Differential Use of Depression and Anxiety Medications in Adults With a History of Cancer

Importance Depression and anxiety disproportionately impact cancer survivors. Sociodemographic factors frequently impact access to cancer care; however, it is unclear if these factors are associated with access to pharmacological care for mental and behavioral health conditions. Objective To evaluate antidepressant and anxiolytic use among cancer survivors compared with the general US population and identify associations between sociodemographic factors and medication use. Design, Setting, and Participants For this cross-sectional study, data from 2016 to 2018 from the National Health Interview Survey were analyzed in January 2024. The nationally representative, population-based sample consisted of respondents to the National Health Interview Survey aged 18 to 85 years without a history of cancer residing in the US. Main outcomes and measures Eligible respondents completed the Adult Functioning and Disability supplements and had nonmissing outcomes. Self-reported antidepressant and anxiolytic use were the main outcomes, estimated through multivariable logistic regression analyses, adjusting for sociodemographic factors. Results Among 53 117 respondents, 48 026 individuals (21 592 aged 40-64 years [41.8%]; 24 589 female [51.2%]; 8260 Hispanic [17.2%], 5859 non-Hispanic Black [12.2%], and 29 584 non-Hispanic White [61.6%]) reported no history of cancer and 5091 individuals (1624 aged 40-64 years [37.7%]; 2927 female [57.5%]; 321 Hispanic [6.3%], 361 non-Hispanic Black [7.1%], and 4159 non-Hispanic White [81.7%]) reported a history of cancer. After adjustment for sociodemographic variables, cancer survivors were more likely to report taking antidepressants (adjusted odds ratio [aOR], 1.32; 95% CI, 1.18-1.49) and anxiolytics (aOR, 1.38; 95% CI, 1.23-1.54) compared with the general population. Among cancer survivors, non-Hispanic Black individuals had lower odds of taking antidepressants (aOR, 0.60; 95% CI, 0.39-0.91) and anxiolytics (aOR, 0.63; 95% CI, 0.42-0.94) compared with non-Hispanic White individuals. Cancer survivors on Medicare (aOR, 2.20; 95% CI, 1.39-3.50) or Medicaid (aOR, 1.83; 95% CI, 1.18-2.84) were more likely to take anxiolytics compared with privately insured individuals. Cancer type was also associated with medication use; respondents with a history of brain cancer were more likely to take antidepressants (aOR, 5.59; 95% CI, 1.79-17.46), and those with a history of pancreatic cancer were more likely to take antidepressants (aOR, 5.30; 95% CI, 1.64-17.18) and anxiolytics (aOR, 6.74; 95% CI, 2.11-21.55) compared with those with a history of breast cancer. Conclusions and Relevance In this study, cancer survivors were significantly more likely to take medications for depression and anxiety compared with noncancer survivors, underscoring the importance of mental health in cancer. However, our findings suggested disparities associated with this, with non-Hispanic Black patients exhibiting decreased use.