Breaking the Silence: A Mixed Methods Analysis Unveiling Barriers to Mental Health Service Use in Breast Cancer Survivors With Clinically Significant Distress
Ana Danner, Tayler Gowan, Madison Schwarz, Matthew Hays, Yang Li, Shelley A. JohnsABSTRACT
Background
Breast cancer survivors are at elevated risk for psychological distress, including depression, anxiety, and post‐traumatic stress (PTS), compared to healthy controls. Fear of cancer recurrence (FCR) is particularly prevalent, with approximately 50% of breast cancer survivors reporting clinically significant FCR.
Aims
This mixed methods study examined associations among psychological distress, mental health service (MHS) use, and barriers to MHS use among breast cancer survivors.
Methods
Using a sequential explanatory mixed methods design, we analyzed baseline data from 384 early‐stage, post‐treatment breast cancer survivors with clinically significant FCR enrolled in a randomized controlled trial. Associations between distress symptoms and MHS use were examined. Subsequently, qualitative interviews were conducted with 24 distressed breast cancer survivors to explore barriers to MHS use.
Results
Of 298 (77.81%) breast cancer survivors with at least one clinically significant distress measure, only 61 (20.47%) reported MHS use within the prior 3 months. Anxiety ( p = 0.0030), depression ( p = 0.0015), and PTS ( p = 0.0387) symptoms were significantly associated with MHS use, whereas FCR was associated with fewer MHS visits. Interviews revealed barriers including avoidant coping, financial and logistical challenges, and limited access to timely, integrated care, as well as suggestions for improved support.
Conclusions
Few clinically distressed breast cancer survivors utilize MHS. Anxiety, depression, and PTS symptoms may better predict MHS use than FCR, potentially due to avoidant coping among fearful survivors. Interventions targeting avoidance, alongside survivor‐informed improvements in mental health care delivery, may enhance MHS access and outcomes.
Trial Registration
NCT05364450