Article

Correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer

School of Social Work, University of Maryland, Baltimore, Baltimore, Maryland, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 06/2005; 23(13):3052-60. DOI: 10.1200/JCO.2005.08.041
Source: PubMed

ABSTRACT To assess the prevalence of depression among low-income, ethnic minority women with breast or gynecologic cancer, receipt of antidepressant medications or counseling services, and correlates of depression.
Study patients were 472 women receiving cancer care in an urban public medical center. Women had a primary diagnosis of breast (stage 0 to III) or gynecologic cancer (International Federation of Gynecology and Obstetrics stage 0 to IIIB). A diagnostic depression screen and baseline questionnaire were administered before or during active treatment or during active follow-up. Self-report data were collected on receipt of depression treatment, use of supportive counseling, pain and receipt of pain medication, functional status and well-being, and perceived barriers to cancer care.
Twenty-four percent of women reported moderate to severe levels of depressive disorder (30% of breast cancer patients and 17% of gynecologic cancer patients). Only 12% of women meeting criteria for major depression reported currently receiving medications for depression, and only 5% of women reported seeing a counselor or participating in a cancer support group. Neither cancer stage nor treatment status was correlated with depression. Primary diagnosis of breast cancer, younger age, greater functional impairment, poorer social and family well-being, anxiety, comorbid arthritis, and fears about treatment side effects were correlated with depression.
Findings indicate that depressive disorder among ethnic minority, low-income women with breast or gynecologic cancer is prevalent and is correlated with pain, anxiety, and health-related quality of life. Because these women are unlikely to receive depression treatment or supportive counseling, there is a need for routine screening, evaluation, and treatment in this population.

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    • "The available studies examining racial differences in mental health among those diagnosed with cancer have many characteristics that do not permit assessment of racial ethnic differences at the population level. First, the vast majority of studies of those with cancer do not compare racial/ethnic groups [33, 34], focus on the comparison of only two groups [8, 27, 31, 35] or have small sample sizes that may prohibit accurate multi-group comparisons [29, 36]. Second, studies often focus on cancer of a specific site [28, 37], or among a certain age group [31, 38, 39], which can skew the prevalence of mental illness away from the population means. "
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    ABSTRACT: Background Little research has examined the interactive effect of cancer status and race/ethnicity on mental health. As such, the present study examined the mental health of adults, 18 and over, diagnosed with cancer. This study examined the extent to which a cancer diagnosis is related to poorer mental health because it erodes finances and the extent to which the mental health impact of cancer differs across racial/ethnic groups. Furthermore, this study aimed to test the stress process model, which posits that the proliferation of stress can lead to mental illness and this process can differ across racial/ethnic groups. Methods Data from the 2005 Adult California Health Interview Survey was used (N = 42,879). The Kessler 6, a validated measure of psychological distress, was used to measure mental health, with higher scores suggesting poorer mental health. Scores on the Kessler 6 ranged from 0 to 24. Linear regression models estimating psychological distress tested each aim. The mediating effect of income and the race by cancer interaction were tested. Results After controlling for gender, age, insurance status, education and race/ethnicity, cancer was associated with higher Kessler 6 scores. About 6% of this effect was mediated by household income (t = 4.547; SE = 0.011; p < 0.001). The mental health impact of cancer was significantly worse for Latinos and Blacks than for non-Hispanic Whites. Conclusions The mental health impact of cancer is not uniform across groups. Future work should explore reasons for these disparities. Efforts to increase access to mental health services among minorities with cancer are needed.
    BMC Public Health 09/2014; 14(1):930. DOI:10.1186/1471-2458-14-930 · 2.32 Impact Factor
    • "Depression is associated with suicide risk. Suicidal ideation is a serious problem in cancer patients and can often indicate, in fact, the presence of major depression (Ell et al., 2005). Epidemiological studies have shown that the risk of suicide among cancer patients is approximately 2 to 10 times higher than the general population (Allebeck, Bolund, & Ringback, 1989; Levi, Bulliard, & La Vecchia, 1991; Louhivuori & Hakama, 1979). "
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    ABSTRACT: The aims of the study were to assess socio-demographic and clinical factors associated with suicidal ideation in patients with cancer who required a psycho-oncological support. Among 504 participants, there were 136 (23 men and 113 women) cancer patients who completed psychological assessment when admitted to the Psycho-oncology Outpatient Clinic between 2006 and 2011. Suicidal ideation was assessed by item n. 9 of the Brief Symptom Inventory, Hopelessness was assessed by the hopelessness subscale of the MINI-Mental Adjustment to Cancer Scale, and Depression was assessed by the depression subscale of the Hospital and Anxiety Depression Scale. Around 30% of our sample reported affective symptoms and around 20% reported suicidal ideation and hopelessness. Patients who reported suicidal ideation were more hopeless (18.8±6.7 vs. 15.7±5.2; t134 = 2.54; P<0.05) and reported more depression (11.8 ±4.8 vs. 6.8±4.1; t134 = 5.30; P<0.001). It is evident that cancer can result in a strong psychological distress in the patient. It is important, therefore, that cancer patients receive a proper assistance and psychological support and that both the possible presence of depression and suicidal ideation are constantly monitored.
    Journal of Psychosocial Oncology 05/2014; 32(4). DOI:10.1080/07347332.2014.917136 · 1.04 Impact Factor
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    • "Relatively few collaborative depression care trials have been conducted among predominantly Hispanic cancer patients, depression care management requires attention to sociocultural factors and care access adaptations consistent with patient and family member perspectives, for example, fearing side effects of antidepressant medication, attributing the cause of depression to social stressors, lacking adequate health coverage for psychotherapy , and cultural norms (Cabassa, Hansen, Palinkas, & Ell, 2008; Cabassa, Lester, & Zayas, 2007; Ell et al., 2005; González et al., 2010; Wells, Lagomasino, Palinkas, Green, & Gonzalez, 2012). If patients prefer psychotherapy, but are only offered pharmacotherapy, they are more likely to drop out of depression treatment or to show a little improved depressive symptoms (Moradveisi, Huibers, Renner, & Arntz, 2014; Wells, Palinkas, Qiu, & Ell, 2011). "
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    ABSTRACT: Objective: This study assessed whether perceived social support (PSS) is a factor in improving physical and functional well-being observed among cancer patients receiving collaborative depression care. Methods: A secondary analysis was conducted of data collected in a randomized clinical trial testing the effectiveness of collaborative depression care. PSS was measured at 12 months; physical and functional well-being were assessed at 18 and 24 months post-baseline. Mediation analyses via a bootstrapping method were conducted. Results: Significant mediation of PSS at 12 months predicted better physical and functional well-being at 18 months and 24 months. Conclusion: Depressed cancer survivors are likely to benefit when social workers provide psychosocial depression care aimed at activating social support, thereby improving physical and functional well-being.
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