Abstract
Purpose
Black cancer survivors are less likely to receive desired psychological services than non-Hispanic White survivors. Black cancer survivors with low socioeconomic status may face additional barriers to receipt of psychological services. This study examined socioeconomic disparities in psychological service recommendation, attempts to access, and receipt among Black breast cancer (BC) survivors.
Methods
Black BC survivors (n = 249) completed surveys at baseline (T1) and follow-up (T2; M 1.6 years post-T1). At T1, participants reported socioeconomic characteristics (employment, income, insurance, and education) and psychological symptoms (hospital anxiety and depression scale [HADS]). Self-reported address was used to identify area deprivation index (ADI), a composite measure of neighborhood socioeconomic disadvantage (least disadvantaged = 1; most disadvantaged = 10). At T2, participants reported provider recommendations for, attempts to access, and receipt of psychological services. Logistic regressions examined relationships between socioeconomic characteristics and psychological service variables, controlling for baseline psychological symptoms.
Results
In multivariable analyses, being employed was associated with a lower likelihood of attempts to access (OR = 0.25) and receipt of (OR = 0.37) psychological services, above and beyond the effect of psychological symptoms. Univariate analyses demonstrated that participants from more disadvantaged areas (i.e., higher ADI) were more likely to receive psychological services (OR = 1.20), but this effect became non-significant in multivariable analyses.
Conclusion
Results highlight the importance of an intersectional perspective in considering mental health care disparities; both race/ethnicity and socioeconomic status should be incorporated when considering barriers and facilitators of psychological care.
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Data availability
The datasets analyzed during the current study are not publicly available due to the terms under which participants provided informed consent. Data are available from the corresponding author on reasonable request.
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Funding
This work was supported by the American Cancer Society (RSG-11–268-01-CPPB), Florida Biomedical Research Program (IBG10-34199), and National Cancer Institute (P30CA076292; T32CA090314).
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Authors and Affiliations
Contributions
Claire C. Conley: formal analysis, interpretation, visualization, writing—original draft; McKenzie McIntyre: data curation, and writing—review and editing; Stephanie Dekkers: data curation and writing—review and editing; Tuya Pal: conceptualization, funding acquisition, investigation, methodology, supervision, and writing—review and editing; Susan T. Vadaparampil: conceptualization, funding acquisition, investigation, methodology, supervision, and writing–review and editing.
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Ethics approval
Study procedures adhered to the principles of the Declaration of Helsinki. All procedures were approved by the University of South Florida (104559) and the Florida Department of Health (DOH H11168) Institutional Review Boards.
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Verbal or written informed consent was obtained from all individual participants included in the study.
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The authors declare no competing interests.
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Conley, C.C., McIntyre, M., Dekkers, S. et al. Socioeconomic disparities in psychosocial service recommendation and receipt among young Black breast cancer survivors. Support Care Cancer 30, 5557–5560 (2022). https://doi.org/10.1007/s00520-022-06884-z
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DOI: https://doi.org/10.1007/s00520-022-06884-z