Breaking the Silence: A Mixed Methods Analysis Unveiling Barriers to Mental Health Service Use in Breast Cancer Survivors With Clinically Significant Distress
4 affiliations
- 1Indiana University School of Medicine Indianapolis Indiana USA
- 2Department of Biostatistics and Health Data Science Indiana University School of Medicine Indianapolis Indiana USA
- 3Richard M. Fairbanks School of Public Health Indiana University Indianapolis Indianapolis Indiana USA
- 4William M. Tierney Center for Health Services Research Regenstrief Institute, Inc. Indianapolis Indiana USA
Abstract
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
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BibTeX
@article{danner2026breaking,
title = {{Breaking the Silence: A Mixed Methods Analysis Unveiling Barriers to Mental Health Service Use in Breast Cancer Survivors With Clinically Significant Distress}},
author = {Ana Danner and Tayler Gowan and Madison Schwarz and Matthew Hays and Yang Li and Shelley A. Johns},
journal = {Psycho-Oncology},
year = {2026},
month = oct,
doi = {10.1002/pon.70599},
url = {https://doi.org/10.1002/pon.70599},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Breaking the Silence: A Mixed Methods Analysis Unveiling Barriers to Mental Health Service Use in Breast Cancer Survivors With Clinically Significant Distress
AU - Ana Danner
AU - Tayler Gowan
AU - Madison Schwarz
AU - Matthew Hays
AU - Yang Li
AU - Shelley A. Johns
PY - 2026
DA - 2026/10/27
JO - Psycho-Oncology
DO - 10.1002/pon.70599
UR - https://doi.org/10.1002/pon.70599
AB - 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
SN - 1057-9249
SN - 1099-1611
ER -