ArticleJNCI cancer spectrum2025
Mental health service utilization in publicly insured survivors of childhood cancer: a claims-based analysis.
Article in JNCI cancer spectrum, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChildhood cancer survivors face long-term psychological challenges, including depression, trauma/stress, and anxiety. However, objective assessments of mental health service utilization among child and young adult (YA) survivors of childhood cancer remain limited. We examined mental health care utilization among publicly insured childhood cancer survivors and disparities by sociodemographic and neighborhood-level factors.
methodsUsing multistate public insurance claims data, we identified 5946 survivors (diagnosed ≤21 years) who completed cancer therapy; initiated treatment episode(s) for depression, trauma/stress, or anxiety post cancer therapy; and maintained continuous coverage. Logistic regressions examined factors associated with having any mental health visit and ≥4 visits within 12 weeks of treatment episode initiation in children (ages 3-17) and YAs (ages 18-39).
resultsAmong 4052 child treatment episodes, 54.6% were in female survivors, 41.5% non-Hispanic White survivors, and 27.4% Hispanic survivors; demographics were similar across 3871 YA episodes. Utilization was highest among survivors aged 3-11 years (any visit: 73.4%; ≥4 visits: 39.8%), followed by those aged 12-17 years (67.8%; 33.2%), 18-26 years (51.9%; 20.2%), and 27-39 years (43.3%; 16.4%). Hispanic children were less likely than non-Hispanic White peers to have ≥4 mental health visits (marginal effect = -8.73 percentage points; 95% CI = -12.78 to -4.68), as were children in most (vs least) deprived neighborhoods (marginal effect = -8.80 percentage points; 95% CI = -14.07 to -3.53). Similar disparities were observed for any mental health visit.
conclusionMental health service utilization was low among publicly insured childhood cancer survivors after mental health diagnosis, with notable disparities by age, ethnicity, and geographic location, underscoring the need for interventions to improve psychological support in this underserved population.
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