Serious Psychological Distress and Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors: NHIS 2024

Serious Psychological Distress and Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors: NHIS 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Serious Psychological Distress and Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors: NHIS 2024 Olinto Linares-Perdomo, Damon Klebe, Bismarck C Odei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8665280/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Importance Serious psychological distress (SPD) and unmet mental health care need are commonly used to characterize mental health burden among cancer survivors, yet they are often treated as interchangeable indicators. Whether these constructs identify the same at-risk survivors in the contemporary, post-pandemic context remains unclear. Objective To examine the prevalence, overlap, and distinct correlates of SPD and unmet mental health care need among U.S. adult cancer survivors using nationally representative data. Design, Setting, and Participants This cross-sectional study used data from the 2024 National Health Interview Survey (NHIS), a nationally representative survey of the U.S. civilian, noninstitutionalized population. The analytic sample included 3,680 adults with a history of cancer. Survey-weighted analyses accounted for NHIS sampling weights, stratification, and clustering. Exposures Sociodemographic characteristics, healthcare access factors (including insurance status, transportation barriers, and telehealth use), and psychosocial measures (loneliness, perceived social support, and life satisfaction). Main Outcomes and Measures Clinically significant psychological distress, defined as a Kessler-6 score ≥ 13, and unmet mental health care need, defined as self-reported inability to obtain needed mental health counseling or treatment in the past 12 months. Survey-weighted logistic regression models were used to estimate unadjusted and mutually adjusted associations. Results SPD and unmet mental health care need demonstrated partial overlap but identified distinct subgroups of cancer survivors. In mutually adjusted models, psychosocial vulnerability showed the strongest and most consistent associations with SPD, particularly frequent loneliness (adjusted odds ratio [aOR], 5.34; 95% CI, 2.47–11.57), low social support (aOR, 2.78; 95% CI, 1.36–5.69), and dissatisfaction with life (aOR, 3.60; 95% CI, 1.51–8.57). In contrast, unmet mental health care need followed a different pattern, with higher odds associated with younger age, female sex, psychosocial vulnerability, and indicators of healthcare access and structural barriers, including insurance status and transportation barriers. Telehealth use was associated with both outcomes, likely reflecting underlying care-seeking behavior or need rather than a causal relationship. Conclusions and Relevance Among U.S. adult cancer survivors, SPD and unmet mental health care need represent overlapping but non-equivalent dimensions of mental health burden. Psychosocial vulnerability was most strongly associated with distress, whereas unmet need more closely reflected access-related barriers to care. These findings underscore the importance of survivorship approaches that integrate psychosocial screening with strategies to reduce structural barriers to mental health services in the post-pandemic healthcare landscape. Figures Figure 1 Figure 2 Figure 3 Introduction Cancer survivorship is increasingly recognized as a period of sustained psychosocial vulnerability, shaped by the long-term physical, emotional, and social consequences of cancer and its treatment. Survivors may experience persistent psychological symptoms, disruptions in social roles, financial strain, and challenges navigating healthcare systems, all of which can affect quality of life and engagement with care. As a result, identifying survivors at risk for poor mental health outcomes remains a central priority in psycho-oncology and survivorship research.¹–³ Serious psychological distress (SPD) is commonly used to characterize clinically meaningful mental health burden in population-based survivorship studies. Measured using validated screening instruments such as the Kessler-6 scale, SPD captures severe, nonspecific psychological symptoms associated with impaired functioning, increased healthcare utilization, and adverse health outcomes.⁴–⁶ However, distress represents only one dimension of survivorship mental health. Many survivors experience difficulties accessing mental health services despite perceiving a need for care, a phenomenon reflected by unmet mental health care need. Unlike distress, unmet need incorporates structural, financial, and logistical barriers to care and may arise even in the absence of severe symptomatology.⁷–⁹ Despite their conceptual differences, SPD and unmet mental health care need are often treated as interchangeable indicators of mental health burden in cancer survivorship research and surveillance. This practice implicitly assumes that survivors with significant distress are the same individuals who experience unmet need for care, and that identifying one outcome adequately captures the other. However, emerging evidence suggests that psychological symptom burden and barriers to care may operate through partially independent pathways, influenced by distinct combinations of psychosocial vulnerability, healthcare access, and structural constraints.¹⁰–¹² The contemporary survivorship landscape further complicates this distinction. The COVID-19 pandemic accelerated changes in healthcare delivery, including rapid expansion of telehealth, shifts in insurance coverage and utilization, and worsening shortages in the mental health workforce. These changes may differentially affect psychological symptoms and access to services, potentially decoupling distress from care receipt. In this context, indicators such as telehealth use may reflect underlying care-seeking behavior or heightened need rather than causal effects on mental health outcomes. Understanding how psychosocial vulnerability and access-related factors relate to distress and unmet need in the post-pandemic era is therefore critical for interpreting current survivorship data and informing intervention strategies.¹³–¹⁵ Evaluating SPD and unmet mental health care need concurrently offers an opportunity to clarify their overlap and divergence and to better characterize mental health burden among cancer survivors. Survivors who experience both severe distress and unmet need may represent a particularly vulnerable subgroup requiring targeted intervention, while those who experience only one of these outcomes may benefit from different clinical or system-level responses. Distinguishing these patterns has direct implications for survivorship screening, referral pathways, quality metrics, and the design of integrated psychosocial oncology services.