Co-morbid mental health conditions in cancer patients at working age – prevalence, risk profiles, and care uptake S. Singer 1,2,3 *, C. Szalai 3 , S. Briest 4 , A. Brown 5 , A. Dietz 6 , J. Einenkel 7 , S. Jonas 8 , A. Konnopka 9 , K. Papsdorf 10 , D. Langanke 11 , M. Löbner 12 , F. Schiefke 13 , J.-U. Stolzenburg 14 , A. Weimann 15 , H. Wirtz 16 , H. H. König 9 and S. Riedel-Heller 12 1 Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University, Mainz, Germany 2 Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany 3 Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany 4 Breast Cancer Centre, University of Leipzig, Leipzig, Germany 5 Cancer Epidemiology Unit, University of Oxford, Oxford, UK 6 Department of Otolaryngology, University of Leipzig, Leipzig, Germany 7 Department of Obstetrics and Gynecology, University of Leipzig, Leipzig, Germany 8 Department of Surgery, University of Leipzig, Leipzig, Germany 9 Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 10 Department of Radiation-Oncology, University of Leipzig, Leipzig, Germany 11 Breast Cancer Centre, Hospital St. Elisabeth, Leipzig, Germany 12 Department of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany 13 Department of Maxillofacial Surgery, University of Leipzig, Leipzig, Germany 14 Department of Urology, University of Leipzig, Leipzig, Germany 15 Cancer Centre, Hospital St. Georg, Leipzig, Germany 16 Department of Pulmonology, University of Leipzig, Leipzig, Germany *Correspondence to: University Medical Centre of Johannes Gutenberg University, Institute of Medical Biostatistics, Epidemiology, and Informatics, Division of Epidemiology and Health Services Research, Obere Zahlbacher Straße 69, 55131 Mainz, Germany. Email: singers@uni-mainz.de Received: 20 September 2012 Revised: 16 February 2013 Accepted: 18 February 2013 Summary Objective: This study examined the prevalence of mental health conditions in cancer patients, the role of socioeconomic position in relation to that, and the use of professional mental health care. Methods: Prospective cohort with measurements at the beginning of inpatient treatment (baseline) and 3, 9, and 15 months after baseline using structured clinical interviews based on DSM-IV, question- naires, and medical records. Results: At baseline, 149 out of 502 cancer patients (30%) were diagnosed with a mental health condition. Prevalence was associated with unemployment (odds ratio [OR] 2.0), fatigue (OR 1.9), and pain (OR 1.7). Of those with mental health conditions, 9% saw a psychotherapist within 3 months of the diagnosis, 19% after 9 months, and 11% after 15 months. Mental health care use was higher in patients with children ≤18 years (OR 3.3) and somatic co-morbidity (OR 2.6). There was no evidence for an effect of sex on the use of mental health care. Conclusion: Few cancer patients with psychiatric disorders receive professional mental health care early enough. If patients are unemployed or if they suffer from fatigue or pain, special attention should be paid because the risk of having a mental health condition is increased in these patients. Copyright © 2013 John Wiley & Sons, Ltd. Introduction As cancer is still a potentially life-threatening disease that requires intense treatment in most cases, it presents a challenge for the coping abilities of the affected patients. The concept of ‘psychiatric morbidity’ as a proxy for their psychosocial distress is frequently applied. In oncology, non-psychotic mental health disorders are of major inter- est for the clinicians. Therefore, usually only so-called common mental disorders (depression, anxiety, and adjust- ment disorders) are diagnosed [1,2], at times also alcohol dependence [3,4]. According to meta-analyses, point prevalence of non- psychotic mental disorders in cancer patients at the begin- ning of treatment is 32% [5] and 29% in palliative-care settings [1]. Not only represents psychiatric co-morbidity enhanced distress of the patients calling for specific support from the medical team but also increases the length of stay in the hospital [6] and worsens, if not treated adequately, survival [7,8]. It is therefore highly important to identify patients suffering from mental health disorders as soon as possible in the cancer treat- ment trajectory. Doctors and nurses often fail in identifying these patients [9–12], resulting in severe under-treatment [3,13–18]. Improvement of case finding, which can be achieved by the use of screening instruments [19,20], does, however, not necessarily, translate into better mental health [21–24]. We assume that the missing link between improved case finding and better emotional well-being is tailored mental health care. This implies that the medical team, in addi- tion to the screening results that measure the patient’s distress, takes into account specific risk profiles of the patients. Known risk factors are pain, symptom burden, Copyright © 2013 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology 22: 2291–2297 (2013) Published online 14 March 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3282