Originally published as JCO Early Release 10.1200/JCO.2005.01.370 on August 29 2005

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Psychiatric Disorders and Mental Health Service Use Among Caregivers of Advanced Cancer Patients

From the Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston, MA; and the Department of Psychiatry and Department of Pediatrics, Section of Pediatric Hematology-Oncology, Yale University School of Medicine, New Haven, CT

Address reprint requests to Holly G. Prigerson, PhD, Dana-Farber Cancer Institute, 44 Binney St, SW G440A, Boston, MA 02115; e-mail: holly_prigerson{at}dfci.harvard.edu

PURPOSE: Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers.

METHODS: Two hundred informal caregivers of advanced cancer patients were interviewed and administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and an assessment of mental health service use.

RESULTS: Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patient's cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%), and generalized anxiety disorder, 3.5% (95% CI, 1.4% to 7.1%). Among caregivers with a current psychiatric disorder, 81% discussed mental health concerns with a health professional before the patient's cancer diagnosis compared with 46% after the diagnosis (McNemar test = 5.40; P = .02). Only 46% of caregivers with a current psychiatric disorder accessed mental health services. Caregivers who discussed mental health concerns with a clinician before the patient's cancer diagnosis (odds ratio [OR] = 3.51; 95% CI, 1.42 to 8.71) and after the diagnosis (OR = 21.23; 95% CI, 9.02 to 49.94) were more likely than caregivers not having these discussions to receive mental health services.

CONCLUSION: Many caregivers of advanced cancer patients either meet criteria or are being treated for psychiatric problems. Discussing mental health issues positively influences the receipt of mental health services and should be actively pursued in this vulnerable population.

Supported in part by the following grants: Grants No. MH56529 (H.G.P.) and MH63892 (HGP) from the National Institute of Mental Health and Grants No. CA106370 (H.G.P.) from the National Cancer Institute; a Soros Open Society Institute Project on Death in America Faculty Scholarship (H.G.P.); a RAND/Hartford Interdisciplinary Geriatric Health Research Center Grant (H.G.P.); a Fetzer Religion at the End-of-Life Grant (H.G.P.); the Claude D. Pepper Older Americans Independence Center Grant No. P30AG21342 from the National Institute on Aging (H.G.P.); the Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute (H.G.P., L.C.V.); Grant No. K12RR17594 (N.S.K.-L.) from the National Center for Research Resources; and a grant for a summer clinical research fellowship sponsored by Yale University School of Medicine (R.E.L.).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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