The impact of mental health conditions on attitudes towards help-seeking and diagnostic testing for potential ovarian cancer symptoms: An online vignette study

Background: Mental health conditions may be associated with delayed cancer diagnosis, yet evidence remains limited. We aimed to explore if anxiety and/or depression influence symptom attribution, intended help-seeking, and attitudes towards diagnostic testing for potential ovarian cancer symptoms. Methods: A total of 1839 women aged ≥40 (889 with self-reported anxiety/depression) participated in an online survey. Participants were presented with two hypothetical scenarios (vignettes), one describing red-flag and the other describing vague ovarian cancer symptoms. Using multivariable regression, we examined the association between anxiety/depression and symptom attribution, intended help-seeking and attitudes towards diagnostic testing (one model per outcome), adjusting for sociodemographic characteristics. Results: Compared to women without, those with anxiety/depression had lower odds of attributing vague ovarian cancer symptoms to cancer (adj. OR = 0.74; 95% CI 0.60-0.91). Additionally, they had lower odds of mentioning symptoms if seeing a nurse for another reason (red-flag symptoms: adj. OR = 0.71; 95% CI 0.56-0.90; vague symptoms: adj. OR = 0.80; 95% CI 0.63-1.00) and higher odds of dismissing vague symptoms (adj. OR = 1.32; 95% CI 1.04-1.69). Anxiety/depression was also associated with lower willingness to undergo transvaginal ultrasounds for red-flag symptoms (adj. OR = 0.61; 95% CI 0.40-0.95) and rectovaginal exams for vague symptoms (adj. OR = 0.77; 95% CI 0.59-0.99). Conclusions: The results highlight several mechanisms that could lead to delayed ovarian cancer diagnosis among women with anxiety and/or depression. To facilitate early ovarian cancer diagnosis in this population, targeted interventions are needed, including raising awareness of vague ovarian cancer symptoms, encouraging help-seeking and providing support for diagnostic investigations.