Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: The purpose of this cross-sectional study was to investigate individual-level and couple-level predictors of depressive symptomatology in older female cancer survivors and their spouses. Older survivors and their families have been underrepresented in psychosocial research on cancer. Given the aging of the U.S. population and advances in cancer care, it has become increasingly important to understand their experiences and needs. Methods: Couples (N = 396) were drawn from two large, national surveys: the 1992 Health and Retirement Survey (HRS) and the 1993 Asset and Health Dynamics Among the Oldest-Old Survey (AHEAD). Couples were selected if the wife reported ever having been told by a doctor that she had cancer and the husband reported he had never had cancer. Depressive symptoms were assessed by an 8-item version of the Center for Epidemiological Studies—Depression Scale (scored 0-8). Individual-level predictors were respondents' age, race, and education; also number of disease conditions (other than cancer), pain, and fatigue for both survivor and spouse. Couple-level predictors were cancer type, treatment status (i.e., any cancer treatment in the past 12 months), household size, income, and length of marriage. Data from survivors and husbands were analyzed simultaneously, using multilevel, over-dispersed Poisson modeling. Results: Mean depressive symptoms were 1.3 (SD = 1.9) for survivors and 0.8 (SD = 1.3) for husbands. Mean age was 61.1 (SD = 10.6) for survivors and 64.2 (SD = 10.2) for husbands. On average, both had a high school diploma and most (92%) were white. Median household income was $36,224; average length of marriage was 33.5 years (SD = 15.3); and 32% of couples had at least one other person living with them. The most common type of cancer was breast (39%). Nearly a third of survivors (31%) reported having recent cancer treatment. On average, both survivors and husbands reported 1.1 diseases (other than cancer; SD = .98). More survivors than husbands reported pain (34% vs. 23%) and fatigue (47% vs. 35%). In multilevel analyses, no significant difference was found between couples in rate of depressive symptoms by cancer type or treatment status. Depressive symptoms were higher in couples with lower than average income, other people in the household, and more recent marriages. Survivors reported significantly higher depressive symptoms than their spouses. However, the difference between survivors and spouses was reduced in couples where the survivor was receiving treatment and where the survivor had breast cancer. Older age, presence of pain and fatigue, as well as spouses' fatigue, predicted higher depressive symptoms. Implications for social work practice: Social workers assisting female cancer survivors and their husbands need to understand potential differences in psychological distress by age, cancer type and treatment status. Symptoms such as pain and fatigue (which may or may not be related to cancer or its treatment) may exacerbate survivors' and spouses' depressive symptomatology. Couples who are older, lower income, in larger households, and with more recent marriages are those at greatest risk for psychological distress.