How are spousal depressed mood, distress, and quality of life associated with risk of depressed mood in cancer survivors? Longitudinal findings from a national sample

Abstract

Background: Spouses of cancer survivors experience both positive and negative effects from caregiving. However, it is less clear what role spousal well-being may have on cancer survivors. This study aimed to determine the impact of spousal psychosocial factors on survivor depressed mood and whether this association differed by gender.

Methods: We examined longitudinal data on cancer survivors and their spouses (n = 910 dyads) from the 2004-2012 Medical Expenditures Panel Survey and a matched sample of cancer-free dyads. Subjects reported depressed mood, psychologic distress, and mental and physical health-related quality of life (HRQoL) at two time points (T1/T2). Dyadic multilevel models evaluated the impact of psychosocial factors at T1 on depressed mood at T2, controlling for sociodemographics, cancer type, survivor treatment status, and depressed mood at T1.

Results: Cancer survivors whose spouses reported depressed mood at T1 were 4.27 times more likely to report depressed mood at T2 [95% confidence interval (CI), 2.01-9.07]; this was stronger for female survivors (OR, 9.49; 95% CI, 2.42-37.20). Better spousal mental and physical HRQoL at T1 were associated with a 30% decrease in survivor depressed mood risk at T2. Most spillover effects were not observed in comparison dyads.

Conclusion: Depressed mood and poor HRQoL in spouses may increase the risk of depressed mood in cancer survivors. The risk may be especially strong for female survivors.

Impact: Identifying and improving spousal mental health and HRQoL problems may reduce the risk of depressed mood in cancer survivors. Future research should examine whether incorporating spousal care into psychooncology and survivorship programs improves survivor outcomes.

Figure 1

Psychosocial characteristics of cancer survivors and their spouses in the Medical Expenditures Panel Survey (2004-2012). Mean mental and physical health-related quality of life (HRQoL) of 910 cancer survivors and their spouses with and without depressed mood at Time 1, controlling for age, gender, race/ethnicity, health insurance coverage, % federal poverty level, family size, presence of health conditions (not including cancer) and limitations in activities of daily living or instrumental activities of daily living. P<0.05 for all survivor-spouse and depressed-non-depressed contrasts. HRQoL was measured using the Short-Form 12 (SF-12) and depressed mood was measured using the Patient Health Questionnaire (PHQ-2), with a cutpoint of 3.

Figure 2

Prevalence of depressed mood in cancer survivors and their spouses, and a comparison group of spousal dyads without cancer (Medical Expenditures Panel Survey, 2004-2012). T1 and T2 were 11 months apart, on average.

Figure 3

Association between depressed moodand partners’ subsequent depressed mood, Medical Expenditures Panel Survey (2004-2012). *p<0.05; Estimates represent odds of depressed mood at T2 in those with depressed mood at T1 (actor effects) or spouses with depressed mood at T1 (partner effects), compared to without depressed mood at T1. T1 and T2 were 11 months apart, on average. Models control for age, gender, race/ethnicity, health insurance coverage, % federal poverty level, family size, presence of health conditions, presence of basic/instrumental activities of daily living limitations, cancer type, survivor treatment status, MEPS panel number, and depressed mood at T1.