Course of Mental Disorders in Early Cancer Survivorship in Relation to Socioeconomic Status: A Multi-Center Prospective Longitudinal Study (LUPE).

Abstract

Objective: Individuals with low socioeconomic status (SES) exhibit higher rates of mental disorders; however, data in oncological populations are insufficient. This study investigated the course of DSM-5 mental disorders in cancer patients, stratified by SES, over a period of 1.5 years following initial cancer diagnosis.

Methods: This multi-center prospective longitudinal study assessed cancer patients within two months of cancer diagnosis (t1), and at 6-, 12-, and 18-month follow-up (t2-t4) using the SCID-5 interview for mental disorders based on DSM-5 criteria. Chi-square-tests were tested for frequency changes over time. A generalized linear mixed model (GLMM) was applied with fixed effects for SES and time on mental disorders.

Results: Out of 1030 patients with a SCID-5 at baseline (53.2% men, 60 years), 821, 719 and 654 participated at respective follow-ups. The most common diagnoses were skin and prostate cancer. Point prevalence of mental disorders was 20.9% at baseline, decreasing to 18.2%, 14.6%, and 15.0% (t2-t4; χ² (3) = 15.3, p = 0.002). Patients with low SES consistently showed highest prevalence rates, whereas patients with high SES showed decreasing rates of mental disorders over time, with a main effect of time (χ² (3) = 19.9, p < 0.001) and SES (χ² (2) = 8.8, p = 0.01) in the GLMM. Two thirds never met diagnostic criteria for a mental disorder. Sensitivity analysis among study completers (n = 592) revealed a similar pattern to the main analysis.

Conclusions: Cancer patients with low SES exhibit impaired coping with cancer-related stressors, increasing their risk for mental disorders. Social disparities affect physical and mental health, possibly via health behavior or health literacy, and need to be addressed by tailored survivorship care planning.