Depression among cancer survivors: Impact of spousal depression, distress, and quality of life

Background: Family caregivers, including spouses, play an essential role in caring for cancer survivors. This study aimed to determine the impact of spousal psychosocial factors on survivor depression.

Methods: We examined data on cancer survivors and their spouses (n=757 dyads) from seven panels from the 2004-2011 Medical Expenditures Panel Survey.  Psychosocial factors (depressive symptoms [Patient Health Questionnaire; cutpoint=3]; psychological distress [Kessler-6]; and health-related quality of life [HRQoL; Short-Form 12], per standard deviation) were reported 6-12 months apart (T1 and T2). Dyadic multilevel models evaluated the cross-lagged impact of psychosocial factors at T1 on depression at T2, controlling for age, sex, survivor treatment status, and depression at T1.

Results: Survivors with depression, more distress, or worse mental or physical HRQoL at T1 were more likely to report being depressed at T2 (p<0.001). Spousal factors were also associated with survivor depression: survivors whose spouses were depressed at T1 were 4.7 times more likely to be depressed at T2 (p<0.001). Similarly, better spousal mental and physical HRQoL at T1 were associated with a 30-40% decrease in survivor depression risk at T2 (OR=0.71 and 0.62, respectively; p<0.001).There was less evidence for the converse effects: while survivor depression at T1 was weakly associated with spousal depression at T2 (OR=2.12, p=0.07), survivor distress and HRQoL were not associated with spouses’ depression risk.

Conclusion: Improving spousal well-being may reduce depression risk in cancer survivors and positively influence survivor health outcomes. Future research should examine whether better incorporating spousal care into psycho-oncology and survivorship programs improves survivor outcomes.