Depression Among Breast, Prostate, and Colorectal Cancer Survivors and Their Partners

The long-term cancer survival rate has been markedly improved and this has resulted in an increasing number of cancer survivors. Given that cancer is considered a chronic illness, cancer survivors and their families continue to experience multiple stresses and demands that can accompany psychological distress (depression). Although a significant amount of research has studied depression after cancer diagnosis, most of the prior work has focused on the treatment or shorter survival periods. Risk factors for depression among cancer survivors and their partners are relatively unexplored.

The primary aims were (1) to compare stresses and family attributes/resources (e.g., family resilience, family communication, and coping) between depressed and non-depressed survivors and between depressed and non-depressed partners, and (2) to identify predictors of depression among cancer survivors and their partners.

A convenience sample of breast, prostate, and colorectal cancer survivors who had been diagnosed 1-5 years prior to the study (N=91) and their partners (N=91) was recruited from a hospital-based cancer registry in Cleveland, OH. Survivors and partners completed a self-administered questionnaire, assessing stress, family resilience, family communication, coping, and psychological distress. Cancer characteristics for the patients, including cancer stage and time since diagnosis, were obtained from the cancer registry. We divided the survivor and caregiver sample into two groups separately (depressed vs. non-depressed survivors; depressed vs. non-depressed partners), based on cut-off scores of 7 for men and 9 for women on the BSI-18 depression subscale score. Family resilience, family communication, and coping were measured using standardized instruments. Chi-square and t-tests were used to test differences in outcomes between depressed and non-depressed groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for depression in separate patient and partner groups.

In this sample, 32 survivors and 32 partners screened positive for depression. Results showed that survivors with depression were more likely that those without depression to be older and male, have a greater marital stress, have poor communication with family, have less family resilience and were less likely to use reframing and seeking social support coping strategies. Partners who had higher financial and marital stress, who had poorer family communication, and who had less family resilience were more likely than their counterparts to screen positive for depression. In univariate logistic regression analyses, risk factors for survivors’ depression included male sex, greater marital stress, less use of seeking social support and reframing coping strategies, and poorer family communication and resilience. Multivariate logistic regression analyses showed that family resilience was associated with depression survivors (OR=.15, 95% CI=.05-.47, p=.001). In both univariate and multivariate logistic regression, the only significant risk factor contributing partners’ depression was marital stress (OR=3.50, 95% CI=1.72-7.14, p=.001).

Depression is prevalent among cancer survivors and their partners during the survivorship period. Study findings suggest that family resilience is a contributing factor for depression in cancer survivors, whereas marital stress is a significant risk factor in partners. Better understanding of risk factors of depression can help tailor interventions to the needs of individuals with cancer and their partners.