ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Mental Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1539180
This article is part of the Research TopicExploring Bereavement and Public Health: The Role of Family and Friend Caregivers in Community Well-BeingView all articles
Risk of Mental Health Conditions in Bereavement: A Population-Based Analysis of Lung Cancer Spouses
Provisionally accepted
Djin Tay1*
Kline Dubose1Jonathan Chipman1Lee Ellington1
Mia Hashibe1
Eli Iacob1Caroline Stephens1Katherine A Ornstein2- 1The University of Utah, Salt Lake City, United States
- 2Johns Hopkins University, Baltimore, Maryland, United States
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Background. Lung cancer caregiving is distressing, isolating, and associated with a high burden of anxiety and depression. However, few population-based studies have examined lung cancer spouses' risk of mental health conditions (MHC) after the death of their partner in the US. Guided by Anderson's Behavioral Health Utilization model, we examined the role of sex, pre-bereavement MHC, and decedents' healthcare utilization on the risk of having a diagnosed MHC after the death of a lung cancer patient.Methods. This retrospective cohort study linked state-wide health facility records of 1,224 dyads-deceased lung cancer patients and their bereaved spouses (824 females, 400 males) in Utah between 2013 and 2021. Bereavement-related mood/stress-related conditions were identified for spouses using diagnostic codes (day 1 onwards after patients' deaths). Kaplan-Meier curves and Cox proportional hazard models estimating the risk for a composite outcome of MHC/death and risk of MHC adjusting for censorship due to death were conducted, adjusting for covariates.Results. The majority of spouses were aged 65+ (female: 67%; male: 33%), white/non-Hispanic (female: 89%; male: 90%), and urban dwelling (female: 69%; male: 71%). Spouses experienced 374 events (MHCs/death) across the follow-up period. Adjusting for census-tract level income, cancer stage, insurance, censoring due to death, and the interaction between sex and MHC, spouses with preexisting MHCs had 4.09 times the risk of MHCs during bereavement (95% CI: 2.70, 6.19) compared with spouses without pre-existing MHCs. Spouses of decedents with some college education (aHR 0.68, 95% CI=0.48-0.97), and longer survival (aHR 0.85, 95% CI=0.74-0.99) had a lower risk of MHCs compared with patients with high school educations and shorter survival.Discussion. This population-based study supports evidence for multi-level risk factors associated with having an MHC after the death of a spouse with lung cancer. Findings suggest the need for targeted bereavement support for subgroups of spouses at greater risk for MHCs.
Keywords: bereavement, Neoplasms, Caregiver stress, Mental Health, Epidemiologic Studies
Received: 03 Dec 2024; Accepted: 14 Apr 2025.
Copyright: © 2025 Tay, Dubose, Chipman, Ellington, Hashibe, Iacob, Stephens and Ornstein. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Djin Tay, The University of Utah, Salt Lake City, United States
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