Mental health status, and the use of mental health services and psychotherapeutic medicines among U.S. cancer survivors an...
Overview <ul><li>Background </li></ul><ul><li>Objectives </li></ul><ul><li>Contributions </li></ul><ul><li>Conceptual Fram...
Background <ul><li>Increase in number of cancer survivors </li></ul><ul><li>Development of a cancer survivor advocacy comm...
Objectives <ul><li>To describe mental health status, mental health service utilization, and psychotherapeutic medicine uti...
Contributions <ul><li>First study to produce the national estimates of mental health status, psychological distress, depre...
Conceptual Framework General Health <ul><li>Socio-economic </li></ul><ul><li>Education </li></ul><ul><li>Employment </li><...
Mental Health Status <ul><li>Mixed results regarding the mental health status of cancer survivors. </li></ul><ul><ul><li>B...
Mental Health Services Utilization <ul><li>Hewitt & Rowland, 2002 and Earle, Neville, & Fletcher, 2007  show that cancer s...
Psychotherapeutic Medicines Utilization <ul><li>Derogatis et al., 1979; Goldberg & Mor, 1985; Stiefel, Kornblith, & Hollan...
Medical Expenditure Panel Survey- Household Component (MEPS-HC) <ul><li>A nationally representative household survey with ...
National Health Interview Survey (NHIS) <ul><li>A cross-sectional multistage household interview survey. </li></ul><ul><li...
Data 1999-2005 NHIS Cancer cases- 1,957  Spouses- 826 2001-2006 MEPS-HC Cancer cases- 679  Spouses- 300 2001-2006 NHIS-MEP...
Measures <ul><li>Mental health status </li></ul><ul><ul><li>Mental component scores (MCS-12) of the SF-12 </li></ul></ul><...
Analysis <ul><li>MEPS Person-level Survey Weights </li></ul><ul><ul><li>Weight Adjustment  </li></ul></ul><ul><ul><ul><li>...
Descriptive Analysis Individuals a Cancer and non-cancer individuals, below ages of 65 years, are significantly different ...
Descriptive Analysis Spouses a Cancer and non-cancer individuals, below ages of 65 years, are significantly different at p...
Multivariate Analysis <ul><li>Dependent variables:   </li></ul><ul><li>Mental health status </li></ul><ul><li>Psychologica...
Regression coefficients and Odds Ratios (OR) for the outcome of interests in full sample * Significant at p=0.05 level  1....
Regression coefficients for the outcomes of interests in the oncology sample <ul><li>Significant at p=0.05 level  </li></u...
Odds Ratios (OR) for the outcomes of interests in the oncology sample * Significant at p=0.05 level
Summary <ul><li>Cancer survivors and their spouses have lower mental health status and higher psychological distress than ...
Policy Implications <ul><li>Policymakers and clinicians should focus on the mental health problems of cancer  survivors as...
Limitations <ul><li>Lacks information about the stage of cancer and the type of treatment  </li></ul><ul><li>No adequate s...
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Thesis Defense [06102010]

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Thesis Defense [06102010]

  1. 1. 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
  2. 2. Overview <ul><li>Background </li></ul><ul><li>Objectives </li></ul><ul><li>Contributions </li></ul><ul><li>Conceptual Framework </li></ul><ul><li>Literature Review </li></ul><ul><li>Methods </li></ul><ul><ul><li>Data </li></ul></ul><ul><ul><li>Measures </li></ul></ul><ul><ul><li>Analysis </li></ul></ul><ul><li>Results </li></ul><ul><li>Policy Implications </li></ul><ul><li>Limitations </li></ul>
  3. 3. Background <ul><li>Increase in number of cancer survivors </li></ul><ul><li>Development of a cancer survivor advocacy community </li></ul><ul><li>Emphasis on understanding the Quality of Life (QOL) of cancer survivors and their family members </li></ul><ul><li>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 § . </li></ul>§ Oncology Population refers to U.S. cancer survivors and their spouses
  4. 4. Objectives <ul><li>To describe mental health status, mental health service utilization, and psychotherapeutic medicine utilization among U.S. cancer survivors and their spouses. </li></ul><ul><li>To compare mental health status, mental health service utilization, and psychotherapeutic medicine utilization between the oncology population and the general population. </li></ul><ul><li>To identify the predictors of mental health status, mental health service utilization, and psychotherapeutic medicine utilization within the oncology population. </li></ul>
  5. 5. Contributions <ul><li>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 </li></ul><ul><li>First study to compare psychotherapeutic medicines utilization between the oncology population and the general population </li></ul><ul><li>First study to explore psychotherapeutic medicines utilization patterns among cancer survivors’ spouses </li></ul>
  6. 6. Conceptual Framework General Health <ul><li>Socio-economic </li></ul><ul><li>Education </li></ul><ul><li>Employment </li></ul><ul><li>Income </li></ul><ul><li>Demographic </li></ul><ul><li>Age </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Marital status </li></ul>Mental Health Status <ul><li>Resources </li></ul><ul><li>Socio-emotional support </li></ul><ul><li>Communication within a family </li></ul><ul><li>Diagnosis or history of cancer </li></ul><ul><li>Cancer characteristics </li></ul><ul><ul><li>Cancer site </li></ul></ul><ul><ul><li>Stage of cancer </li></ul></ul><ul><ul><li>Recurrence </li></ul></ul><ul><ul><li>Age at diagnosis </li></ul></ul><ul><ul><li>Time since diagnosis </li></ul></ul><ul><ul><li>Type of treatment </li></ul></ul>Use of Mental Health Services and Psychotherapeutic Medicines
