilization (OR) 1.27 1.01 1.04 1.16 Mental health services utilization (OR) 1.88* 1.77* 1.42* 1.59* Depression (OR) 0.09 0.23* 0.15* 0.23* Psychological distress -0.31 -1.12* -0.42 -1.15* MCS-12 65 and older 25-64 65 and older 25-64 Spouses Individuals Outcomes
Regression coefficients for the outcomes of interests in the oncology sample
Significant at p=0.05 level
Reference group: Breast Cancer Survivors
0.41 -0.52 0.24 -0.25 Prostate cancer 0.51 -1.29 0.46 -0.48 Lung cancer 0.56 0.32 0.37 0.45* Gynecological cancer -0.68 -0.69 -0.58* -0.16 Colorectal cancer Psychological Distress -1.66 1.07 -1.28 1.51 Prostate cancer 0.26 2.96 0.03 0.92 Lung cancer -3.01 -1.10 -2.25 -2.33* Gynecological cancer -0.12 -0.15 0.22 -0.41 Colorectal cancer MCS-12 65 and older 25-64 65 and older 25-64 Spouses Individuals
Odds Ratios (OR) for the outcomes of interests in the oncology sample * Significant at p=0.05 level
Cancer survivors and their spouses have lower mental health status and higher psychological distress than the general population.
Cancer survivors and their spouses are more likely to be depressed than the general population.
Cancer survivors and their spouses are equally likely to use mental health services compared to the general population.
Cancer survivors and their spouses are more likely to use psychotherapeutic medicines than the general population.
Policymakers and clinicians should focus on the mental health problems of cancer survivors as well as their spouses
Oncologists and primary care physicians should screen gynecological cancer survivors between 25 and 64 years of age for mental health problems and refer them to mental health professionals.
Insurance companies should offer generous coverage on prescription psychotropic medicines for cancer survivors and their spouses.
Lacks information about the stage of cancer and the type of treatment
No adequate sample sizes for less prevalent cancer sites such as brain and bone cancers
Utilization is self-reported, not based on medical records or insurance claims