Inaccessible mental health care is a risk factor for risky drinking behaviors among cancer survivors: an All of Us survey-based cohort study.

PURPOSE: Access to mental health care services and the impact on substance use among cancer survivors has not been well-defined. Patients with cancer may be at particular risk of mental health challenges and excessive alcohol consumption. We sought to characterize the impact of mental health care access on drinking behaviors among cancer survivors. METHODS: Data on cancer survivors were obtained from the National Institutes of Health All of Us Research Program from the Basics, Overall Health, and the personal and family health history surveys. The association of access to mental health care and moderate drinking and binge drinking was assessed using multivariable logistic regression. RESULTS: Among 18,879 cancer survivors, the majority was female (n = 12,160, 64.5%) and White (n = 14,576, 77.4%). Overall, 1934 participants (13.6%) reported exceeding moderate drinking, and 3507 (24.4%) reported binge drinking. Among participants with at least one mental health diagnosis, the most frequently reported condition was major depression (n = 3999, 72.9%), followed by anxiety disorder (n = 2648, 48.2%) and post-traumatic stress disorder (PTSD; n = 1113, 20.3%); 5.4% respondents reported that in the past 12 months needing mental health counseling but were unable to obtain it due to cost. Individuals who reported an unmet mental health need more often exceeded moderate drinking (21.3% vs 13.2%) or binge drank (35.3% vs 23.8%) (both p < 0.001). On multivariable analysis, inability to access mental health care was independently associated with exceeding moderate drinking (OR 1.48, 95% CI 1.16-1.89, p = 0.001) and binge drinking (OR 1.36, 95% CI 1.10-1.66, p = 0.004), even among participants without preexisting mental illness. CONCLUSION: Limited access to mental health care access was associated with an increased risk of risky drinking behaviors and excessive alcohol consumption. These findings support the integration of routine mental health screening and affordable counseling services into survivorship care pathways and highlight the need for policy efforts to close gaps in mental health care access.