¹⁶–¹⁸ Using nationally representative data from the 2024 National Health Interview Survey (NHIS), this study examines serious psychological distress and unmet mental health care need among U.S. adult cancer survivors in the contemporary, post-pandemic context. The objectives were to estimate the prevalence and overlap of these outcomes and to identify sociodemographic, psychosocial, and healthcare access factors associated with each. By treating distress and unmet need as related but distinct constructs, this study aims to inform more precise approaches to survivorship mental health assessment and care within psycho-oncology. Methods Study Design and Data Source We conducted a cross-sectional study using data from the 2024 National Health Interview Survey (NHIS), a nationally representative survey of the U.S. civilian, noninstitutionalized population administered annually by the National Center for Health Statistics.¹⁹ The NHIS employs a complex, multistage probability sampling design and collects detailed information on sociodemographic characteristics, health conditions, healthcare access, and psychosocial factors. The 2024 NHIS includes expanded post-pandemic content related to healthcare utilization, telehealth use, cost barriers, and mental health needs. Because this study used publicly available, deidentified data, it was exempt from institutional review board review. Study Population The analytic sample included adults aged 18 years or older who reported a history of cancer. Individuals reporting a history of nonmelanoma skin cancer only were excluded. Analyses were restricted to respondents with complete data for each outcome of interest, resulting in outcome-specific analytic samples. All analyses incorporated NHIS person-level sampling weights, strata, and primary sampling units to produce nationally representative estimates of U.S. adult cancer survivors.¹⁹ Outcomes Serious Psychological Distress (SPD). Psychological distress was assessed using the Kessler-6 (K6) scale, a validated measure of nonspecific psychological distress widely used in population-based surveillance.⁴–⁶ Scores range from 0 to 24, with higher scores indicating greater distress. Clinically significant psychological distress was defined as a K6 score ≥ 13, consistent with established thresholds used in national surveillance.⁴–⁶ Unmet Mental Health Care Need. Unmet mental health care need was defined as self-reported inability to obtain needed mental health counseling or treatment during the past 12 months. This measure reflects perceived need for services that were not received and captures access-related barriers independently of symptom severity.⁷–⁹ Ethical Approval This study used publicly available, de-identified data from the National Health Interview Survey (NHIS). Because the data are publicly available and do not contain identifiable private information, this study did not constitute human subjects research and was therefore exempt from institutional review board review. Informed Consent Written informed consent was obtained by the National Center for Health Statistics from all participants at the time of enrollment in the National Health Interview Survey (NHIS). The present study used archived, de-identified NHIS data. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Results Study Sample The analytic sample included 3,680 U.S. adults with a history of cancer. Weighted characteristics of the study population are presented in Table 1. The sample was predominantly older, with most survivors aged 65 years or older, and included a higher proportion of females than males. Most participants reported private or Medicare insurance coverage. Measures of healthcare access, psychosocial factors, and comorbidity burden varied across the population. Serious Psychological Distress Clinically significant psychological distress was present among a subset of cancer survivors. Prevalence varied across sociodemographic, healthcare access, and psychosocial subgroups (Table S1). Higher prevalence was observed among younger survivors, females, and those reporting transportation barriers. Psychosocial characteristics demonstrated the strongest gradients, with markedly higher prevalence among survivors reporting frequent loneliness, low social support, or dissatisfaction with life. In unadjusted analyses, younger age, female sex, non-private insurance, transportation barriers, telehealth use, and psychosocial vulnerability were associated with higher odds of psychological distress (eFigure 1). In mutually adjusted models, psychosocial factors remained the most consistent correlates of distress (Figure 1; Table 2). Frequent loneliness was associated with higher odds of distress (adjusted odds ratio [aOR], 5.34; 95% CI, 2.47–11.57), as were low social support (aOR, 2.78; 95% CI, 1.36–5.69) and dissatisfaction with life (aOR, 3.60; 95% CI, 1.51–8.57). Associations with several sociodemographic and access-related factors were attenuated after adjustment (Table S3). Unmet Mental Health Care Need Unmet mental health care need was reported by a distinct subset of survivors (Table S2). Prevalence patterns differed from those observed for psychological distress, with higher prevalence among younger survivors, females, and those experiencing psychosocial vulnerability. Several healthcare access indicators, including insurance status and transportation barriers, were also associated with higher prevalence. In unadjusted analyses, younger age, female sex, non-private insurance, transportation barriers, telehealth use, and psychosocial vulnerability were associated with higher odds of unmet mental health care need (eFigure 2). In adjusted models, unmet need followed a different pattern than distress (Figure 2; Table 2). Younger age and female sex remained associated with higher odds, along with psychosocial vulnerability. Healthcare access variables showed elevated but less precise associations, consistent with structural barriers contributing to unmet need (Table S4). Overlap Between Psychological Distress and Unmet Need Psychological distress and unmet mental health care need demonstrated partial overlap (Figure 3). While most survivors experienced neither outcome, subsets reported distress only, unmet need only, or both. Notably, many survivors with clinically significant distress did not report unmet mental health care need, and conversely, many survivors reporting unmet need did not meet criteria for distress, indicating that the two outcomes identified overlapping but non-identical groups of at-risk survivors. Discussion In this nationally representative study of U.S. adult cancer survivors, serious psychological distress (SPD) and unmet mental health care need emerged as overlapping but non-equivalent dimensions of survivorship mental health burden. Although related, these outcomes identified distinct subgroups of survivors, reinforcing that psychological symptom severity and barriers to care do not operate through identical pathways. Treating these constructs as interchangeable may therefore obscure clinically meaningful vulnerability and limit the effectiveness of survivorship screening and intervention strategies.