Study Evaluates Risk of Depression by Race and Sex Among Patients With Newly Diagnosed Lung Cancer
In a study reported in the Journal of Clinical Oncology, Traeger et al evaluated risk of depression symptoms and psychosocial service use by race and sex among patients with newly diagnosed lung cancer. The investigators found that black men have the highest prevalence of depressive symptoms, white women are at greater risk for depression than white men and black women on analysis adjusting for covariates, and black women more frequently access psychosocial support.
Study Details
This multiregional Cancer Care Outcomes Research and Surveillance study examined race by sex differences in depression symptoms and use of psychosocial services (including contact with pastors, social workers, mental health workers, and support groups) among 1,043 black or white patients with newly diagnosed stage I to III lung cancer. Depression symptoms were assessed using the modified Center for Epidemiologic Studies Depression Scale, with a score ≥ 6 indicating positive depression screen.
Characteristics of Patients
The population included 76 black women, 89 black men, 432 white women, and 446 white men. Black patients were significantly more likely to be younger, have low income, and have lower educational attainment vs white patients, and black women were most likely to be living without a spouse or partner. Black patients were more likely to have stage III vs I/II disease, less likely to have undergone surgery, and more likely to have received radiation or chemotherapy, with not all differences by sex being significant. Black and white men reported worse lung cancer symptoms vs white women. White men reported better nursing care quality vs white women. Black patients reported greater fatalism than white patients, with not all differences by sex being significant.
Prevalence of Depression Symptoms and Support Contact
A total of 18.2% patients screened positive for depression symptoms, including 24.7% of black men, 20.6% of white women, 15.8% of black women , and 15.0% of white men. Contact with a pastoral counselor was reported by 45.3% of black women, 27.6% of black men, 25.0% of white women, and 24.3% of white men. Contact with a social worker was reported by 28.4% of black women, 24.1% of black men, 16.0% of white men, and 13.4% of white women. Contact with a psychiatrist, psychologist, or mental health worker and contact with a support group were reported by 5.3% and 2.7% of black women, 8.1% and 6.9% of black men, 6.5% and 4.9% of white women, and 9.0% and 3.8% of white men.
Adjusted Analysis
In a logistic regression model adjusting for covariates, white women had greater risk for depression symptoms compared with white men (adjusted odds ratio [OR] = 2.11, P = .002) and compared with black women (OR = 2.74, P = .01), with no other differences between groups being significant. Other predictors of risk were age < 65 years (OR = 1.73, P = .01), general perceived health (OR = 0.66, P < .001), worst recent bodily pain (OR = 1.10, P = .001), lung cancer symptoms (OR = 1.02, P < .001), patient-doctor communication (OR = 0.99, P = .02), and emotional/information support (OR = 0.58, P < .001).
Among 838 patients who reported at least one depression symptom, 28.0% wanted help for mood, including 40.4% of black women (adjusted OR = 2.56, P = .005 vs white men), 32.3% of black men, 30.8% of white women (adjusted OR = 1.98, P = .002, vs white men), and 22.2% of white men (no other significant differences between groups). Among patients who wanted help for mood, 77.8% received the help they wanted from their doctor, including 81.9% of white men, 79.4% of white women, 69.6% of black women, and 63.2% of black men. The significant difference between white patients vs black patients in likelihood of receiving desired help (OR = 3.29, P = .02) was no longer apparent on adjusted analysis (no significant differences among the four groups).
The investigators concluded: “Race and sex interacted to predict risk of depression symptoms. Covariates accounted for elevated risk among black men. White women showed greater risk than black women and white men, independent of covariates. Black patients may experience greater barriers to receiving help for mood from their doctors. Race by sex differences in contact with psychosocial services highlight potential differences in the extent to which services are available, acceptable, and/or sought by patients.”
Lara Traeger, PhD, of Massachusetts General Hospital, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Cancer Institute, with additional support from the American Cancer Society. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
