Disparities in mental health outcomes among lung cancer survivors associated with ruralness of residence

Michael A. Andrykowski, Rachel F. Steffens, Heather M. Bush, Thomas C. Tucker

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Objective Healthy People 2020 identifies elimination of health disparities as a key aim. Rural residence is associated with disparities in cancer screening, physical morbidity, and survival. The present study aimed to identify potential disparities in mental health (MH) outcomes (e.g., anxiety and depression symptoms, distress) in lung cancer (LC) survivors associated with ruralness of residence. Methods Lung cancer survivors (LC group; n = 193; mean age = 63.1 years; mean time since diagnosis = 15.6 months) were recruited from the population-based SEER Kentucky Cancer Registry. LC survivors completed a telephone interview and questionnaire assessing MH outcomes. U.S. Department of Agriculture Rural-Urban Continuum Codes were used to identify Rural (n = 117) and Urban (n = 76) LC survivors. A healthy comparison (HC) group was recruited (n = 152) and completed a questionnaire assessing MH outcomes. Results Across six MH indices, Rural LC survivors reported poorer MH relative to Urban LC survivors with a mean effect size (ES) of 0.43 SD in unadjusted analyses and 0.29 SD in analyses adjusted for education and physical comorbidity. Comparison of the LC and HC groups revealed significant Ruralness × Group interactions for five of six MH indices. The Rural LC group reported poorer MH than the Rural HC group with a mean ES of 0.51 SD. The MH of Urban LC and HC groups did not differ (mean ES = 0.00 SD). Conclusions Rural residence is a risk factor for poorer MH outcomes for LC survivors. The MH of Rural LC survivors may be more negatively impacted by cancer diagnosis and treatment than the MH of Urban LC survivors.

Original languageEnglish
Pages (from-to)428-436
Number of pages9
Issue number4
StatePublished - Apr 2014


  • cancer
  • disparities
  • distress
  • mental health
  • oncology
  • rural
  • survivorship

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health


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