Factors associated with serious psychological distress among US adult cancer survivors: a cross-sectional observational analysis of the 2024 National Health Interview Survey.

PURPOSE: Our study identifies sociodemographic, clinical, and behavioral factors associated with serious psychological distress (SPD) among US adult cancer survivors, highlighting actionable targets for mental health interventions in survivorship care.

METHODS

We analyzed 2024 National Health Interview Survey data from adults aged ≥ 18 years with a self-reported history of cancer and complete Kessler-6 and covariate data (unweighted n = 3,680; weighted ~ 22.2 million). SPD was defined as a Kessler-6 score ≥ 13. Weighted prevalence and multivariable logistic regression identified independent correlates.

RESULTS

The weighted prevalence of SPD was 3.7% (95% CI, 3.0%-4.5%). SPD was higher among adults aged 18-44 years (10.2% [5.5%-14.9%]) versus ≥ 65 years (2.4% [1.7%-3.1%]), women (4.8% [3.5%-6.0%]) versus men (2.6% [1.7%-3.6%]), and those with Medicaid (14.4% [7.5%-21.2%]) or no insurance (14.1% [3.6%-24.5%]). SPD was also elevated among survivors with frequent loneliness (11.7% [8.9%-14.4%]), low social support (10.7% [7.8%-13.7%]), life dissatisfaction (24.0% [16.5%-31.5%]), and functional limitations (5.5% [4.3%-6.7%]). In multivariable analyses, frequent loneliness (aOR 5.46 [2.39-12.47]), low social support (2.92 [1.40-6.08]), and life dissatisfaction (3.92 [1.64-9.46]) were independently associated with SPD; odds were lower among non-Hispanic Black adults (0.28 [0.08-1.00]). Sensitivity analyses excluding psychosocial variables strengthened associations for younger age and Non-Hispanic Black race/ethnicity.

CONCLUSIONS

Serious psychological distress affected a clinically important minority of US cancer survivors and was strongly associated with psychosocial factors, including loneliness, social support, and life satisfaction.

IMPLICATIONS FOR CANCER SURVIVORS: Integrating psychosocial assessment and targeted support into survivorship care may reduce distress and improve overall well-being.