Cancer As Traumatic Stressor: Mental Health Diagnoses, Chronic Stress, and Subjective Health Appraisals In a Nationally Representative U.S. Sample

Background

Subjective health appraisals (i.e., individuals' self-rated perceptions of their physical and mental well-being) are robust predictors of health outcomes and healthcare utilization. Despite their clinical significance, little is known about how co-occurring mental health diagnoses, chronic stress, and serious illness intersect to shape these appraisals across diverse populations. Cancer, in particular, may function as a traumatic stressor that compounds existing psychological vulnerabilities. Using a nationally representative U.S. sample, this study examined how depression, anxiety, PTSD, stress, race/ethnicity, and cancer diagnosis predict subjective physical and mental health appraisals.

Methods

This study utilized the Stress in America 2023 dataset (N = 3,795), a nationally representative survey of U.S. adults collected in 2023 by the Harris Poll in partnership with American Psychological Association. Respondents were ages 18 and older, selected via probability sampling. The survey was conducted by telephone and online. Subjective physical health and subjective mental health served as dependent variables, each measured on a 5-point Likert scale (1 = Poor to 5 = Excellent). Independent variables included self-reported diagnoses of anxiety, depression, and PTSD, race/ethnicity (White, Black, Hispanic, Asian, Indigenous, Other) and gender (female vs. all others). Interaction terms were created to test moderation by cancer diagnosis. Two multivariate ordinary linear regression models were created (one per dependent variable) with a quadratic term for stress included to address a non-linear relationship identified during assumption testing.

Results

The sample was predominantly female (59.13%) and White (47.59%), with approximately 22% endorsing depression and 22% endorsing anxiety. The model for subjective physical health was significant (p < .001, r² = .136). Depression (b= −0.26, p < .001), PTSD (b= −0.16, p < .001), and stress (b= −0.08, p < .001) were all negatively associated with subjective physical health. All racial and ethnic minority groups showed significant negative associations compared to White respondents. Cancer diagnosis was significant (b= −0.59, p = .002) and also moderated the relationships between subjective physical health and PTSD (b= −0.70, p = .03), Asian race (b= −0.46, p = .03), female gender (b= 0.30, p = .03), and stress (b= 0.07, p = .01). The model for subjective mental health was also significant (p < .001, r² = .317). Depression (b= −0.54, p < .001), anxiety (b= −0.28, p < .001), and stress (b= −0.14, p < .001) were negatively associated with subjective mental health appraisal. Cancer moderated the relationship between PTSD and subjective mental health (b= −0.74, p = .02).

Discussion

These findings highlight the complex interplay between mental health diagnoses, stress, and subjective health appraisals across diverse populations. The co-occurrence of cancer and PTSD consistently produced pronounced negative appraisals of physical and mental health, suggesting that cancer may function as a traumatic stressor. Future research should examine how subjective health appraisals develop and influence health-related behaviors and decision-making. Social work practitioners should attend to how intersecting identities and co-occurring diagnoses compound to produce negative self-appraisals.