  7. 7. Mental Health Status <ul><li>Mixed results regarding the mental health status of cancer survivors. </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>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. </li></ul></ul><ul><li>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 </li></ul>
  8. 8. Mental Health Services Utilization <ul><li>Hewitt & Rowland, 2002 and Earle, Neville, & Fletcher, 2007 show that cancer survivors use more mental health services compared to the general population. </li></ul><ul><li>Investigations into the mental health service utilization among spouses of cancer survivors are very rare. </li></ul>
  9. 9. Psychotherapeutic Medicines Utilization <ul><li>Derogatis et al., 1979; Goldberg & Mor, 1985; Stiefel, Kornblith, & Holland, 1990; and Cullivan, Crown, & Walsh, 1998 </li></ul><ul><ul><li>Examined the prescription patterns of psychotropic medicines among hospitalized cancer patients </li></ul></ul><ul><ul><li>Compared it with the prescription rates of psychotropic medicines in the general population, which were derived from other research studies. </li></ul></ul><ul><ul><li>Concluded that cancer survivors use more psychotropic medicines compared to the general population. </li></ul></ul><ul><li>Investigations into the utilization of psychotropic medicines among spouses of cancer survivors are almost non-existent. </li></ul>
  10. 10. Medical Expenditure Panel Survey- Household Component (MEPS-HC) <ul><li>A nationally representative household survey with an overlapping panel design. </li></ul><ul><li>The household component of the MEPS (MEPS-HC) is drawn from the previous year's NHIS sample. </li></ul><ul><li>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. </li></ul><ul><li>Information about demographics, socio-economic characteristics, health status, and health care utilization. </li></ul>
  11. 11. National Health Interview Survey (NHIS) <ul><li>A cross-sectional multistage household interview survey. </li></ul><ul><li>The study sample restricted to the sample adult population. </li></ul><ul><li>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?” </li></ul><ul><li>Information about cancer sites, age when diagnosed with cancer, and time since diagnosed with cancer. </li></ul>
  12. 12. 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
  13. 13. Measures <ul><li>Mental health status </li></ul><ul><ul><li>Mental component scores (MCS-12) of the SF-12 </li></ul></ul><ul><li>Psychological Distress </li></ul><ul><ul><li>Kessler Index (K6) </li></ul></ul><ul><li>Depression </li></ul><ul><ul><li>Patient Health Questionnaire-2 </li></ul></ul><ul><li>Mental health service utilization </li></ul><ul><ul><li>Total annual number of events for mental health disorders </li></ul></ul><ul><li>Psychotropic medicine utilization </li></ul><ul><ul><li>Total annual number of psychotropic medicine prescriptions. </li></ul></ul>
  14. 14. Analysis <ul><li>MEPS Person-level Survey Weights </li></ul><ul><ul><li>Weight Adjustment </li></ul></ul><ul><ul><ul><li>Adjustment factor 1f = Σ i weight if / weight 1f </li></ul></ul></ul><ul><ul><li>Post Stratification </li></ul></ul><ul><ul><ul><li>Raking </li></ul></ul></ul><ul><ul><li>Rescaling weights </li></ul></ul><ul><li>Survey Design Adjustment </li></ul><ul><ul><li>Taylor-series Linearization </li></ul></ul>
  15. 15. 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
  16. 16. 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
  17. 17. Multivariate Analysis <ul><li>Dependent variables: </li></ul><ul><li>Mental health status </li></ul><ul><li>Psychological distress </li></ul><ul><li>Depression </li></ul><ul><li>Mental health services use </li></ul><ul><li>Psychotherapeutic medications use </li></ul><ul><li>Independent variables: </li></ul><ul><li>Cancer diagnosis </li></ul><ul><li>Cancer sites </li></ul><ul><li>Time since diagnosed with cancer </li></ul><ul><li>Age </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Ethnicity </li></ul><ul><li>Marital Status </li></ul><ul><li>Education </li></ul><ul><li>Chronic conditions </li></ul>
  18. 18. 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
  19. 19. Regression coefficients for the outcomes of interests in the oncology sample <ul><li>Significant at p=0.05 level </li></ul><ul><li>Reference group: Breast Cancer Survivors </li></ul>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
  20. 20. Odds Ratios (OR) for the outcomes of interests in the oncology sample * Significant at p=0.05 level
  21. 21. Summary <ul><li>Cancer survivors and their spouses have lower mental health status and higher psychological distress than the general population. </li></ul><ul><li>Cancer survivors and their spouses are more likely to be depressed than the general population. </li></ul><ul><li>Cancer survivors and their spouses are equally likely to use mental health services compared to the general population. </li></ul><ul><li>Cancer survivors and their spouses are more likely to use psychotherapeutic medicines than the general population. </li></ul>
  22. 22. Policy Implications <ul><li>Policymakers and clinicians should focus on the mental health problems of cancer survivors as well as their spouses </li></ul><ul><li>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. </li></ul><ul><li>Insurance companies should offer generous coverage on prescription psychotropic medicines for cancer survivors and their spouses. </li></ul>
  23. 23. Limitations <ul><li>Lacks information about the stage of cancer and the type of treatment </li></ul><ul><li>No adequate sample sizes for less prevalent cancer sites such as brain and bone cancers </li></ul><ul><li>Utilization is self-reported, not based on medical records or insurance claims </li></ul>
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