title: Psychiatric disorders and mental health service use among caregivers of advanced cancer patients.
abstract: OBJECTIVE
  Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers.
  
  
  METHODS
  Two hundred informal caregivers of advanced cancer patients were interviewed and administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and an assessment of mental health service use.
  
  
  RESULTS
  Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patient's cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%), and generalized anxiety disorder, 3.5% (95% CI, 1.4% to 7.1%). Among caregivers with a current psychiatric disorder, 81% discussed mental health concerns with a health professional before the patient's cancer diagnosis compared with 46% after the diagnosis (McNemar test = 5.40; P = .02). Only 46% of caregivers with a current psychiatric disorder accessed mental health services. Caregivers who discussed mental health concerns with a clinician before the patient's cancer diagnosis (odds ratio [OR] = 3.51; 95% CI, 1.42 to 8.71) and after the diagnosis (OR = 21.23; 95% CI, 9.02 to 49.94) were more likely than caregivers not having these discussions to receive mental health services.
  
  
  CONCLUSIONS
  Many caregivers of advanced cancer patients either meet criteria or are being treated for psychiatric problems. Discussing mental health issues positively influences the receipt of mental health services and should be actively pursued in this vulnerable population.
authors.affiliation: Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Vanderwerker
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Laff
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
authors.forename: Suzanne
authors.initials: S
authors.lastname: McColl
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000534:rehabilitation; D035862:Vulnerable Populations