Mental health disparities among gynecologic cancer survivors: a cross-sectional analysis

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Introduction: Mental health outcomes among gynecologic cancer survivors remain under-investigated. Using the Canadian Longitudinal Study on Aging (CLSA), a population-based cohort of over 50,000 individuals, we evaluated differences in mental health outcomes between gynecologic cancer survivors and those without a history of gynecologic cancer. Materials and methods: Cross-sectional data from 26,155 female participants were analyzed. Mental health outcomes included depression (Center for Epidemiologic Studies Depression Scale, CES-D10), psychological distress (Kessler Psychological Distress Scale, K10), and self-rated mental health (SRMH: five-point Likert scale). Regression models were used to describe associations between history of a gynecologic cancer and the three mental health outcomes. Results: Participants with a history of gynecologic cancer (n = 765, weighted prevalence 2.9%, 95% confidence interval (CI) 2.4–3.3) showed a non-significant directional shift toward higher odds of screening positive for depression (adjusted odds ratio (aOR) CES-D10 1.2, 95% CI 0.9–1.5) than those without. However, among participants with any history of cancer, those with a gynecologic cancer were at higher risk of depression (aOR 1.6, 95% CI 1.1–2.5). Among gynecologic cancer survivors, lower household income showed a strong, graded association with all outcomes: income < 20,000 Canadian dollars was associated with elevated odds of depression (odds ratio (OR) 8.4, 95% CI 2.8–25.7), poor SRMH (OR 26.5, 95% CI 4.0–176.2), and psychological distress (OR 22.0, 95% CI 1.3–366.9). Within this group, current smoking was associated with increased odds of depression (OR 4.9, 95% CI 2.5–9.7) and psychological distress (OR 3.6, 95% CI 1.2–10.9). Conclusions: Gynecologic cancer survivors tend to experience a higher burden of depressive symptoms, particularly those facing socioeconomic disadvantage. These findings support routine mental health screening and underscore the need for targeted interventions and sustained psychosocial support throughout treatment and survivorship.

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