Psychological distress and mental health care utilization among Hispanic/Latino survivors of adolescent and young adult cancer

Eunju Choi; Amy M Berkman; Christabel K Cheung; Andrea C Betts; John M Salsman; Clark R Andersen; Carol Yesenia Ochoa-Dominguez; Kimberly Miller; Joel Milam; Ashna Shah; Susan K Peterson; Qian Lu; J Andrew Livingston; Michelle A T Hildebrandt; Susan K Parsons; David Freyer; Michael E Roth

doi:10.1002/pon.6248

Psychological distress and mental health care utilization among Hispanic/Latino survivors of adolescent and young adult cancer

Psychooncology. 2023 Dec;32(12):1918-1929. doi: 10.1002/pon.6248. Epub 2023 Nov 13.

Authors

Eunju Choi¹, Amy M Berkman², Christabel K Cheung³, Andrea C Betts⁴, John M Salsman⁵, Clark R Andersen⁶, Carol Yesenia Ochoa-Dominguez^{7

8}, Kimberly Miller⁹, Joel Milam¹⁰, Ashna Shah¹¹, Susan K Peterson¹², Qian Lu¹³, J Andrew Livingston¹⁴, Michelle A T Hildebrandt¹⁵, Susan K Parsons¹⁶, David Freyer¹⁷, Michael E Roth¹⁸

Affiliations

¹ Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
² Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
³ University of Maryland School of Social Work, Baltimore, Maryland, USA.
⁴ Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA.
⁵ Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA.
⁶ Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁷ Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, USA.
⁸ Center for Health Equity Education and Research, University of California San Diego, La Jolla, California, USA.
⁹ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
¹⁰ Department of Epidemiology & Biostatistics, University of California, Irvine, California, USA.
¹¹ School of Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹² Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹³ Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Institute, Houston, Texas, USA.
¹⁴ Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁵ Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁶ Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
¹⁷ Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
¹⁸ Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Abstract

Purpose: Survivors of adolescent and young adult (AYA) cancer experience psychological distress and insufficient access to mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes in this population. This study compared psychological distress, mental health care use, and inability to afford mental health care between Hispanic/Latino survivors of AYA cancer and Hispanic/Latino controls.

Methods: The National Health Interview Survey data (2010-2018) were analyzed to identify Hispanic/Latino survivors of AYA cancer and Hispanic/Latino age- and sex-matched non-cancer controls. Sociodemographic, chronic health, modifiable factors, and psychological outcomes were compared using chi-square tests. Logistic regression models with survey weights were used to assess the log-odds of psychological distress in relation to covariates, along with the cancer group. Interactions were evaluated between each variable and cancer group.

Results: The study included 370 Hispanic/Latino survivors of AYA cancer (mean time since diagnosis = 12.34 years) and 3700 Hispanic/Latino controls. Compared to controls, survivors were more likely to report moderate/severe distress (OR = 2.23, p < 0.001), use of mental health care (OR = 2.11, p < 0.001) and inability to afford mental health care (OR = 3.05, p < 0.001). Forty-one percent of survivors reported moderate/severe distress and only 16% utilized mental health care. Among survivors, having more than two chronic health conditions and public insurance (compared to private insurance) were associated with the presence of moderate/severe distress. Among survivors experiencing moderate/severe distress, lack of insurance was associated with decreased utilization of mental health care.

Conclusions: Having cancer as an AYA may exacerbate disparities in psychological health within the Hispanic/Latino population.

Keywords: AYA; Hispanic/Latino; adolescent and young adult; cancer survivors; disparities; mental health care; psychological distress.

MeSH terms

Adolescent
Cancer Survivors* / psychology
Hispanic or Latino / psychology
Humans
Mental Health Services*
Neoplasms* / psychology
Neoplasms* / therapy
Patient Acceptance of Health Care*
Psychological Distress*
Young Adult

Abstract

MeSH terms

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