Use and expenditure of mental health service and psychotropic medication by race and ethnicity among cancer survivors with serious psychological distress.

Abstract

Access to mental health care is critical to improving cancer survivors' quality of life; however, evidence on mental health care use among cancer survivors is limited, particularly by race and ethnicity. By using 2012-2021 Medical Expenditure Panel Survey data, this study examined racial and ethnic disparities in mental health care visits, expenditures, prescription pattern, and medication use, adjusted for multiple individual socioeconomic factors and health status among cancer survivors with serious psychological distress (SPD; Kessler Psychological Distress Scale score, ≥13). Of cancer survivors with SPD (N = 1132), only 28% had mental health care visits. The number of counseling visits in non-Hispanic Black (NHB) survivors (-1.74 visits; 95% CI, -2.70 to -0.79 visits) and psychiatrist visits in non-Hispanic other (NHO) survivors (-1.21 visits; 95% CI, -1.91 to -0.52 visits) was lower compared with non-Hispanic White (NHW) survivors. NHB survivors spent less on mental health visits than NHW survivors (total annual expenditure: -$226; 95% CI, -$384 to -$68; out-of-pocket expenditure: -$75; 95% CI, -$110 to -$40). Although psychotropic medications were more likely to be prescribed to NHB than NHW survivors by 22.2 percentage points (95% CI, 9.2 to 35.2 percentage points), NHB survivors were less likely to use antidepressants (-15.1 percentage points; 95% CI, -24.9 to -5.4 percentage points) and anxiolytics (-12.7 percentage points; 95% CI, -20.0 to -5.4 percentage points). Psychotropic medication prescription was similar between NHW and other racial and ethnic groups but Hispanic survivors were less likely to use antidepressants (-9.6 percentage points; 95% CI, -18.7 to -0.5 percentage points) and NHO survivors were less likely to use anxiolytics (-15.0 percentage points; 95% CI, -24.8 to -5.3 percentage points). Racial and ethnic differences were found in office-based mental health care professional visits, related expenditures, and prescription medication use among cancer survivors with SPD, which calls for equitable interventions in mental health care.