Risk for anxiety and depression among men with prostate cancer.

Abstract

280 Background: Men with prostate cancer (PC) commonly experience symptoms of anxiety, depression, and suicidality; yet, identifying men in need of mental health support can be difficult, particularly as gender role socialization may deter men from seeking care. We aimed to identify sociodemographic, clinical, and social factors associated with risk for clinically significant anxiety and depression among men with PC. Methods: 118 men with PC completed the Cancer Experience Registry, provided sociodemographic and clinical information, degree of symptom and side effect (SSE) burden in the prior month (16 items), completed the CancerSupportSource Risk for Anxiety and Risk for Depression 2-item subscales , and PROMIS Emotional Support and Instrumental Support 4-item subscales. Bivariate analysis was used to identify significant variables associated with risk for anxiety or depression to be included in subsequent models. Multivariable logistic regression was used to determine which factors significantly predicted risk (1=At risk; 0=Not) for 1) anxiety and 2) depression Independent variables included sociodemographic (age, race/ethnicity, employment, income, marital status), and clinical factors (time since diagnosis, staging, treatment status, history of recurrence, radical prostatectomy, chemotherapy, hormone or radiation therapy, total SSE burden), and social support (caregiver (Y/N), emotional and instrumental support). Results: The sample was 84% Non-Hispanic (NH) White, 9% NH Black. Mean age was 66 years ( SD=9.8). 42% NED, 23% localized, 26% metastatic disease. 53% were retired, 35% employed, and 10% unemployed due to disability (UDTD). 31% were at risk for clinical levels of anxiety; 25% were at risk for clinical levels of depression. In multivariable logistic regression analysis: significant predictors of risk for anxiety ( p<.001) included age (OR =0.88, p<.01), not having a caregiver (OR =5.02, p=.02), and emotional support (OR =0.81, p=.04). Risk for depression ( p<.001) was significantly predicted by instrumental support (OR=0.67, p=.01) and higher among those with active, localized disease compared to NED (OR =10.84, p=.02), and among those UDTD compared to employed (OR =11.09, p=.03). Significant correlates of risk for anxiety and depression in bivariate but not multivariate analysis: marital status, time since diagnosis, and total SSE burden. Conclusions: Younger age, UDTD, localized cancer status, social support, and not having a caregiver were significant predictors of risk for clinical levels of anxiety or depression. Routine risk assessment for anxiety and depression, coupled with multidimensional distress screening can help triage patients to tailored care. Further, those with greater social support and those with a caregiver had lower odds of being at risk for anxiety or depression, emphasizing the need for connecting men with cancer to emotional and instrumental supportive services in their community.