Abstract
Abstract
Background
Cancer survivors are twice as likely to experience psychological distress, with racial and ethnic minorities reporting higher distress and healthcare needs compared to non-Hispanic White Americans. However, this group is more likely to seek informal support over formal care. Discrimination has been identified as a key factor influencing individuals’ mental health and help-seeking behaviors, but its impact on mental healthcare utilization remains unclear.
Methods
This cross-sectional study used surveys and electronic health records from the All of Us Research Program. Adults aged 18 or older who self-identify as Asian, Hispanic, or Black/African American, have a cancer history, and responded to surveys on discrimination and mental healthcare utilization were included. Multivariable regression models estimated the association between discrimination and mental healthcare utilization, stratified by race and ethnicity.
Results
One thousand nine hundred twenty-two ethnic minority cancer survivors participated. 249 (13.0%) were Asian Americans, 909 (47.3%) were Black/African Americans, and 673 (39.8%) were Hispanic Americans. Most participants were female (70.1%,
n
= 1,348), had health insurance (95.1%,
n
= 1,828), and were US-born (71.2%,
n
= 1,368). Demographic patterns varied across groups. 78.8% (
n
= 1514) and 67.7% (
n
= 1301) of respondents experienced everyday and healthcare discrimination, respectively. 24.5% (
n
= 470) used mental healthcare within the past year.
Experiencing everyday discrimination was associated with higher odds of mental healthcare utilization among Hispanic American cancer survivors (OR = 2.40, 95% CI [1.68, 3.51]) and increased it by 57% among Black/African American cancer survivors (OR = 1.57, 95% CI [1.07, 2.31]). However, it did not significantly influence such use among Asian Americans. Conversely, discrimination in healthcare settings was not associated with the odds of mental healthcare utilization. Increased age and an advanced degree were independently associated with lower odds of mental healthcare utilization, while specific cancer types, like head and neck cancers, were correlated with higher odds of such use.
Conclusions
Racial and ethnic minority cancer survivors experienced high levels of discrimination, and those experiencing everyday discrimination were more likely to use mental healthcare. Healthcare discrimination did not significantly increase mental healthcare utilization, suggesting unsuccessful engagement with mental healthcare. Anti-discrimination efforts should be organizational initiatives with clear benchmarks. Survivors of head and neck, thyroid, endocrine, and colorectal cancers may benefit most from integrated mental health services in routine oncology care.