¹⁰–¹² Clinical Implications Psychosocial vulnerability was the most consistent correlate of clinically significant distress. Frequent loneliness, low perceived social support, and dissatisfaction with life showed strong associations with SPD even after adjustment for sociodemographic, clinical, and healthcare access factors. These findings align with psycho-oncology frameworks that conceptualize distress as embedded within social and relational context rather than solely reflecting individual psychopathology. From a clinical perspective, they underscore the importance of psychosocial assessment that extends beyond symptom screening to include social connection, support networks, and subjective well-being.¹–³,¹⁶–¹⁸ In contrast, unmet mental health care need followed a different pattern. While psychosocial vulnerability remained relevant, unmet need was more closely associated with healthcare access and structural barriers, including insurance coverage and transportation difficulties. This distinction suggests that unmet need reflects system-level constraints rather than symptom burden alone. Survivors may perceive a need for mental health care without meeting high thresholds for distress, while others with severe distress may not report unmet need if care is inaccessible, not sought, or normalized as part of the cancer experience.⁷–⁹,¹⁰–¹² The association between telehealth use and both outcomes warrants careful interpretation. In the post-pandemic context, telehealth use likely reflects underlying care-seeking behavior, complexity of need, or engagement with the healthcare system rather than a causal relationship with distress or unmet care. Rapid expansion of telehealth occurred alongside persistent mental health workforce shortages and shifting access patterns, which may decouple symptom burden from service receipt. These findings highlight the importance of avoiding causal inference from cross-sectional associations and of interpreting telehealth use as a marker of engagement or need.¹³–¹⁵ The partial overlap observed between SPD and unmet mental health care need has direct implications for survivorship care. Survivors experiencing both outcomes may represent a particularly vulnerable subgroup, facing compounded risk from severe psychological distress and barriers to accessing care. However, survivors experiencing only one outcome may require different clinical or system-level responses. Distress-focused screening alone may miss survivors struggling to obtain care, while access-focused metrics may fail to identify those experiencing substantial psychological suffering. Integrated approaches that incorporate both constructs may therefore improve identification of at-risk survivors and guide more tailored interventions.¹⁶–¹⁸ Study Limitations Several limitations should be considered. The cross-sectional design precludes causal inference, and measures were self-reported. SPD was defined using a high Kessler-6 threshold, capturing severe distress but not subthreshold symptoms that may also be clinically relevant. Low outcome prevalence contributed to imprecision for some estimates, particularly for access-related variables. In addition, NHIS lacks detailed cancer clinical characteristics such as stage, treatment modality, and time since diagnosis, which may further shape survivorship mental health experiences.⁴–⁶,¹⁹ Despite these limitations, this study provides timely insight into survivorship mental health in the post-pandemic era. By demonstrating that SPD and unmet mental health care need capture overlapping but distinct dimensions of vulnerability, our findings support more nuanced surveillance and care strategies in psycho-oncology. Incorporating both constructs into survivorship research and clinical practice may improve identification of vulnerable survivors and inform integrated approaches that address both psychological suffering and structural barriers to mental health care.¹–³,¹⁰–¹² Conclusions In this nationally representative study of U.S. adult cancer survivors, serious psychological distress and unmet mental health care need were overlapping but non-equivalent dimensions of survivorship mental health burden. Psychosocial vulnerability—particularly loneliness, low social support, and dissatisfaction with life—was most strongly associated with distress, whereas unmet need more closely reflected healthcare access and structural barriers. These findings highlight the limitations of relying on single-domain indicators in survivorship care and underscore the value of integrated approaches that combine psychosocial assessment with strategies to reduce barriers to mental health services. Incorporating both constructs into psycho-oncology research and survivorship programs may improve identification of vulnerable survivors and inform more precise, patient-centered care in the post-pandemic healthcare landscape. Declarations Data responsibility: Linares-Perdomo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Concept and design: Linares-Perdomo, Odei.Acquisition, analysis, or interpretation of data: Linares-Perdomo, Klebe, Odei.Drafting of the manuscript: Linares-Perdomo.Critical revision of the manuscript for important intellectual content: Klebe, Odei.Statistical analysis: Linares-Perdomo.Supervision: Odei.Data responsibility: Linares-Perdomo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Data Availability Data Availability StatementThe data analyzed in this study are publicly available from the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics. NHIS data can be accessed through the Centers for Disease Control and Prevention website (https://www.cdc.gov/nchs/nhis). The datasets are de-identified and available to qualified users without restriction. The analytic code used in this study is available from the corresponding author upon reasonable request. References Stanton AL, Rowland JH, Ganz PA. Life after diagnosis and treatment of cancer in adulthood: Contributions from psychosocial oncology research. J Clin Oncol. 2015;33(23):2653–2659. Hewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2006. Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, hematological, and palliative-care settings: A meta-analysis. Lancet Oncol. 2011;12(2):160–174. Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–976. Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184–189. 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Hyattsville, MD: Centers for Disease Control and Prevention; 2024 Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files TableS1.docx TableS2.docx TableS3.docx TableS4.docx eFigure1.pdf eFigure 1. Survey-Weighted Unadjusted Associations With Clinically Significant Psychological Distress Among U.S. Adult Cancer Survivors The forest plot displays unadjusted odds ratios (ORs) and 95% confidence intervals from separate survey-weighted logistic regression models, each including a single predictor. Clinically significant psychological distress was defined as a Kessler-6 (K6) score ≥13. Estimates account for the complex sampling design of the National Health Interview Survey (NHIS). eFigure2.pdf eFigure 2. Survey-Weighted Unadjusted Associations With Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors The forest plot displays unadjusted odds ratios (ORs) and 95% confidence intervals from separate survey-weighted logistic regression models, each including a single predictor. Unmet mental health care need was defined as self-reported inability to obtain needed mental health counseling or treatment in the past 12 months. Estimates account for the complex sampling design of the National Health Interview Survey (NHIS). Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 03 Mar, 2026 Editor assigned by journal 03 Mar, 2026 Submission checks completed at journal 03 Feb, 2026 First submitted to journal 21 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8665280","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":600093080,"identity":"190e8dba-80b4-495b-b954-e3605b4a5c31","order_by":0,"name":"Olinto Linares-Perdomo","email":"","orcid":"","institution":"University of Utah","correspondingAuthor":false,"prefix":"","firstName":"Olinto","middleName":"","lastName":"Linares-Perdomo","suffix":""},{"id":600093081,"identity":"011325fa-9fb8-46c3-a051-39c9a800850d","order_by":1,"name":"Damon Klebe","email":"","orcid":"","institution":"University of Utah","correspondingAuthor":false,"prefix":"","firstName":"Damon","middleName":"","lastName":"Klebe","suffix":""},{"id":600093084,"identity":"7d4592d4-c193-4dc6-9ee4-d1b4a9e7c452","order_by":2,"name":"Bismarck C Odei","email":"data:image/png;base64,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","orcid":"","institution":"University of Utah","correspondingAuthor":true,"prefix":"","firstName":"Bismarck","middleName":"C","lastName":"Odei","suffix":""}],"badges":[],"createdAt":"2026-01-22 04:54:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8665280/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8665280/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104207119,"identity":"28a88048-0a0b-471b-ac88-4e45ef79f211","added_by":"auto","created_at":"2026-03-09 07:07:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":112775,"visible":true,"origin":"","legend":"\u003cp\u003eSurvey-Weighted Adjusted Associations With Clinically Significant Psychological Distress Among U.S. Adult Cancer Survivors\u003cbr\u003e\nThe forest plot displays adjusted odds ratios (ORs) and 95% confidence intervals from multivariable survey-weighted logistic regression models. Clinically significant psychological distress was defined as a Kessler-6 (K6) score ≥13. Models were adjusted for sociodemographic, clinical, healthcare access, and psychosocial covariates as specified in the Methods. 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Estimates account for the complex sampling design of the National Health Interview Survey (NHIS).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/d61a2affd317a657d5cdfaf8.png"},{"id":104207124,"identity":"d86728e2-84b8-4786-801f-e35bac3d1a68","added_by":"auto","created_at":"2026-03-09 07:07:32","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":48907,"visible":true,"origin":"","legend":"\u003cp\u003eCo-Occurrence of Serious Psychological Distress and Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors (NHIS 2024)\u003cbr\u003e\nBars represent survey-weighted prevalence estimates with 95% confidence intervals for the overlap between clinically significant psychological distress (Kessler-6 [K6] score ≥13) and unmet mental health care need. Estimates account for the complex NHIS sampling design.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/c3103b1bbe084948c971d578.png"},{"id":104784106,"identity":"8972cfa3-d869-4de7-b59c-23c42680f920","added_by":"auto","created_at":"2026-03-17 08:05:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":646548,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/f0fd4bbc-777b-43c5-be99-e7b94eb7dcb3.pdf"},{"id":104207123,"identity":"54743940-d468-410b-870a-7654d58baf3f","added_by":"auto","created_at":"2026-03-09 07:07:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22376,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/c1fd2504af1fd0b9fc2f20c9.docx"},{"id":104207122,"identity":"57aaedd2-d7ab-4ee2-9df3-e5c7cfe78e57","added_by":"auto","created_at":"2026-03-09 07:07:32","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19937,"visible":true,"origin":"","legend":"","description":"","filename":"TableS2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/cdb09954e492c7063e0c18ac.docx"},{"id":104207128,"identity":"4ae05e5d-6aa2-4cae-97a7-93efa9e60569","added_by":"auto","created_at":"2026-03-09 07:07:32","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":20361,"visible":true,"origin":"","legend":"","description":"","filename":"TableS3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/6f218b67729c340fb88f0645.docx"},{"id":104405009,"identity":"dc8f8fa5-b0bc-46cc-a375-e4625554c6e3","added_by":"auto","created_at":"2026-03-11 12:21:34","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":20403,"visible":true,"origin":"","legend":"","description":"","filename":"TableS4.docx","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/9b798bfd6c89cafd19e77669.docx"},{"id":104207127,"identity":"57538190-f6b9-44eb-96b1-57d97d1546b1","added_by":"auto","created_at":"2026-03-09 07:07:32","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":118104,"visible":true,"origin":"","legend":"\u003cp\u003eeFigure 1. Survey-Weighted Unadjusted Associations With Clinically Significant Psychological Distress Among U.S. Adult Cancer Survivors\u003cbr\u003e\nThe forest plot displays unadjusted odds ratios (ORs) and 95% confidence intervals from separate survey-weighted logistic regression models, each including a single predictor. Clinically significant psychological distress was defined as a Kessler-6 (K6) score ≥13. Estimates account for the complex sampling design of the National Health Interview Survey (NHIS).