title: Physical activity, psychological distress, and receipt of mental healthcare services among cancer survivors.
abstract: OBJECTIVE
  Physical activity confers multiple health benefits in the general population. This study examined the associations of physical activity with serious psychological distress (SPD) and receipt of mental healthcare services among U.S. adult cancer survivors.
  
  
  METHODS
  We analyzed data from 4,797 cancer survivors (aged ≥18 years) and 38,571 adults without cancer who participated in the 2009 Behavioral Risk Factor Surveillance System. SPD was assessed using the Kessler-6 questionnaire. Adjusted prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders.
  
  
  RESULTS
  Overall, 6.6 % of cancer survivors (vs. 3.7 % of adults without cancer, P < 0.001) reported having SPD, and 14.0 % of cancer survivors (vs. 10.0 % of adults without cancer, P < 0.001) reported receiving mental healthcare services; the percentages decreased with increasing physical activity levels. After multivariate adjustment, compared to cancer survivors who were physically inactive, cancer survivors who engaged in physical activity >0 to <150 min/week and ≥150 min/week were 62 % and 61 % (P < 0.001 for both) less likely to report SPD, respectively; cancer survivors who engaged in physical activity ≥150 min/week were 33 % (P < 0.05) less likely to report receiving mental healthcare services. Additionally, the inverse association between physical activity and receiving mental healthcare services persisted among women with breast or reproductive cancers and among men and women with gastrointestinal cancers.
  
  
  CONCLUSIONS
  The inverse associations between physical activity and SPD or receiving mental healthcare services suggest that physical activity may play a role in improving mental health among cancer survivors.
  
  
  CONCLUSIONS
  Healthcare clinicians may consider routinely monitoring and assessing the psychological well-being of cancer survivors and educate them about the potential benefits of physical activity in improving their mental health.
authors.affiliation: Division of Behavioral Surveillance, Public Health Surveillance and Informatics Program Office, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA. fwj4@cdc.gov
authors.forename: Guixiang
authors.initials: G
authors.lastname: Zhao
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Lina S
authors.initials: LS
authors.lastname: Balluz
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D015438:Health Behavior; D006296:Health Services; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy; D013315:Stress, Psychological; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult