School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA.
Adolescent and Young Adult Oncology Program, Michigan Medicine, Ann Arbor, MI 48109, USA.
Curr Oncol. 2021 Oct 11;28(5):4042-4052. doi: 10.3390/curroncol28050343.
Self-rated health (SRH) is a salient patient outcome for cancer survivors, and depressive mood and education are known determinants of cancer survivors' SRH. Moving beyond the well-established direct association between depressive mood, education, and SRH among cancer survivors, this epidemiological study investigated the pathoplastic role of education on depressive mood in relation to SRH among a nationally representative sample of cancer survivors in the United States.
The 2019 National Health Interview Survey was analyzed using data from adult participants (≥18 years old) who self-reported as cancer survivors ( = 3844). Ordered logistic regression was used to evaluate the direct impact of depressive mood and education in relation to SRH. In addition, the pathoplastic moderating effect was evaluated using ordered logistic regression with an interaction term of depressive mood and education in the regression model. All analyses adjusted for complex sample weights so that findings are nationally representative.
After adjusting for all covariates, U.S. cancer survivors' depressive mood was significantly associated with lower SRH, and U.S. cancer survivors' higher education was significantly associated with higher SRH. As a pathoplastic moderator, cancer survivors' education significantly moderated the association between depressive mood and SRH. The negative association between depressive mood and SRH was significantly greater among those with higher education.
Moving beyond the direct association between depressive mood, education, and SRH, education served as a pathoplastic moderator in relation to depressive mood and SRH. Psycho-oncology providers need to be mindful of the "protective-risk" effect of education in relation to cancer survivors' depressive mood and SRH.
自评健康（SRH）是癌症幸存者的一个重要患者结局，抑郁情绪和教育是已知的影响癌症幸存者 SRH 的决定因素。本研究超越了抑郁情绪、教育与癌症幸存者 SRH 之间已确立的直接关联，通过对美国具有全国代表性的癌症幸存者样本进行流行病学研究，探讨了教育在抑郁情绪与 SRH 之间的病理塑造作用。
使用 2019 年全国健康访谈调查中来自自我报告为癌症幸存者的成年参与者（≥18 岁，n=3844）的数据进行分析。采用有序逻辑回归评估抑郁情绪和教育与 SRH 的直接影响。此外，还通过回归模型中的抑郁情绪和教育交互项评估了病理塑造的调节作用。所有分析均采用复杂样本权重进行调整，以使研究结果具有全国代表性。
在调整了所有协变量后，美国癌症幸存者的抑郁情绪与较低的 SRH 显著相关，而较高的教育与较高的 SRH 显著相关。作为一个病理塑造的调节因素，癌症幸存者的教育显著调节了抑郁情绪和 SRH 之间的关系。在受教育程度较高的人群中，抑郁情绪与 SRH 之间的负相关显著更大。
本研究超越了抑郁情绪、教育与 SRH 之间的直接关联，教育在抑郁情绪与 SRH 之间具有病理塑造调节作用。心理肿瘤学服务提供者需要注意教育在癌症幸存者的抑郁情绪和 SRH 方面的“保护-风险”作用。