\u003c/p\u003e","description":"","filename":"eFigure1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/6c3caa8f752fd9ecfae3fd7a.pdf"},{"id":104779595,"identity":"b0df98ac-b636-4d74-bf41-798264c8dad5","added_by":"auto","created_at":"2026-03-17 07:42:53","extension":"pdf","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":130347,"visible":true,"origin":"","legend":"\u003cp\u003eeFigure 2. Survey-Weighted Unadjusted Associations With Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors\u003cbr\u003e\nThe forest plot displays unadjusted odds ratios (ORs) and 95% confidence intervals from separate survey-weighted logistic regression models, each including a single predictor. Unmet mental health care need was defined as self-reported inability to obtain needed mental health counseling or treatment in the past 12 months. Estimates account for the complex sampling design of the National Health Interview Survey (NHIS).\u003c/p\u003e","description":"","filename":"eFigure2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/1599208d36d0bdd61d3e3ed5.pdf"},{"id":104403809,"identity":"c6f752b2-643b-478c-8419-858df451f7c0","added_by":"auto","created_at":"2026-03-11 12:19:07","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":39612,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8665280/v1/fab7b9d7b95ae62ba5ac7528.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Serious Psychological Distress and Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors: NHIS 2024","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer survivorship is increasingly recognized as a period of sustained psychosocial vulnerability, shaped by the long-term physical, emotional, and social consequences of cancer and its treatment. Survivors may experience persistent psychological symptoms, disruptions in social roles, financial strain, and challenges navigating healthcare systems, all of which can affect quality of life and engagement with care. As a result, identifying survivors at risk for poor mental health outcomes remains a central priority in psycho-oncology and survivorship research.\u0026sup1;\u0026ndash;\u0026sup3;\u003c/p\u003e \u003cp\u003eSerious psychological distress (SPD) is commonly used to characterize clinically meaningful mental health burden in population-based survivorship studies. Measured using validated screening instruments such as the Kessler-6 scale, SPD captures severe, nonspecific psychological symptoms associated with impaired functioning, increased healthcare utilization, and adverse health outcomes.⁴\u0026ndash;⁶ However, distress represents only one dimension of survivorship mental health.\u003c/p\u003e \u003cp\u003eMany survivors experience difficulties accessing mental health services despite perceiving a need for care, a phenomenon reflected by unmet mental health care need. Unlike distress, unmet need incorporates structural, financial, and logistical barriers to care and may arise even in the absence of severe symptomatology.⁷\u0026ndash;⁹\u003c/p\u003e \u003cp\u003eDespite their conceptual differences, SPD and unmet mental health care need are often treated as interchangeable indicators of mental health burden in cancer survivorship research and surveillance. This practice implicitly assumes that survivors with significant distress are the same individuals who experience unmet need for care, and that identifying one outcome adequately captures the other. However, emerging evidence suggests that psychological symptom burden and barriers to care may operate through partially independent pathways, influenced by distinct combinations of psychosocial vulnerability, healthcare access, and structural constraints.\u0026sup1;⁰\u0026ndash;\u0026sup1;\u0026sup2;\u003c/p\u003e \u003cp\u003eThe contemporary survivorship landscape further complicates this distinction. The COVID-19 pandemic accelerated changes in healthcare delivery, including rapid expansion of telehealth, shifts in insurance coverage and utilization, and worsening shortages in the mental health workforce. These changes may differentially affect psychological symptoms and access to services, potentially decoupling distress from care receipt. In this context, indicators such as telehealth use may reflect underlying care-seeking behavior or heightened need rather than causal effects on mental health outcomes. Understanding how psychosocial vulnerability and access-related factors relate to distress and unmet need in the post-pandemic era is therefore critical for interpreting current survivorship data and informing intervention strategies.\u0026sup1;\u0026sup3;\u0026ndash;\u0026sup1;⁵\u003c/p\u003e \u003cp\u003eEvaluating SPD and unmet mental health care need concurrently offers an opportunity to clarify their overlap and divergence and to better characterize mental health burden among cancer survivors. Survivors who experience both severe distress and unmet need may represent a particularly vulnerable subgroup requiring targeted intervention, while those who experience only one of these outcomes may benefit from different clinical or system-level responses. Distinguishing these patterns has direct implications for survivorship screening, referral pathways, quality metrics, and the design of integrated psychosocial oncology services.\u0026sup1;⁶\u0026ndash;\u0026sup1;⁸\u003c/p\u003e \u003cp\u003eUsing nationally representative data from the 2024 National Health Interview Survey (NHIS), this study examines serious psychological distress and unmet mental health care need among U.S. adult cancer survivors in the contemporary, post-pandemic context. The objectives were to estimate the prevalence and overlap of these outcomes and to identify sociodemographic, psychosocial, and healthcare access factors associated with each. By treating distress and unmet need as related but distinct constructs, this study aims to inform more precise approaches to survivorship mental health assessment and care within psycho-oncology.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Data Source\u003c/p\u003e \u003cp\u003eWe conducted a cross-sectional study using data from the 2024 National Health Interview Survey (NHIS), a nationally representative survey of the U.S. civilian, noninstitutionalized population administered annually by the National Center for Health Statistics.\u0026sup1;⁹ The NHIS employs a complex, multistage probability sampling design and collects detailed information on sociodemographic characteristics, health conditions, healthcare access, and psychosocial factors. The 2024 NHIS includes expanded post-pandemic content related to healthcare utilization, telehealth use, cost barriers, and mental health needs. Because this study used publicly available, deidentified data, it was exempt from institutional review board review.