MENTAL HEALTH, AMBULATORY MENTAL HEALTH VISITS, AND PSYCHOTHERAPEUTIC MEDICATIONS OF U.S. CANCER SURVIVORS AND THEIR SPOUSES
Open Access
- Author:
- Punekar, Rajeshwari S
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 10, 2010
- Committee Members:
- Pamela Farley Short, Dissertation Advisor/Co-Advisor
Pamela Farley Short, Committee Chair/Co-Chair
John Raymond Moran Jr., Committee Member
Marianne Messersmith Hillemeier, Committee Member
Elana Farace, Committee Member - Keywords:
- Cancer Survivors
Cancer
Psychotherapeutic Medications
Ambulatory Mental Health Visits
Mental Health - Abstract:
- Background: A cancer diagnosis has a great psychological impact on the lives of cancer survivors and their spouses. However, the existing literature fails to provide national estimates of the mental health status and the utilization patterns of psychotherapeutic medications of U.S. cancer survivors. In addition, the current literature the current literature has limited information about the ambulatory mental health visits and the utilization of psychotherapeutic medicines by cancer survivors’ spouses. Objectives: Therefore, the current study aims to: 1) To describe the mental health status, ambulatory mental health visits, and psychotherapeutic medicines utilization of U.S. cancer survivors and their spouses. 2) To compare mental health status, ambulatory mental health visits, and psychotherapeutic medicine utilization between the oncology population (cancer survivors and their spouses) and the general population. 3) To identify the predictors of mental health status, ambulatory mental health visits, and psychotherapeutic medicine utilization within the oncology population. Data: The primary source of data is six years (2001-2006) of interviews from the Medical Expenditure Panel Survey - Household Component (MEPS-HC) linked to the National Health Interview Survey (NHIS). Study population: The compiled data set includes 2,636 individuals with a history of cancer and 1,126 spouses of cancer survivors. Out of 2,636 cancer survivors, 381 are incident cancer cases and 2,255 are prevalent cancer cases. Measures: The unit of analysis is an individual with or without a history of cancer diagnosis, or that person’s spouse. Mental health status is measured by the mental component scores (MCS-12) of the Short Form-12 (version 2) Health Survey, psychological distress is measured by the Kessler Index (K6) scores, and depression is measured by Patient Health Questionnaire. Ambulatory mental health visit is measured by the total annual number of visits made to outpatient department, emergency room, or physician’s office due to mental health disorders. Psychotropic drug utilization is measured by the total annual number of psychotropic drug prescriptions. Analysis: The univariate analysis was conducted using independent t-tests and chi-square to examine statistical differences in mental health status, ambulatory mental health visits and psychotropic drug utilization between the oncology population and the general population. Then, multivariate regression analysis of mental health scores, psychological distress, depression, ambulatory mental health visits, and psychotropic drug utilization was conducted as a function of cancer diagnosis or cancer history, demographic factors, socio-economic factors, and medical factors to determine the relative explanatory power of each set of predictor variables. A separate multivariate regression analysis was conducted for the oncology population, in order to investigate the relative significance of each set of predictor variables within the oncology group. Results: Cancer survivors have lower mental health status, higher psychological distress, and higher odds of being depressed than the general population. Similar to cancer survivors, cancer survivors’ spouses have lower mental health status, higher psychological distress, and higher odds of being depressed compared to spouses of non-cancer adults. The utilization of psychotherapeutic medicines is 1.3-1.4 percentage points higher for the oncology population than the general population, but cancer survivors and their spouses are no more likely to make ambulatory mental health related visits than the general population. Policy Implications: This study reinforces the argument that cancer care providers need to routinely screen cancer patients and their spouses for mental health problems and assess their psychosocial health needs. Oncologists and primary care providers should make extensive assessment of the psychological needs of cancer survivors or their spouses with low education or chronic conditions and direct them to appropriate psychosocial services. Cancer care providers, if possible, should provide counseling and psychotherapy services in addition to psychopharmacotherapy services or should link cancer patients and their family members to organizations that provide counseling and psychotherapy services. This study suggests that gynecological cancer survivors have an unmet need for psychosocial services and therefore need routine screening, evaluation and treatment for mental health problems. Limitations: MEPS and NHIS lack information about the stage of cancer and the type of treatment. Consequently, we were unable to investigate the influence of cancer stage and treatment modality on mental health status, mental services utilization and psychotherapeutic medication utilization. MEPS and NHIS also lack information about the mental health status of cancer survivors and their spouses prior to cancer diagnosis. As a result, we were not able to assess the influence of prior psychiatric history (or mental health before cancer diagnosis) on mental health status, mental health visits and psychotherapeutic medication utilization after cancer diagnosis. The data do not have adequate sample sizes to describe the mental health status, mental health related ambulatory visits, and utilization of psychotropic medicines of patients with less prevalent cancer sites such as brain and bone cancers. The utilization of psychotherapeutic medications and mental health visits is self-reported, not based on medical records or insurance claims.