title: Low socioeconomic status and mental health outcomes in colorectal cancer survivors: disadvantage? advantage?... or both?
abstract: OBJECTIVE
  The goal of this study is to examine the relationship between socioeconomic status (SES) and both positive and negative mental health (MH) outcomes in a population-based sample of colorectal cancer survivors. On the basis of theoretical conceptualizations of trauma and posttraumatic growth, low SES was hypothesized to be positively associated with both greater negative MH outcomes (e.g., distress) and greater positive MH outcomes (e.g., growth).
  
  
  METHODS
  Colorectal cancer survivors (n = 1300; 57% male; mean age 69.4 and 4.0 years post-diagnosis) were recruited using a regional, population-based cancer registry in the Netherlands and completed a questionnaire assessing current negative and positive MH outcomes. Low, medium, and high SES respondents were identified using an area-level indicator of SES based on aggregated individual fiscal data on monetary home value and household income.
  
  
  RESULTS
  Analysis of covariance and logistic regression analyses indicated that low SES was a risk factor for greater negative MH outcomes. Relative to high SES survivors, low SES survivors reported poorer status on nine indices of MH, and high SES survivors were about 50% less likely to report clinically important levels of anxiety and depression. Results provided partial support for the hypothesis low SES was a 'risk' factor for greater positive MH outcomes. Relative to high SES survivors, low SES survivors reported greater positive MH outcomes on 2 of 5 positive MH indices examined (Positive Self-Evaluation, Meaning of Cancer).
  
  
  CONCLUSIONS
  Study findings are the first to suggest that low SES might increase the likelihood of both greater negative as well as positive MH outcomes in cancer survivors.
authors.affiliation: Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Andrykowski
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: Aarts
authors.forename: Lonneke V
authors.initials: LV
authors.lastname: van de Poll-Franse
authors.forename: Floortje
authors.initials: F
authors.lastname: Mols
authors.forename: Gerrit D
authors.initials: GD
authors.lastname: Slooter
authors.forename: Melissa S Y
authors.initials: MS
authors.lastname: Thong
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000523:psychology; D015179:Colorectal Neoplasms / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D063868:Patient Outcome Assessment; D010549:Personal Satisfaction; D011159:Population Surveillance; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D040921:Stress Disorders, Traumatic / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
keywords: adjustment; cancer; distress; socioeconomic status; survivor; well-being