The Role of Social Engagement and Support in the Association Between Combined Caregiver-Cancer Survivor Status and Depressive Symptoms.

BACKGROUND AND OBJECTIVES: This study examined the overall impact of dual role status (cancer survivor and caregiver) compared with caregivers who were not cancer survivors, cancer survivors who were not caregivers, and noncaregivers and not cancer survivors, on depressive symptoms. We also explored the potential mediating role of social engagement and support in the association between combined cancer-caregiver status and depressive symptoms. RESEARCH DESIGN AND METHODS: We analyzed cross-sectional data from the National Social Life, Health, and Aging Project. We used causal mediation analysis methods to examine social engagement and social support as mediators of the association between intersections of cancer survivor and caregiver status and depressive symptoms. Models were adjusted for age, sex, ethnicity, race, education, household size, and partnership status. RESULTS: Cancer survivors with caregiving responsibilities had higher levels of depressive symptoms compared to caregivers only (Estimate=1.440, SE=0.423, p<0.001), cancer survivors only (Estimate=1.286, SE=0.390, p<0.001), and noncaregivers who were not cancer survivors (Estimate=1.590, SE=0.372, p<0.001). A significant indirect effect of combined cancer-caregiver status on depressive symptoms was found through family support (Estimate=-0.099, 95%CI: -0.189;-0.020) and through reliance on partner (Estimate=0.124, 95%CI: 0.021;0.260). DISCUSSION: Cancer survivors with caregiving responsibilities reported higher depressive symptoms but also reported more family support and less reliance on their partners, which were associated with fewer depressive symptoms. IMPLICATIONS: Cancer survivors face unique challenges as family caregivers. Attention to the unique needs of this group, including higher risk of depressive symptoms and complex social relationships, should be a priority for intervention efforts in public health.