Examining the Pathoplastic Moderating Role of Education on the Association between Depressive Mood and Self-Rated Health among Cancer Survivors: A Population-Based Study.

Anao Zhang,Kaipeng Wang,Adam S Duvall

doi:10.3390/curroncol28050343

Abstract

Objective: Self-rated health (SRH) is a salient patient outcome for cancer survivors, and depressive mood and education are known determinants of cancer survivors’ SRH. Moving beyond the well-established direct association between depressive mood, education, and SRH among cancer survivors, this epidemiological study investigated the pathoplastic role of education on depressive mood in relation to SRH among a nationally representative sample of cancer survivors in the United States. Methods: The 2019 National Health Interview Survey was analyzed using data from adult participants (≥18 years old) who self-reported as cancer survivors (n = 3844). Ordered logistic regression was used to evaluate the direct impact of depressive mood and education in relation to SRH. In addition, the pathoplastic moderating effect was evaluated using ordered logistic regression with an interaction term of depressive mood and education in the regression model. All analyses adjusted for complex sample weights so that findings are nationally representative. Results: After adjusting for all covariates, U.S. cancer survivors’ depressive mood was significantly associated with lower SRH, and U.S. cancer survivors’ higher education was significantly associated with higher SRH. As a pathoplastic moderator, cancer survivors’ education significantly moderated the association between depressive mood and SRH. The negative association between depressive mood and SRH was significantly greater among those with higher education. Conclusion: Moving beyond the direct association between depressive mood, education, and SRH, education served as a pathoplastic moderator in relation to depressive mood and SRH. Psycho-oncology providers need to be mindful of the “protective-risk” effect of education in relation to cancer survivors’ depressive mood and SRH.

Highlights

Self-rated health (SRH) is a salient general health status indicator for cancer survivors because it indicates a set of robust clinical outcomes, including cancer patients’ ability to manage and cope with treatment-related symptoms, quality of life, and mortality [1,2,3]
Using a national representative dataset, the National Health Interview Survey, this study aims to test the following hypotheses: (1) cancer survivors’ depressive mood is negatively associated with SRH; (2) cancer survivors’ education is positively associated with SRH; and (3) to explore whether and how education moderates the association between depressive mood and cancer survivors’ SRH
Over half of the cancer survivors were female (58.43%), and about one-third had below high school (8.56%) or high school or equivalent education (24.25%), one-third had some college experience (30.41%), and about one-third had a bachelor’s degree (21.37%) or higher (15.4%)

Summary

Introduction

Self-rated health (SRH) is a salient general health status indicator for cancer survivors because it indicates a set of robust clinical outcomes, including cancer patients’ ability to manage and cope with treatment-related symptoms, quality of life, and mortality [1,2,3]. SRH is a significant patient-reported outcome measure (PROM) among cancer patients, which has the strongest predictive validity for health status when compared with any other single-item health rating question, such as physicians’ assessment or BMI [1,4,5]. A compelling body of social determinants of health literature has identified that demographic, e.g., race and socioeconomic status, and psychosocial factors, e.g., depression and social support, are significant predictors of SRH among cancer survivors [9,10,11]. One of the key variables representing individual socioeconomic status, is another established factor associated with cancer survivors’ SRH [2,11]. Individuals with higher levels of education are expected to have better access to healthcare resources and are likely to report a higher level of SRH [16,17]

Methods

Results

Discussion

Conclusion