Mental Health Outcomes Among Long-Term Survivors of Childhood, Adolescent and Young Adult Cancer: A Scottish Population-Based Cohort Study.
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BACKGROUND: Survivors of cancer face increased risks of long-term morbidity compared to people without a cancer history. AIMS: To quantify the long-term burden of mental health morbidity and to evaluate the healthcare settings in which these events are identified in long-term Scottish cancer survivors diagnosed before 40 years of age. METHODS: Five-year survivors of cancer diagnosed before 40 years of age in the Lothian region of Scotland between 1980 and 2018 (n = 8862) were matched (1:3) to individuals without cancer history by age, sex, and socioeconomic deprivation (n = 26,586). Mental-health outcomes were identified from psychotropic drug prescribing, hospital admission and general-practice records. Time to first mental health event was analysed using time-stratified Cox proportional-hazards models. RESULTS: During median follow-up of 14.8 years for survivors and 16.7 years for comparators, 2983 survivors (33.7%) and 6774 comparators (25.5%) experienced a first mental health event. Around 90% of first events were identified in general practice or prescribing records, and fewer than 10% in hospital admissions. Survivors had a consistently higher incidence of first mental health events across follow-up intervals when all data sources were considered, with hazard ratios ranging from 1.3 in the first year after study entry (95% CI 1.2-1.4) to 1.5 beyond 15 years (95% CI 1.4-1.6). CONCLUSIONS: Integrating data sources provides a more comprehensive assessment of the mental health burden than hospital records alone. Mental health should be a core component of long-term survivorship care, particularly within primary care, and cost-effective strategies are needed to address the sustained excess burden.