\u003c/p\u003e \u003cp\u003eStudy Population\u003c/p\u003e \u003cp\u003eThe analytic sample included adults aged 18 years or older who reported a history of cancer. Individuals reporting a history of nonmelanoma skin cancer only were excluded. Analyses were restricted to respondents with complete data for each outcome of interest, resulting in outcome-specific analytic samples. All analyses incorporated NHIS person-level sampling weights, strata, and primary sampling units to produce nationally representative estimates of U.S. adult cancer survivors.\u0026sup1;⁹\u003c/p\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003cp\u003eSerious Psychological Distress (SPD).\u003c/p\u003e \u003cp\u003ePsychological distress was assessed using the Kessler-6 (K6) scale, a validated measure of nonspecific psychological distress widely used in population-based surveillance.⁴\u0026ndash;⁶ Scores range from 0 to 24, with higher scores indicating greater distress. Clinically significant psychological distress was defined as a K6 score\u0026thinsp;\u0026ge;\u0026thinsp;13, consistent with established thresholds used in national surveillance.⁴\u0026ndash;⁶\u003c/p\u003e \u003cp\u003eUnmet Mental Health Care Need.\u003c/p\u003e \u003cp\u003eUnmet mental health care need was defined as self-reported inability to obtain needed mental health counseling or treatment during the past 12 months. This measure reflects perceived need for services that were not received and captures access-related barriers independently of symptom severity.⁷\u0026ndash;⁹\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used publicly available, de-identified data from the National Health Interview Survey (NHIS). Because the data are publicly available and do not contain identifiable private information, this study did not constitute human subjects research and was therefore exempt from institutional review board review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained by the National Center for Health Statistics from all participants at the time of enrollment in the National Health Interview Survey (NHIS). The present study used archived, de-identified NHIS data.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eStudy Sample\u003c/p\u003e\n\u003cp\u003eThe analytic sample included 3,680 U.S. adults with a history of cancer. Weighted characteristics of the study population are presented in Table 1. The sample was predominantly older, with most survivors aged 65 years or older, and included a higher proportion of females than males. Most participants reported private or Medicare insurance coverage. Measures of healthcare access, psychosocial factors, and comorbidity burden varied across the population.\u003c/p\u003e\n\u003cp\u003eSerious Psychological Distress\u003c/p\u003e\n\u003cp\u003eClinically significant psychological distress was present among a subset of cancer survivors. Prevalence varied across sociodemographic, healthcare access, and psychosocial subgroups (Table S1). Higher prevalence was observed among younger survivors, females, and those reporting transportation barriers. Psychosocial characteristics demonstrated the strongest gradients, with markedly higher prevalence among survivors reporting frequent loneliness, low social support, or dissatisfaction with life.\u003c/p\u003e\n\u003cp\u003eIn unadjusted analyses, younger age, female sex, non-private insurance, transportation barriers, telehealth use, and psychosocial vulnerability were associated with higher odds of psychological distress (eFigure 1). In mutually adjusted models, psychosocial factors remained the most consistent correlates of distress (Figure 1; Table 2). Frequent loneliness was associated with higher odds of distress (adjusted odds ratio [aOR], 5.34; 95% CI, 2.47–11.57), as were low social support (aOR, 2.78; 95% CI, 1.36–5.69) and dissatisfaction with life (aOR, 3.60; 95% CI, 1.51–8.57). Associations with several sociodemographic and access-related factors were attenuated after adjustment (Table S3).\u003c/p\u003e\n\u003cp\u003eUnmet Mental Health Care Need\u003c/p\u003e\n\u003cp\u003eUnmet mental health care need was reported by a distinct subset of survivors (Table S2). Prevalence patterns differed from those observed for psychological distress, with higher prevalence among younger survivors, females, and those experiencing psychosocial vulnerability. Several healthcare access indicators, including insurance status and transportation barriers, were also associated with higher prevalence.\u003c/p\u003e\n\u003cp\u003eIn unadjusted analyses, younger age, female sex, non-private insurance, transportation barriers, telehealth use, and psychosocial vulnerability were associated with higher odds of unmet mental health care need (eFigure 2). In adjusted models, unmet need followed a different pattern than distress (Figure 2; Table 2). Younger age and female sex remained associated with higher odds, along with psychosocial vulnerability. Healthcare access variables showed elevated but less precise associations, consistent with structural barriers contributing to unmet need (Table S4).\u003c/p\u003e\n\u003cp\u003eOverlap Between Psychological Distress and Unmet Need\u003c/p\u003e\n\u003cp\u003ePsychological distress and unmet mental health care need demonstrated partial overlap (Figure 3). While most survivors experienced neither outcome, subsets reported distress only, unmet need only, or both. Notably, many survivors with clinically significant distress did not report unmet mental health care need, and conversely, many survivors reporting unmet need did not meet criteria for distress, indicating that the two outcomes identified overlapping but non-identical groups of at-risk survivors.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this nationally representative study of U.S. adult cancer survivors, serious psychological distress (SPD) and unmet mental health care need emerged as overlapping but non-equivalent dimensions of survivorship mental health burden. Although related, these outcomes identified distinct subgroups of survivors, reinforcing that psychological symptom severity and barriers to care do not operate through identical pathways. Treating these constructs as interchangeable may therefore obscure clinically meaningful vulnerability and limit the effectiveness of survivorship screening and intervention strategies.