Serious Psychological Distress and Unmet Mental Health Care Need Among U.S. Adult Cancer Survivors: NHIS 2024

Importance Serious psychological distress (SPD) and unmet mental health care need are commonly used to characterize mental health burden among cancer survivors, yet they are often treated as interchangeable indicators. Whether these constructs identify the same at-risk survivors in the contemporary, post-pandemic context remains unclear. Objective To examine the prevalence, overlap, and distinct correlates of SPD and unmet mental health care need among U.S. adult cancer survivors using nationally representative data. Design, Setting, and Participants This cross-sectional study used data from the 2024 National Health Interview Survey (NHIS), a nationally representative survey of the U.S. civilian, noninstitutionalized population. The analytic sample included 3,680 adults with a history of cancer. Survey-weighted analyses accounted for NHIS sampling weights, stratification, and clustering. Exposures Sociodemographic characteristics, healthcare access factors (including insurance status, transportation barriers, and telehealth use), and psychosocial measures (loneliness, perceived social support, and life satisfaction). Main Outcomes and Measures Clinically significant psychological distress, defined as a Kessler-6 score ≥ 13, and unmet mental health care need, defined as self-reported inability to obtain needed mental health counseling or treatment in the past 12 months. Survey-weighted logistic regression models were used to estimate unadjusted and mutually adjusted associations. Results SPD and unmet mental health care need demonstrated partial overlap but identified distinct subgroups of cancer survivors. In mutually adjusted models, psychosocial vulnerability showed the strongest and most consistent associations with SPD, particularly frequent loneliness (adjusted odds ratio [aOR], 5.34; 95% CI, 2.47–11.57), low social support (aOR, 2.78; 95% CI, 1.36–5.69), and dissatisfaction with life (aOR, 3.60; 95% CI, 1.51–8.57). In contrast, unmet mental health care need followed a different pattern, with higher odds associated with younger age, female sex, psychosocial vulnerability, and indicators of healthcare access and structural barriers, including insurance status and transportation barriers. Telehealth use was associated with both outcomes, likely reflecting underlying care-seeking behavior or need rather than a causal relationship. Conclusions and Relevance Among U.S. adult cancer survivors, SPD and unmet mental health care need represent overlapping but non-equivalent dimensions of mental health burden. Psychosocial vulnerability was most strongly associated with distress, whereas unmet need more closely reflected access-related barriers to care. These findings underscore the importance of survivorship approaches that integrate psychosocial screening with strategies to reduce structural barriers to mental health services in the post-pandemic healthcare landscape.