Association between prostate cancer and mental health: A comparison across cancer types using the Medical Expenditure Panel Survey, 2017–2022.

Abstract

132 Background: Mental health is a critical yet often underrecognized dimension of cancer survivorship, influencing quality of life, treatment adherence, and long-term outcomes. This study evaluated whether men with prostate cancer (PCa) experience better mental health outcomes than those with other major cancers or no cancer, using nationally representative data. Methods: We conducted a repeated cross-sectional study using Medical Expenditure Panel Survey Household Component data (2017–2022). Respondents were categorized into three groups: PCa, other malignancies, and no history of cancer. The primary outcome was fair/poor self-rated mental health. Secondary outcomes included major depressive symptoms (PHQ-2 ≥ 3) and serious psychological distress (K6 ≥ 13). Multivariable logistic regression was employed to estimate adjusted odds ratios (aORs) with 95% confidence intervals, controlling for sociodemographic and health-related covariates. Results: Among 31,706 respondents (mean age 62.2 ± 10.9 years), most were non-Hispanic White (60.5%). Overall, 5.3% had PCa, 5.1% other cancers, and 89.6% no cancer (Table 1). In the primary analysis, 41.0% reported less-than-good self-rated mental health: 42.1% among PCa survivors, 40.4% among those without cancer, and 47.2% among individuals with other malignancies (p < 0.001). Compared with PCa, men without cancer had similar odds (aOR 0.96, 95% CI 0.85–1.09), while those with other cancers had higher odds (aOR 1.24, 95% CI 1.05–1.46), driven mainly by colorectal cancer (aOR 1.37, 95% CI 1.03–1.81). In secondary analyses, depressive symptoms (PHQ-2 ≥ 3) were reported by 7.3% of PCa survivors, 7.4% without cancer (aOR 0.98, 95% CI 0.76–1.27), and 8.6% with other cancers (aOR 1.21, 95% CI 0.87–1.68; p = 0.31). On the K6 scale, serious psychological distress was observed in 3.0% of PCa survivors and 3.7% of other groups (p = 0.47); colorectal cancer showed lower odds (aOR 0.12, 95% CI 0.02–0.86) and lymphoma higher (aOR 2.34, 95% CI 0.98–5.59). Conclusions: Mental health outcomes among PCa survivors were comparable to men without cancer and more favorable than in other malignancies. Nonetheless, over 40% reported suboptimal well-being, underscoring the need for integrated mental health screening and support across cancer populations. Mental health measures by cancer history. No history of cancer Prostate Non-prostate cancer Total Test N 28,405 (90.7) 1,690 (5.4) 1,611(5.1) 31,706(100.0) Overall Mental Health Status Below 'Good', n (%)  No 16,931(59.6) 978 (57.9) 850(52.8) 18,759(59.2) <0.001  Yes 11,474(40.4) 712 (42.1) 761(47.2) 12,947(40.8) K6 Score 13 or higher, n (%)  No 20,564(96.3) 1,255 (97.0) 1,192(96.3) 23,011(96.4) 0.473  Yes 782(3.7) 39 (3.0) 46(3.7) 867(3.6) Having Depression Symptom, n (%)  No 20,004(92.6) 1,218 (92.7) 1,154(91.4) 22,376 (92.5) 0.308  Yes 1,599(7.4) 96 (7.3) 108(8.6) 1,803 (7.5)