Assessment of Current Mental Health Status in a Population-Based Sample of Canadian Men With and Without a History of Prostate Cancer Diagnosis: An Analysis of the Canadian Longitudinal Study on Aging (CLSA)

Abstract

Background: Small-scale studies indicate an increase in mental health disorders among prostate cancer survivors compared to the general population, but large population-based data assessing this relationship are scarce. The present study examined the prevalence of lifetime history of prostate cancer in a cross-sectional sample of Canadian men and assessed the contribution of lifetime history of a prostate cancer diagnosis, multimorbidity, and current alcohol and smoking status to the association with current mental health outcomes in this population.Methods: The analytical sample included 25,183 men (aged 45 to 85 years old), who completed a survey as part of the Canadian Longitudinal Study on Aging (CLSA). The Center for Epidemiological Studies Depression Scale (CES-D10), Kessler's Psychological Distress Scale (K10), and self-reported mental health were mental health outcomes. Multiple logistic regression analyses, and controlling for the complexity of the design and covariates, evaluated the association between prostate cancer survivorship, multimorbidity, alcohol and smoking status, and current mental health outcomes.Results: The prevalence of lifetime history of prostate cancer diagnosis in this population-based sample of men was 4% (95% CI: 3.7, 4.4). Our results indicate statistically significantly higher odds of current psychological distress (aOR = 1.52, 95% CI: 1.09, 2.11) and screening positive for depression (aOR = 1.24; 95% CI: 1.02, 1.51) among survivors of prostate cancer, compared to men without a history of prostate cancer diagnosis in demographics controlled analyses. After addition of multimorbidity and substance use, the odds of screening positive for depression among survivors of prostate cancer are 1.32 (95% CI: 1.06, 1.64) higher compared to men who never had a history of prostate cancer diagnosis.Interpretation: Patient education and empowerment programs aimed at addressing concerns during the diagnosis and treatment and enhancing survivorship care plans by adding routine screening for mental distress to help survivors overcome poor mental health during the cancer survivorship journey, are warranted.

Post-Treatment Adverse Health Correlates among Prostate Cancer Survivors in a Sample of Men Residing in Atlantic Canada

“…Furthermore, recent evidence from large population-based studies demonstrated that men diagnosed with prostate cancer have more than double the odds of mental health issues compared with men with no history of cancer and men with any other type of cancer except prostate [9,12,17]. Few studies, however, have been conducted examining the relationship between treatment modality among males with a history of cancer, cancer type, and the potential association with mental health illness in this population [11].…”

“…With over 1.1 million men diagnosed annually, there is an ever growing population of patients living with a prostate cancer diagnosis [3][4][5][6]. As such, it is becoming increasingly important to understand what unmet survivorship needs may lead to poor quality of life and short-and long-term mental health issues in this population [7][8][9][10][11][12]. Prostate cancer treatments including surgery, radiation, hormone therapy, chemotherapy, or a combination are highly effective, but are also plagued by a host of life-altering side effects.…”

“…Physical side effects may include urinary, bowel and sexual dysfunction [13][14][15]. In recent years, mental health issues emerging from unmet survivorship needs among prostate cancer survivors revealed a silent epidemic of loneliness and disconnect [7,9,12]. A recent report presents evidence of an association between poor mental health and psychological morbidity and biopsychosocial variables, including poor oncological outcomes, particularly but not limited to advanced forms of the disease [8].…”

“…A recent report presents evidence of an association between poor mental health and psychological morbidity and biopsychosocial variables, including poor oncological outcomes, particularly but not limited to advanced forms of the disease [8]. More than one in two men diagnosed with prostate cancer experience mental health distress [16], with 10-40% scoring positive for clinically significant depression at various points during their survivorship journey [9,12,17,18]. Younger age, Caucasian ethnicity, urinary problems and erectile dysfunction, dissatisfaction in relationships with current partner, substance abuse, and multimorbidity have been identified as factors predicting depression and/or anxiety in prostate cancer survivors [9][10][11][12].…”

“…More than one in two men diagnosed with prostate cancer experience mental health distress [16], with 10-40% scoring positive for clinically significant depression at various points during their survivorship journey [9,12,17,18]. Younger age, Caucasian ethnicity, urinary problems and erectile dysfunction, dissatisfaction in relationships with current partner, substance abuse, and multimorbidity have been identified as factors predicting depression and/or anxiety in prostate cancer survivors [9][10][11][12]. When compared to the general population, cancer patients are disproportionately affected by suicidality (31.4 suicides per 100,000), with prostate cancer patients among the most at-risk for death by suicide (48.3 suicides per 100,000) [4,19,20].…”