Ambulatory Mental Health Visits and Use of

Psychotropic Medicines by Cancer Survivors’ Spouses

Rajeshwari S. Punekar, Ph.D., M.P.HScott & White Healthcare

Temple, TX

Cancer diagnosis has negative psychological impact on cancer survivors and their family members1,2,3.

Lower mental health status of cancer survivors’ spouses 4,5,6,7.

Few studies examining use of mental health services and prescribed psychotropic medicines among cancer survivors’ spouses 8

Background

To describe the utilization patterns of mental health services and psychotropic medications among cancer survivors’ spouses.

To compare use of mental health services and psychotropic medications between cancer survivors’ spouses and spouses of non-cancer individuals.

Objectives

Data

1999-2008NHIS

Spouses- 1,592

2001-2009MEPS-HC

Spouses-226

2001-2009 NHIS-MEPS link files

Ambulatory mental health visits =the total annual number of mental health visits made to outpatient department, or physician’s office.

Use of psychotropic medicines =the total annual number of psychotropic medication prescriptions.

Survey design adjusted Logistic regression model

Measures & Analysis

Percentage of spouses using mental health services and psychotropic medicines by age, 2001-2009

Characteristics Age 25-64 Age 65+

Cancer(N=0.2 million)

Non-cancer(N=2

million)

Cancer(N=0.3 million)

Non-cancer(N=12

million)

% % % %

Ambulatory mental health visits a

12 8 10 8

Psychotropic medicines

Antidepressants 16 13 17 14

Antipsychotics 2 1 4 2

Anxiolytics, hypnotics and sedatives a

8 5 8 7

CNS stimulants 0 1 1 0

Total a 20 16 23 20

a Spouses of cancer and non-cancer individuals, ages 25-64, are significantly different at p=0.05 levelb Spouses of cancer and non-cancer individuals, 65 and above, are significantly different at p=0.05 level

Odds Ratios (OR) for ambulatory mental health visits and use of prescribed psychotropic medicines, 2001-2009

Predictors Ambulatory mental health visits

Prescribed psychotropic medicines

25-64 65+ 25-64 65+

OR OR OR OR

Cancer survivor 1.49* 1.21 1.16 1.03

Time since diagnosed with cancer (TSD)

TSD is less than 1 year 1.97* 0.49 2.25 0.29

TSD between 1 year and 5 years

1.22 0.55 1.56 0.56

TSD between 6 years and 10 years

1.81 1.25 1.13 0.80

TSD between 11 years and 20 years

1.64 1.16 1.67 1.18

Cancer sites

Breast cancer 1.58 0.52 1.85 1.02

Gynecological cancer 2.49 1.04 2.00 0.52

Lung cancer 0.67 0.64 0.24 0.81

Prostate cancer 0.81 0.56 0.79 0.80

Other cancer 0.51 0.76 0.44 1.27Colorectal cancer survivors who have been diagnosed with cancer for more than 21 years is the reference group.* significantly different at p=0.05 level

Higher percentage of younger age cancer survivors’ spouses use ambulatory mental health services and psychotropic medicines

Cancer diagnosis within a year is a significant predictor of ambulatory mental health services utilization.

Cancer diagnosis and cancer-related factors are not significant predictors for using prescribed psychotropic medicines.

Summary

No information about the stage of cancer and the type of treatment.

No information about the mental health status of cancer survivors and their spouses prior to cancer diagnosis

Smaller sample sizes for patients with less prevalent cancer sites such as brain and bone cancers

Use of psychotherapeutic medications and mental health visits is self-reported

Limitations

Identify mental health issues in cancer survivors’ spouses and refer them to appropriate psycho-oncology therapy.

Cancer survivors’ spouses should be made aware of psychological challenges involved with cancer diagnosis.

Encourage cancer survivors’ spouses to pursue pharmacotherapy to overcome their mental health issues.

Implications

Future studies: Use of mental health services and

prescribed psychotropic medicines among VA cancer patients

Cancer patients and provider communications about mental health issues and barriers to access mental health services

What’s next?

Contact Information:Rajeshwari S. Punekar, Ph.D.539,Brindley Circles,Scott & White Hospital,2401 S 31st Street,Temple, TX 76508Phone: 254-724-5460E-mail: rpunekar@swmail.sw.org

1. Badger, T., Braden, C., Mishel, M., & Longman, A. (2004). Depression burden, psychological adjustment, and quality of life in women with breast cancer: Patterns over time. Research in Nursing & Health, 27(1), 19-28.

2. Ben, E., & Valerie, C. (2004). The psychological impact of a cancer diagnosis on families: The influence of family functioning and patients' illness characteristics on depression and anxiety. Psycho-Oncology, 13(8), 562-576.

3. Ferrario, S., Zotti, A., Massara, G., & Nuvolone, G. (2003). A comparative assessment of psychological and psychosocial characteristics of cancer patients and their caregivers. Psycho-Oncology, 12(1), 1-7.

4. Ganz, P. A. (2002). Adult Cancer Survivors: Understanding Late Effects Of Cancer And Its Treatment: National Cancer Policy Board.

5. Edwards, B., & Clarke, V. (2004). The psychological impact of a cancer diagnosis on families: The influence of family functioning and patients' illness characteristics on depression and anxiety. Psycho-Oncology, 13(8), 562-576.

6. Ezer, H. (2003). Predictors of adaptation in wives during the initial psychosocial phase of prostate cancer. Unpublished Ph.D., Universite de Montreal (Canada), Canada.

7. Wagner, C., Bigatti, S., & Storniolo, A. (2006). Quality of life of husbands of women with breast cancer. Psycho-Oncology, 15(2), 109-120.

8. Vanderwerker, L., Laff, R., Kadan-Lottick, N., McColl, S., & Prigerson, H. (2005). Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol, 23, 6899-6907.

References