Abstract
OBJECTIVE: We examined the prevalence of psychological distress and its association with emergency room (ER) usage and all-cause mortality among colorectal cancer (CRC) survivors. METHODS: We utilized data from the 2000-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files. The main exposure was psychological distress, assessed with the six-item Kessler Psychological Distress Scale (K6) and classified as (no/low, moderate, severe). The outcomes were ER usage during the past 12 months and all-cause mortality. Multivariable logistic and Cox proportional hazards models were used to examine the associations between psychological distress and ER usage and all-cause mortality, respectively. RESULTS: A total of 3198 CRC survivors were included in the study, of whom 4.1% and 19.6% reported severe and moderate psychological distress, respectively. Approximately 30% of CRC survivors had ER use, and 41.5% of deaths occurred with a median follow-up of 84 months. In the adjusted model, compared to CRC survivors with low/no psychological distress, those with severe (aOR = 1.83; 95% CI, 1.10-3.04) or moderate (aOR = 1.60; 95% CI, 1.21-2.10) psychological distress had higher odds of reporting ER use. However, there was no statistically significant association between psychological distress and all-cause mortality. CONCLUSION: CRC survivors with severe or moderate psychological distress have higher ER usage. This finding emphasizes the significance of timely identifying and addressing psychological distress to improve the quality of life and clinical outcomes of patients diagnosed with CRC. Integrating mental health support into routine cancer care may reduce distress levels, potentially leading to fewer ER usages among CRC survivors.