Risk of Psychiatric Disorders Among Spouses of Patients With Cancer in Denmark and Sweden

Abstract

ImportanceThere is emerging evidence that spouses of patients with cancer may have a higher prevalence of mental illness, but these studies have been limited by pre-post designs, focus on a single mental illness, and short follow-up periods.ObjectivesTo assess the overall burden of psychiatric disorders among spouses of patients with cancer vs spouses of individuals without cancer and to describe possible changes in this burden over time.Design, Setting, and ParticipantsThis population based cohort study included spouses of patients with cancer (diagnosed 1986-2016 in Denmark and 1973-2014 in Sweden; exposed group) and spouses of individuals without cancer (unexposed group). Members of the unexposed group were individually matched to individuals in the exposed group on the year of birth, sex, and country. Spouses with and without preexisting psychiatric morbidity were analyzed separately. Data analysis was performed between May 2021 and January 2022.ExposuresBeing spouse to a patient with cancer.Main Outcomes and MeasuresThe main outcome was a clinical diagnosis of psychiatric disorders through hospital-based inpatient or outpatient care. Flexible parametric models and Cox models were fitted to estimate hazard ratios (HRs) with 95% CIs, adjusted for sex, age and year at cohort entry, country, household income, and cancer history.ResultsAmong 546 321 spouses in the exposed group and 2 731 574 in the unexposed group who had no preexisting psychiatry morbidity, 46.0% were male participants, with a median (IQR) age at cohort entry of 60 (51-68) years. During follow-up (median, 8.4 vs 7.6 years), the incidence rate of first-onset psychiatric disorders was 6.8 and 5.9 per 1000 person-years for the exposed and unexposed groups, respectively (37 830 spouses of patients with cancer [6.9%]; 153 607 of spouses of individuals without cancer [5.6%]). Risk of first-onset psychiatric disorders increased by 30% (adjusted HR, 1.30; 95% CI, 1.25-1.34) during the first year after cancer diagnosis, especially for depression (adjusted HR, 1.38; 95% CI, 1.30-1.47) and stress-related disorders (adjusted HR, 2.04; 95% CI, 1.88-2.22). Risk of first-onset psychiatric disorders increased by 14% (adjusted HR, 1.14; 95% CI, 1.13-1.16) during the entire follow-up, which was similar for substance abuse, depression, and stress-related disorders. The risk increase was more prominent among spouses of patients diagnosed with a cancer with poor prognosis (eg, pancreatic cancer: adjusted HR, 1.41; 95% CI, 1.32-1.51) or at an advanced stage (adjusted HR, 1.31; 95% CI, 1.26-1.36) and when the patient died during follow-up (adjusted HR, 1.29; 95% CI, 1.27-1.31). Among spouses with preexisting psychiatric morbidity, the risk of psychiatric disorders (first-onset or recurrent) increased by 23% during the entire follow-up (adjusted HR, 1.23; 95% CI, 1.20-1.25).Conclusions and RelevanceIn this cohort study of 2 populations in Denmark and Sweden, spouses of patients with cancer experienced increased risk of several psychiatric disorders that required hospital-based specialist care. Our results support the need for clinical awareness to prevent potential mental illness among the spouses of patients with cancer.

Prevalence of mental disorders, psychosocial distress, and perceived need for psychosocial support in cancer patients and their relatives stratified by biopsychosocial factors: rationale, study design, and methods of a prospective multi-center observational cohort study (LUPE study)

“… Hu et al (2023) showed a higher risk of any mental disorder in spouses of cancer patients compared to spouses of individuals without cancer in a binational study in Denmark and Sweden. The risk of first-onset mental disorders increased by 30% during the first year after cancer diagnosis, especially for depression and stress-related disorders.…”

“…Many informal caregivers also face a difficult task: while they are often the main source of emotional and practical support for the sick person and are involved in medical decision-making (Ernst et al, 2017;Laidsaar-Powell et al, 2017;Weissflog et al, 2017;Cincidda et al, 2022), they themselves have a high psychosocial burden that requires support (Zimmermann, 2022). Hu et al (2023) showed a higher risk of any mental disorder in spouses of cancer patients compared to spouses of individuals without cancer in a binational study in Denmark and Sweden. The risk of first-onset mental disorders increased by 30% during the first year after cancer diagnosis, especially for depression and stress-related disorders.…”

When Family Life Contributes to Cancer Caregiver Burden in Palliative Care

“…A. Given et al, 2004;Hsu et al, 2014;Hu et al, 2023;Northouse et al, 2012). Ample evidence also suggests that cancer caregiving can introduce problems or magnify preexisting tensions in the wider family network (Girardon-Perlini & Ângelo, 2017;Nissen et al, 2016;A.…”

Are digital health interventions valuable to support patients with cancer and caregivers? An umbrella review of web‐based and app‐based supportive care interventions

“…In addition, given the high risk of psychopathological disorders in the relatives of patients with cancer, such new cost-effective interventions should also be available to them. 9 In the last two decades, digital technologies have expanded tremendously. Technologies developed to support human health and well-being are more recent, and their effectiveness and impact on the healthcare system need to be evaluated constantly.…”

“…These costs can be related, for example, to the professional who takes more time with one patient to the detriment of others, additional training costs, or increased demand. In addition, given the high risk of psychopathological disorders in the relatives of patients with cancer, such new cost‐effective interventions should also be available to them 9 …”