Psychiatric disorders and mental health service use in patients with advanced cancer

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Abstract
BACKGROUND: Psychological morbidity has been proposed as a source of distress in cancer patients. This study aimed to: 1) determine the prevalence of diagnosable psychiatric illnesses, and 2) describe the mental health services received and predictors of service utilization in patients with advanced cancer.METHODS: This was a cross‐sectional, multi‐institutional study of 251 eligible patients with advanced cancer. Eligibility included: distant metastases, primary therapy failure, nonpaid caregiver, age ≥20 years, stamina for the interview, English or Spanish‐speaking, and adequate cognitive ability. Trained interviewers administered the Structured Clinical Interview for the Diagnostic Statistical Manual IV (DSM‐IV) modules for Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Post‐Traumatic Stress Disorder, and a detailed questionnaire regarding mental health service utilization.RESULTS: Overall, 12% met criteria for a major psychiatric condition and 28% had accessed a mental health intervention for a psychiatric illness since the cancer diagnosis. Seventeen percent had discussions with a mental health professional; 90% were willing to receive treatment for emotional problems. Mental health services were not accessed by 55% of patients with major psychiatric disorders. Cancer patients who had discussed psychological concerns with mental health staff (odds ratio [OR] = 19.2; 95% confidence interval [95% CI], 8.90–41.50) and non‐Hispanic white patients (OR = 2.7; 95% CI, 1.01–7.43) were more likely to receive mental health services in adjusted analysis.CONCLUSIONS: Advanced cancer patients experience major psychiatric disorders at a prevalence similar to the general population, but affected individuals have a low rate of utilizing mental health services. Oncology providers can enhance utilization of mental health services, and potentially improve clinical outcomes, by discussing mental health concerns with their patients. Cancer 2005. © 2005 American Cancer Society.
Funding Information
  • National Institute of Mental Health (CA106370)
  • National Cancer Institute (MH56529, MH63892)
  • Soros Open Society Institute Project on Death in America Faculty Scholarship
  • RAND/Hartford Interdisciplinary Geriatric Health Research Center grant
  • Fetzer Religion at the End-of-Life grant
  • Claude D. Pepper Older Americans Independence Center grant from the National Institute on Aging (P30AG21342)
  • National Center for Research Resources (K12RR17594)