International journal of epidemiology · 2026
Health behavior buffering the spillover effect of cancer on spousal depressive symptoms: causal evidence from a multicountry analysis.
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Wang Yanshang, Xia Yiqi, Cai Chang, Shi Zhenyu, He Ping
Аннотация
BACKGROUND: Cancer, often described as a "family disease," can negatively affect the mental health of spouses or partners through negative spillover effects. However, there is a lack of rigorous causal evidence regarding the spillover effects of cancer onset, and the dynamic pattern remains unclear. This study aims to assess the spillover effects of cancer onset on spousal depressive symptoms using a multicohort approach and examine the moderating role of a healthy lifestyle.
METHODS: We conducted a pooled multicountry analysis utilizing 21 countries datasets. We employed a causal inference research design, combining matching with difference-in-differences (DID) as the primary identification strategy to analyze the causal effect and its heterogeneity. Moreover, we conducted the interaction term analysis to explore the role of health lifestyles. Using an event study methodology, we examined the dynamic pattern and validated the parallel trends assumption.
RESULTS: Our findings reveal a robust causal link between cancer onset and spousal depressive symptoms. Further analysis indicates that healthy lifestyles serve as a buffer against this adverse spillover effect, particularly reflected in moderate alcohol use (β = -0.052, 95% confidence interval [CI] [-0.099, -0.005]), physical exercise (β = -0.116, 95% CI [-0.183, -0.049]), social activities (β = -0.126, 95% CI [-0.181, -0.071]), and tobacco use (β = 0.100, 95% CI [0.029-0.171]). Additionally, the spillover effect exhibits a "bimodal" pattern, manifesting primarily in the short term (within 2 years) and later stages (4-5 years) of cancer.
CONCLUSION: This study reveals a dynamic negative impact of cancer on spousal mental health, closely related to the cancer trajectory and spousal behaviors. It underscores the imperative for establishing a family-based integrated care model for cancer. Future research should explore the underlying mechanisms of these spillover effects as well as develop care models to conduct prospective impact assessments.
METHODS: We conducted a pooled multicountry analysis utilizing 21 countries datasets. We employed a causal inference research design, combining matching with difference-in-differences (DID) as the primary identification strategy to analyze the causal effect and its heterogeneity. Moreover, we conducted the interaction term analysis to explore the role of health lifestyles. Using an event study methodology, we examined the dynamic pattern and validated the parallel trends assumption.
RESULTS: Our findings reveal a robust causal link between cancer onset and spousal depressive symptoms. Further analysis indicates that healthy lifestyles serve as a buffer against this adverse spillover effect, particularly reflected in moderate alcohol use (β = -0.052, 95% confidence interval [CI] [-0.099, -0.005]), physical exercise (β = -0.116, 95% CI [-0.183, -0.049]), social activities (β = -0.126, 95% CI [-0.181, -0.071]), and tobacco use (β = 0.100, 95% CI [0.029-0.171]). Additionally, the spillover effect exhibits a "bimodal" pattern, manifesting primarily in the short term (within 2 years) and later stages (4-5 years) of cancer.
CONCLUSION: This study reveals a dynamic negative impact of cancer on spousal mental health, closely related to the cancer trajectory and spousal behaviors. It underscores the imperative for establishing a family-based integrated care model for cancer. Future research should explore the underlying mechanisms of these spillover effects as well as develop care models to conduct prospective impact assessments.