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

Background 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. Methods Using multistate public insurance claims data, we identified 5,946 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). Results Among 4,052 child treatment episodes, 54.6% were in females, 41.5% non-Hispanic White, and 27.4% Hispanic; demographics were similar across 3,871 YA episodes. Utilization was highest among survivors aged 3–11 (any visit: 73.4%; ≥4 visits: 39.8%), followed by those aged 12–17 (67.8%; 33.2%), 18–26 (51.9%; 20.2%), and 27–39 (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, -4.68), as were children in most (vs. least) deprived neighborhoods (marginal effect=-8.80 percentage points; 95% CI=-14.07, -3.53). Similar disparities were observed for any mental health visit. Conclusion Mental health service utilization was low among publicly-insured childhood cancer survivors following 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.