Cancer as a risk factor for distress and its interactions with sociodemographic variables in the context of the first wave of the COVID-19 pandemic in Germany

Mareike Ernst,Manfred E Beutel,Elmar Brähler

doi:10.1038/s41598-022-06016-x

Abstract

The COVID-19 pandemic poses a psychological challenge, especially for individuals with chronic illnesses. The aim of this study was to investigate associations of cancer with distress, including its interplay with further risk and protective factors. We conducted a representative survey of the German population (N = 2503, including N = 144 with a cancer diagnosis) during the first wave of the pandemic. In multiple linear and logistic regression analyses, we tested associations of cancer with depression and anxiety symptoms and suicidal ideation. We also investigated moderating effects of age, gender, income, living situation, marital status, and loneliness. Individuals with cancer were more likely to report anxiety symptoms (φ = .061), suicidal ideation (φ = .050), and loneliness (φ = .044) than other participants. In regression analyses that controlled for sociodemographic differences, cancer was still associated with anxiety symptoms. We also observed interaction effects, indicating that this relation was especially strong in men with cancer and that cancer survivors with a low income were particularly likely to report anxiety symptoms. The findings demonstrate that cancer survivors are a vulnerable group and that factors of different life domains interact in shaping well-being in the population, necessitating comprehensive risk assessment and support offers during the pandemic and beyond.

Highlights

The COVID-19 pandemic poses a psychological challenge, especially for individuals with chronic illnesses
The objective of the present study was to investigate potential differences in mental health outcomes of individuals with cancer and the rest of the general public during the first wave of the COVID-19 pandemic in Germany and to explore the interplay with other risk/protective factors which were previously found to play a relevant role in cancer patients’ and survivors’ mental health and in the emotional well-being of the general population in the context of the pandemic
Besides anhedonia and depressed mood/hopelessness, the depression symptoms captured by the PHQ-2, the present study investigated suicidal ideation separately

Summary

Introduction

The COVID-19 pandemic poses a psychological challenge, especially for individuals with chronic illnesses. We observed interaction effects, indicating that this relation was especially strong in men with cancer and that cancer survivors with a low income were likely to report anxiety symptoms. The closure of educational institutions and childcare facilities, cuts in the labour market, and far-reaching contact restrictions have led to an ongoing stagnation of public life Against this background, potential mental health sequelae of the COVID-19 pandemic which could constitute a public health crisis in their own right have come into focus[1,2]. Researchers have warned that especially questionnaire instruments that include items assessing somatic complaints (such as the PHQ-9) could overestimate rates of mental distress in cancer patients/survivors due to their overlap with symptoms of the disease and/or side effects and late effects of its treatment, e.g., tiredness and low e nergy[18,19]

Objectives

Methods

Results

Discussion

Conclusion