# Mental health service utilization in publicly insured survivors of childhood cancer: a claims-based analysis

## TL;DR

Publicly insured childhood cancer survivors have low mental health service use, with disparities by age, ethnicity, and neighborhood deprivation.

## Contribution

This study provides objective data on mental health service utilization and disparities among publicly insured childhood cancer survivors.

## Key findings

- Utilization of mental health services was highest among survivors aged 3–11 years and lowest among those aged 27–39 years.
- Hispanic children and those in deprived neighborhoods were less likely to have ≥4 mental health visits compared to non-Hispanic White children and those in least deprived areas.
- Disparities in mental health service use were observed for both any visit and ≥4 visits within 12 weeks of treatment episode initiation.

## Abstract

Childhood cancer survivors face long-term psychological challenges, including depression, trauma/stress, and anxiety. However, objective assessments of mental health service utilization among child and young adult (YA) survivors of childhood cancer remain limited. We examined mental health care utilization among publicly insured childhood cancer survivors and disparities by sociodemographic and neighborhood-level factors.

Using multistate public insurance claims data, we identified 5946 survivors (diagnosed ≤21 years) who completed cancer therapy; initiated treatment episode(s) for depression, trauma/stress, or anxiety post cancer therapy; and maintained continuous coverage. Logistic regressions examined factors associated with having any mental health visit and ≥4 visits within 12 weeks of treatment episode initiation in children (ages 3-17) and YAs (ages 18-39).

Among 4052 child treatment episodes, 54.6% were in female survivors, 41.5% non-Hispanic White survivors, and 27.4% Hispanic survivors; demographics were similar across 3871 YA episodes. Utilization was highest among survivors aged 3–11 years (any visit: 73.4%; ≥4 visits: 39.8%), followed by those aged 12–17 years (67.8%; 33.2%), 18–26 years (51.9%; 20.2%), and 27–39 years (43.3%; 16.4%). Hispanic children were less likely than non-Hispanic White peers to have ≥4 mental health visits (marginal effect = –8.73 percentage points; 95% CI = –12.78 to –4.68), as were children in most (vs least) deprived neighborhoods (marginal effect = –8.80 percentage points; 95% CI = –14.07 to –3.53). Similar disparities were observed for any mental health visit.

Mental health service utilization was low among publicly insured childhood cancer survivors after mental health diagnosis, with notable disparities by age, ethnicity, and geographic location, underscoring the need for interventions to improve psychological support in this underserved population.