¹⁰–¹²\u003c/p\u003e\n\u003cp\u003eClinical Implications\u003c/p\u003e\n\u003cp\u003ePsychosocial vulnerability was the most consistent correlate of clinically significant distress. Frequent loneliness, low perceived social support, and dissatisfaction with life showed strong associations with SPD even after adjustment for sociodemographic, clinical, and healthcare access factors. These findings align with psycho-oncology frameworks that conceptualize distress as embedded within social and relational context rather than solely reflecting individual psychopathology. From a clinical perspective, they underscore the importance of psychosocial assessment that extends beyond symptom screening to include social connection, support networks, and subjective well-being.¹–³,¹⁶–¹⁸\u003c/p\u003e\n\u003cp\u003eIn contrast, unmet mental health care need followed a different pattern. While psychosocial vulnerability remained relevant, unmet need was more closely associated with healthcare access and structural barriers, including insurance coverage and transportation difficulties. This distinction suggests that unmet need reflects system-level constraints rather than symptom burden alone. Survivors may perceive a need for mental health care without meeting high thresholds for distress, while others with severe distress may not report unmet need if care is inaccessible, not sought, or normalized as part of the cancer experience.⁷–⁹,¹⁰–¹²\u003c/p\u003e\n\u003cp\u003eThe association between telehealth use and both outcomes warrants careful interpretation. In the post-pandemic context, telehealth use likely reflects underlying care-seeking behavior, complexity of need, or engagement with the healthcare system rather than a causal relationship with distress or unmet care. Rapid expansion of telehealth occurred alongside persistent mental health workforce shortages and shifting access patterns, which may decouple symptom burden from service receipt. These findings highlight the importance of avoiding causal inference from cross-sectional associations and of interpreting telehealth use as a marker of engagement or need.¹³–¹⁵\u003c/p\u003e\n\u003cp\u003eThe partial overlap observed between SPD and unmet mental health care need has direct implications for survivorship care. Survivors experiencing both outcomes may represent a particularly vulnerable subgroup, facing compounded risk from severe psychological distress and barriers to accessing care. However, survivors experiencing only one outcome may require different clinical or system-level responses. Distress-focused screening alone may miss survivors struggling to obtain care, while access-focused metrics may fail to identify those experiencing substantial psychological suffering. Integrated approaches that incorporate both constructs may therefore improve identification of at-risk survivors and guide more tailored interventions.¹⁶–¹⁸\u003c/p\u003e\n\u003cp\u003eStudy Limitations\u003c/p\u003e\n\u003cp\u003eSeveral limitations should be considered. The cross-sectional design precludes causal inference, and measures were self-reported. SPD was defined using a high Kessler-6 threshold, capturing severe distress but not subthreshold symptoms that may also be clinically relevant. Low outcome prevalence contributed to imprecision for some estimates, particularly for access-related variables. In addition, NHIS lacks detailed cancer clinical characteristics such as stage, treatment modality, and time since diagnosis, which may further shape survivorship mental health experiences.⁴–⁶,¹⁹\u003c/p\u003e\n\u003cp\u003eDespite these limitations, this study provides timely insight into survivorship mental health in the post-pandemic era. By demonstrating that SPD and unmet mental health care need capture overlapping but distinct dimensions of vulnerability, our findings support more nuanced surveillance and care strategies in psycho-oncology. Incorporating both constructs into survivorship research and clinical practice may improve identification of vulnerable survivors and inform integrated approaches that address both psychological suffering and structural barriers to mental health care.¹–³,¹⁰–¹²\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this nationally representative study of U.S. adult cancer survivors, serious psychological distress and unmet mental health care need were overlapping but non-equivalent dimensions of survivorship mental health burden. Psychosocial vulnerability\u0026mdash;particularly loneliness, low social support, and dissatisfaction with life\u0026mdash;was most strongly associated with distress, whereas unmet need more closely reflected healthcare access and structural barriers. These findings highlight the limitations of relying on single-domain indicators in survivorship care and underscore the value of integrated approaches that combine psychosocial assessment with strategies to reduce barriers to mental health services. Incorporating both constructs into psycho-oncology research and survivorship programs may improve identification of vulnerable survivors and inform more precise, patient-centered care in the post-pandemic healthcare landscape.\u003c/p\u003e"},{"header":"Declarations","content":"\n\u003cp\u003e\u003cstrong\u003eData responsibility:\u003c/strong\u003e Linares-Perdomo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConcept and design: Linares-Perdomo, Odei.Acquisition, analysis, or interpretation of data: Linares-Perdomo, Klebe, Odei.Drafting of the manuscript: Linares-Perdomo.Critical revision of the manuscript for important intellectual content: Klebe, Odei.Statistical analysis: Linares-Perdomo.Supervision: Odei.Data responsibility: Linares-Perdomo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData Availability StatementThe data analyzed in this study are publicly available from the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics. NHIS data can be accessed through the Centers for Disease Control and Prevention website (https://www.cdc.gov/nchs/nhis). The datasets are de-identified and available to qualified users without restriction. The analytic code used in this study is available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStanton AL, Rowland JH, Ganz PA. Life after diagnosis and treatment of cancer in adulthood: Contributions from psychosocial oncology research. J Clin Oncol. 2015;33(23):2653\u0026ndash;2659.\u003c/li\u003e\n\u003cli\u003eHewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2006.\u003c/li\u003e\n\u003cli\u003eMitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, hematological, and palliative-care settings: A meta-analysis. Lancet Oncol. 2011;12(2):160\u0026ndash;174.\u003c/li\u003e\n\u003cli\u003eKessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959\u0026ndash;976.\u003c/li\u003e\n\u003cli\u003eKessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184\u0026ndash;189.