Disparities in mental health outcomes among lung cancer survivors associated with ruralness of residence.
OBJECTIVE
Healthy People 2020 identifies elimination of health disparities as a key aim. Rural residence is associated with disparities in cancer screening, physical morbidity, and survival. The present study aimed to identify potential disparities in mental health (MH) outcomes (e.g., anxiety and depression symptoms, distress) in lung cancer (LC) survivors associated with ruralness of residence.


METHODS
Lung cancer survivors (LC group; n = 193; mean age = 63.1 years; mean time since diagnosis = 15.6 months) were recruited from the population-based SEER Kentucky Cancer Registry. LC survivors completed a telephone interview and questionnaire assessing MH outcomes. U.S. Department of Agriculture Rural-Urban Continuum Codes were used to identify Rural (n = 117) and Urban (n = 76) LC survivors. A healthy comparison (HC) group was recruited (n = 152) and completed a questionnaire assessing MH outcomes.


RESULTS
Across six MH indices, Rural LC survivors reported poorer MH relative to Urban LC survivors with a mean effect size (ES) of 0.43 SD in unadjusted analyses and 0.29 SD in analyses adjusted for education and physical comorbidity. Comparison of the LC and HC groups revealed significant Ruralness × Group interactions for five of six MH indices. The Rural LC group reported poorer MH than the Rural HC group with a mean ES of 0.51 SD. The MH of Urban LC and HC groups did not differ (mean ES = 0.00 SD).


CONCLUSIONS
Rural residence is a risk factor for poorer MH outcomes for LC survivors. The MH of Rural LC survivors may be more negatively impacted by cancer diagnosis and treatment than the MH of Urban LC survivors.
Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA.
Michael A
MA
Andrykowski
Rachel F
RF
Steffens
Heather M
HM
Bush
Thomas C
TC
Tucker
D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*
cancer; disparities; distress; mental health; oncology; rural; survivorship