Depression symptom severity and mental health utilization following breast cancer diagnosis.

Abstract

142 Background: Depression is prevalent among patients with breast cancer, but engagement with mental health (MH) services might vary across demographic and clinical groups. This study explores depression symptom severity and MH related utilization in patients with breast cancer. Methods: This retrospective study evaluated adults with breast cancer (1/1/2018 – 12/31/2022) in Kaiser Permanente Northern California. Descriptive statistics were used to report maximum incident PHQ-9 scores 1 year after breast cancer diagnosis, stratified by cancer stage and clinical severity. Poisson regressions were used to examine the associations between demographic and clinical characteristics and rates of utilization of MH services including behavioral health and psychiatry department visits, and related emergency department (ED) / hospitalizations. IRR and 95% confidence intervals (CI) were calculated. Results: The study cohort included 12,060 patients with breast cancer including DCIS (median age 61, 99.3% female, 57% white). Depression was prevalent in 6.1% of the population with 12.5% having a PHQ-9 score recorded within 1 year of breast cancer diagnosis. Patients with advanced disease had higher PHQ-9 scores than earlier stages, with 49% of stage IV with PHQ-9 score >=15. Adjusting for demographic and clinical factors, PHQ-9 screening was associated with MH services (IRR 24.30, CI 22.80, 26.00) and ED / hospitalization (IRR 9.22, CI 5.92, 14.40). Utilization of MH services was lower in older (age 81+; 0.22, CI 0.18, 0.27), Asian and Hispanic compared to White (Asian; 0.73, CI 0.68, 0.79; Hispanic; 0.82, CI 0.74, 0.91), obese compared to normal weight (BMI 40 or higher; 0.70, CI 0.61, 0.79), DCIS compared to Stage 1 (0.68, CI 0.62, 0.74), and excess alcohol consumption compared to abstinence (0.78, CI 0.70, 0.87). Utilization of MH services were higher in underweight compared to normal weight (BMI < 18.5; 1.89, CI 1.46, 2.41), non-smokers compared to smokers (1.96, CI 1.70, 2.29), and single compared to married (1.32, CI 1.26, 1.40). MH related ED / hospitalization rates were lower in older (age 81+; 0.19, CI 0.04, 0.79) and non-smokers compared to smokers (0.42, CI 0.20, 0.89). Conclusions: High depression screening scores are seen in higher stage patients with breast cancer. However, there is limited MH screening in all patients after diagnosis, with differences in screening and utilization based on multiple demographic and clinical characteristics. This study informs health systems seeking to increase MH screening and services to address the high rate of depression post diagnosis. Incident max PHQ score 1 year after breast cancer diagnosis (N=1487). Cancer Stage 0-4 5-9 10-14 15-27 N(%) N(%) N(%) N(%) 0 90 (40.2%) 52 (23.2%) 17 (7.6%) 65 (29.0%) 1 238 (27.0%) 199 (22.6%) 131 (14.9%) 313 (35.5%) 2 59 (25.1%) 59 (25.1%) 43 (18.3%) 74 (31.5%) 3 25 (26.0%) 21 (21.9%) 8 (8.3%) 42 (43.8%) 4 7 (13.7%) 15 (29.4%) 4 (7.8%) 25 (49.0%)