\u003c/li\u003e\n\u003cli\u003eFurukawa TA, Kessler RC, Slade T, Andrews G. The performance of the K6 and K10 screening scales for psychological distress. Psychol Med. 2003;33(2):357\u0026ndash;362.\u003c/li\u003e\n\u003cli\u003eKent EE, Arora NK, Rowland JH, et al. Health-related quality of life and unmet needs among survivors of cancer. Psycho-Oncology. 2012;21(9):947\u0026ndash;954.\u003c/li\u003e\n\u003cli\u003eMcCabe MS, Bhatia S, Oeffinger KC, et al. Achieving high-quality cancer survivorship care. J Clin Oncol. 2013;31(5):631\u0026ndash;640.\u003c/li\u003e\n\u003cli\u003eWeaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost: Disparities among cancer survivors. Cancer. 2010;116(14):3493\u0026ndash;3504.\u003c/li\u003e\n\u003cli\u003eAndersen RM. Revisiting the behavioral model and access to medical care: Does it matter? J Health Soc Behav. 1995;36(1):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003ePirl WF, Greer JA, Temel JS, et al. Depression and anxiety in patients with cancer. Psycho-Oncology. 2012;21(12):1191\u0026ndash;1201.\u003c/li\u003e\n\u003cli\u003eThoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145\u0026ndash;161.\u003c/li\u003e\n\u003cli\u003ePatt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: Delays in diagnosis and treatment. JCO Oncol Pract. 2020;16(10):e1213\u0026ndash;e1221.\u003c/li\u003e\n\u003cli\u003eMoreno C, Wykes T, Galderisi S, et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813\u0026ndash;824.\u003c/li\u003e\n\u003cli\u003eMehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. The impact of the COVID-19 pandemic on outpatient visits. Health Aff (Millwood). 2020;39(11):1965\u0026ndash;1974.\u003c/li\u003e\n\u003cli\u003eHolt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality. Perspect Psychol Sci. 2015;10(2):227\u0026ndash;237.\u003c/li\u003e\n\u003cli\u003eYellowlees P, Shore J, Roberts L. Practice guidelines for videoconferencing-based telemental health. World Psychiatry. 2010;9(2):82\u0026ndash;89.\u003c/li\u003e\n\u003cli\u003ePierce BS, Perrin PB, Tyler CM, McKee GB, Watson JD. The COVID-19 telepsychology revolution. Am Psychol. 2021;76(1):14\u0026ndash;25.\u003c/li\u003e\n\u003cli\u003eNational Center for Health Statistics. National Health Interview Survey: Survey Description, 2024. Hyattsville, MD: Centers for Disease Control and Prevention; 2024\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8665280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8665280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eImportance\u003c/h2\u003e \u003cp\u003eSerious psychological distress (SPD) and unmet mental health care need are commonly used to characterize mental health burden among cancer survivors, yet they are often treated as interchangeable indicators. Whether these constructs identify the same at-risk survivors in the contemporary, post-pandemic context remains unclear.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo examine the prevalence, overlap, and distinct correlates of SPD and unmet mental health care need among U.S. adult cancer survivors using nationally representative data.\u003c/p\u003e\u003ch2\u003eDesign, Setting, and Participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional study used data from the 2024 National Health Interview Survey (NHIS), a nationally representative survey of the U.S. civilian, noninstitutionalized population. The analytic sample included 3,680 adults with a history of cancer. Survey-weighted analyses accounted for NHIS sampling weights, stratification, and clustering.\u003c/p\u003e\u003ch2\u003eExposures\u003c/h2\u003e \u003cp\u003eSociodemographic characteristics, healthcare access factors (including insurance status, transportation barriers, and telehealth use), and psychosocial measures (loneliness, perceived social support, and life satisfaction).\u003c/p\u003e\u003ch2\u003eMain Outcomes and Measures\u003c/h2\u003e \u003cp\u003eClinically significant psychological distress, defined as a Kessler-6 score\u0026thinsp;\u0026ge;\u0026thinsp;13, and unmet mental health care need, defined as self-reported inability to obtain needed mental health counseling or treatment in the past 12 months. Survey-weighted logistic regression models were used to estimate unadjusted and mutually adjusted associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSPD and unmet mental health care need demonstrated partial overlap but identified distinct subgroups of cancer survivors. In mutually adjusted models, psychosocial vulnerability showed the strongest and most consistent associations with SPD, particularly frequent loneliness (adjusted odds ratio [aOR], 5.34; 95% CI, 2.47\u0026ndash;11.57), low social support (aOR, 2.78; 95% CI, 1.36\u0026ndash;5.69), and dissatisfaction with life (aOR, 3.60; 95% CI, 1.51\u0026ndash;8.57). In contrast, unmet mental health care need followed a different pattern, with higher odds associated with younger age, female sex, psychosocial vulnerability, and indicators of healthcare access and structural barriers, including insurance status and transportation barriers. Telehealth use was associated with both outcomes, likely reflecting underlying care-seeking behavior or need rather than a causal relationship.\u003c/p\u003e\u003ch2\u003eConclusions and Relevance\u003c/h2\u003e \u003cp\u003eAmong U.S. adult cancer survivors, SPD and unmet mental health care need represent overlapping but non-equivalent dimensions of mental health burden. Psychosocial vulnerability was most strongly associated with distress, whereas unmet need more closely reflected access-related barriers to care. These findings underscore the importance of survivorship approaches that integrate psychosocial screening with strategies to reduce structural barriers to mental health services in the post-pandemic healthcare landscape.\u003c/p\u003e","manuscriptTitle":"Serious Psychological Distress and Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors: NHIS 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-09 07:07:27","doi":"10.21203/rs.3.rs-8665280/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-03T15:30:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-03T15:29:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T13:07:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-01-22T04:40:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e0646f0f-802b-4ffa-b9a9-5db67f470821","owner":[],"postedDate":"March 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T07:07:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-09 07:07:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8665280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8665280","identity":"rs-8665280","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}