Geographical Distance Predicts Psychiatric Treatment Retention for Hispanic WomenWith Comorbid Major Depression and Breast Cancer

Abstract Purpose Depression is among the most common comorbid psychiatric disorders for patients with breast cancer. Depression can decrease patient quality of life and adversely affect cancer treatment if untreated. We sought to identify treatment barriers to women with breast cancer treated with psychotherapy for depression. Findings may help policy makers and researchers determine funding and design of future studies involving this population, especially in communities with high rates of health disparities. Methods We used data from a randomized trial for women with breast cancer and current DSM-IV non-psychotic unipolar major depressive disorder (MDD). Patients were randomly assigned to 12 weeks of one of three psychotherapies and attrition was assessed by whether subjects completed 12 weekly treatment sessions. Descriptive analyses and logistic regression were used to identify treatment barriers. R shiny was used to determine the residence of study participants. Results Of 134 randomized patients, 84 (62.7%) were Hispanic. Fifty-nine (44%) either did not start or dropped out of treatment, 49 (83.1%) of them Hispanic. Being a Hispanic woman, less educated, and living geographically distant significantly predicted attrition. Single Hispanic mothers had significantly higher attrition risk than married and/or childless women. Conclusion Identifying barriers to treatment is important to improve treatment adherence for women with concurrent diagnoses of breast cancer and MDD, especially for traditionally underserved minorities. Additional support, such as affordable tele-medicine, multi-language assistance, financial aid for transportation and child-care, and allocating more funds to assist some identified barriers should be considered to improve treatment adherence and outcomes.