Depression and Family Interaction Among Low-Income, Predominantly Hispanic Cancer Patients: A Longitudinal Analysis

Purpose: Among cancer patients, family interaction has been associated with depression. According to the stress generation theory, depression among cancer patients triggers stressful interpersonal events contributing to poor family interactions and prolonged depressive symptoms. This conflict may occur with a spouse/partner or other family member, including extended family. Because family conflict in a relationship with the spouse/partner and with other family members may be different, this study evaluated the longitudinal association between depression and marital and family conflict among low-income, predominantly Hispanic cancer patients during two years after the depression diagnosis.

Methods: Data were collected during a randomized controlled clinical trial of depression treatment among 472 low-income cancer patients with baseline depression scores of 10 or more on the Patient Health Questionnaire-9 and whose depression symptoms and negative family interactions were assessed at baseline and at 6, 12, 18, and 24 months. Because not every participant was in an intimate relationship, only 237 participants were included in the analysis of marital conflict. The total sample (n=472) was used in the analysis of conflict involving any family members. Fixed effect analysis was conducted to investigate whether having any marital or family conflict during two years is associated with change over time of depression. In addition, mixed linear modeling with and without decomposition of between- and within-person variability, usually used to analyze data collected with ecological momentary assessment, was conducted to examine the longitudinal association between instant change of family interaction and depression.  

Results: In findings from fixed effect modeling, the group with any family conflict during two years showed significantly blunt declining depression on average compared to the group without any report of family conflict.  However, this longitudinal association was not found in the analysis of marital conflict. In addition, within-subject change in both marital and family conflict was significantly associated with within-patient deviation from average depression levels as well as between-patient deviation.

Conclusion: Findings provide evidence of an association between depression and negative family interaction among depressed cancer patients. First of all, cancer patient’s depressive symptom is associated with immediate change of negative interactions with a spouse/partner and other family members. However, this finding does not assume the temporal order as posited in the stress generation theory. In addition, family conflict may be more influential to depression than that of marital conflict. However, this finding does not exclude the possible cultural impacts often observed among recently immigrated Latino couples. As a clinical implication, Cancer patients with clinically significant depressive symptoms may benefit from clinical assessment and psychotherapy relevant to family interaction.