Exploring associations between psychiatric disorder, psychological distress and healthcare utilization in cancer patients

Abstract

Objective

The mental burden of cancer might elicit additional healthcare utilization. However, it is unclear how psychiatric disorder and psychological distress relate to healthcare utilization. Therefore, this study explores associations between psychiatric disorder, psychological distress and healthcare utilization. It was hypothesized that presence of psychiatric disorder and psychological distress were associated with increased healthcare utilization and costs.

Methods

The current study consisted of secondary analyses of baseline data of a larger randomized controlled trial. 245 mixed-cancer patients with at least mild symptoms of psychological distress (Hospital Anxiety and Depression Scale (HADS-T) ≥11) were mainly recruited via online media, participating centres and patient associations. Patients were assessed with SCID-I for depressive, anxiety and/or adjustment disorder. Psychological distress was measured by the HADS. Retrospective self-reported healthcare utilization in the past three months was collected. Associations between predictors and healthcare utilization in terms of incidence rate ratios and costs per category (mental, primary, somatic, complementary) were assessed by negative binomial, logistic and gamma regression.

Results

89 (36.3%) patients suffered from psychiatric disorder, which was associated with mental healthcare utilization (IRR=1.63) and costs (OR=3.11). We observed a non-significant trend of somatic healthcare utilization in patients with psychiatric disorder. Psychological distress was associated with mental healthcare utilization (IRR=1.09) and costs (OR=1.09). Psychological distress was also associated with complementary healthcare utilization (IRR=1.03).

Conclusion

Psychiatric disorder and psychological distress were associated with mental healthcare use and costs. Psychological distress was associated with complementary healthcare use. Adequate assessment and referral to mental healthcare might prevent unnecessary healthcare utilization.

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