According to the National Cancer Institute, almost 119,130 women are estimated to be diagnosed with a gynecologic cancer in 2022 (19,880 ovarian, 69,950 uterine, 14,100 cervical, 6330 vulvar, 8870 vaginal) – this is any cancer which starts in a woman’s reproductive organs [1]. Difficulties with mental health well-being often accompany cancer diagnosis and can have lasting impacts on treatment success and length of survivorship [5], [6]. There is a significant gap in our understanding of the long-term mental health risks, particularly depression, among women who have been treated for gynecological cancers when compared to those without a cancer history [12]. While research on the general mental health outcomes of cancer survivors has grown, few studies focus specifically on depression and anxiety among women who have undergone treatment for gynecological cancers. Moreover, differences in mental health outcomes, including depression and anxiety, across racial and ethnic groups have not been adequately evaluated in U.S. cohorts.

Anxiety and depression are comorbid conditions, with poor recognition of both related to poorer quality of life and survival among cancer patients [9], [10] In the general cancer population, the prevalence of anxiety and depression ranges from 8 % to 24 % depending on cancer type, treatment, and duration of treatment [3]. Women previously treated for depression were at risk for receiving non-guideline breast cancer treatment and poorer survival in a large Danish cohort study of 45,325 women with early breast cancer diagnosed between 1998 and 2011 with up to 13 years of follow-up [7]. A separate Danish cohort found a two-fold increased risk for hospitalization due to depression among 608,591 cancer survivors in the first year after diagnosis compared to healthy controls [8].

Patients with early-stage gynecologic cancers tend to demonstrate different psychosocial outcomes based on their primary cancer site. In a sample of 242 patients, those with cervical and vaginal/vulvar cancers reported greater distress, anxiety, and post-traumatic stress disorder (PTSD) symptoms related to their cancer, and those with endometrial cancers reported the lowest scores [4]. Previous research found that one-third of a sample of 199 gynecologic cancer survivors (1–8 years post treatment) reported clinical levels of anxiety, and a diagnosis of anxiety or PTSD resulted in a four-fold increase in unmet needs, including mental health support [11]. An increased risk for use of antidepressants after one year of diagnosis was found among women treated for ovarian, endometrial, and cervical cancer compared to healthy controls [12]. This persisted for all three types of cancers, with ovarian cancer survivors using antidepressants the longest (eight years). Comorbidities, less education, and advanced disease stage were all associated with greater antidepressant use.

Adherence to treatment, difficulties in symptom control may be experienced to a greater degree in women with gynecologic cancers. According to Yang et al., depressive symptoms can result in cervical cancer patients reporting trouble adhering with treatments, difficulties in in symptom control, and longer recoveries which, in turn, decrease perceived quality of life [13]. In a cohort study with follow up to five years post cancer treatment, Chinese cervical cancer patients with anxiety and depressive symptomology were found to have shorter disease-free survival and overall survival, compared with healthy controls [14].

The lack of sufficient information on how race, age, and other demographic factors influence mental health outcomes further complicates the development of comprehensive and effective treatment plans. These gaps contribute to inadequate mental health follow-up and a lack of appropriate services for vulnerable groups such as racial minorities, older women, and those from disadvantaged socio-economic backgrounds. Without a thorough understanding of these factors, healthcare providers may miss critical opportunities to address mental health needs in cancer care.

Black Americans are reported to have lower rates of lifetime major depression compared to their White counterparts 1. However, when depression is present, Black Americans are more likely to describe it as severe and disruptive to their daily functioning 1. This complex relationship between race and depression warrants further evaluation, particularly as it pertains to cancer treatment. Disparities in cancer diagnosis exist among Black and Hispanic women as compared to other races, with both Black and Hispanic women having a greater risk of cervical cancer [2]. Understanding whether similar trends between depression and cancer diagnosis emerge in diverse cancer patient populations is needed to develop evidence-based best practices in mental health care for gynecologic cancer patients. Thus, tailored approaches to treatment are needed that include an emphasis on ensuring mental health care support within the context of race for cancer patients. These approaches account for the impact of cancer treatment on psychological and physical health.

To address this gap, the current study utilizes data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) to investigate whether survivors of gynecologic cancer are at greater risk of developing depressive disorders compared to women with no history of cancer and those with histories of other types of cancer. By examining this relationship, the study aims to better understand the mental health challenges faced by gynecologic cancer survivors and identify potential disparities in risk based on cancer type, race, and other demographic factors. Ultimately, this research seeks to inform better mental health strategies and support systems for women affected by gynecological cancers.