Association of Skin Cancer With Clinical Depression and Poor Mental Health Days: Cross-Sectional Analysis

Mental health is becoming increasingly recognized as an important part of overall health, especially for patients with cancer. However, the relationship between nonmelanoma skin cancer and mental health has not been widely studied.

The aim of this study was to examine the association between nonmelanoma skin cancer diagnosis and 2 key mental health outcomes (ie, clinical depression and the number of poor mental health days).

This study used the 2023 Behavioral Risk Factor Surveillance System, a nationally representative survey of adults in the United States, which included 312,317 participants. Nonmelanoma skin cancer diagnosis, depression, and self-reported mental health days were analyzed. Logistic regression was used to evaluate the association between nonmelanoma skin cancer and depression, whereas Poisson regression was used to model the number of poor mental health days, adjusting for age, sex, race and ethnicity, education, BMI, income, and major comorbid conditions (other cancers, heart disease, lung disease, and kidney disease).

Individuals with nonmelanoma skin cancer (5086/26,552, 19.15%) reported a lower overall rate of depression compared to those without nonmelanoma skin cancer (61,438/285,765, 21.50%; P<.001) but reported more poor mental health days on average (4.54, SD 8.37 d vs 3.20, SD 7.37 d; P<.001). After adjustment, nonmelanoma skin cancer diagnosis was not significantly associated with depression (adjusted odds ratio 1.01, 95% CI 0.98-1.05) and was associated with a slightly lower number of poor mental health days (adjusted rate ratio 0.94, 95% CI 0.91-0.97).

Adults with nonmelanoma skin cancer experienced a meaningful mental health burden, and unadjusted analyses suggested greater day-to-day distress than among adults without nonmelanoma skin cancer. However, these differences were reduced and no longer significant for depression after adjusting for sociodemographic factors and comorbid chronic illnesses. These findings support the need for mental health screenings and support services in dermatologic and oncologic care.