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May 8, 2026JNCI Cancer Spectrum0 citationsOpen Access

Psychosocial factors and overall mortality after prostate cancer diagnosis among predominantly low-income Black and White adults

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DDDouglas DeMoulinLLLoren LipworthMAMelinda C. Aldrich

Key Result

Major depressive symptoms were associated with increased mortality in White prostate cancer patients (aHR 2.56; 95% CI 1.13-5.77), with a significant race-depression interaction (P=0.02).

Key Points

  • This study investigates the impact of psychosocial factors on mortality following a prostate cancer diagnosis in low-income populations.
  • Utilized data from the Southern Community Cohort Study with 1,367 prostate cancer patients (1,058 Black, 309 White).
  • Applied the Kaplan-Meier method for survival rates and multivariable Cox models for hazard ratio estimation.
  • Conducted follow-up over 18 years to assess psychosocial-mortality associations.
  • 291 Black (27.5%) and 59 White (19.1%) PCa patients died, with a significant difference (P=0.03).
  • White men with major depressive symptoms had 11% (aHR=2.56, 95% CI=1.13-5.77) and inability to control life aspects had 12% (aHR=2.30, 95% CI=1.07-4.95) lower 5-year survival rates.
  • Among Black patients, each SD increase in depression score was associated with lower survival (aHR=0.84, 95% CI=0.74-0.96).

Study Design

Type

Cohort (n=1,367)

Multicenter

Yes

Structured PICO

Do psychosocial factors like depressive symptoms and perceived lack of control affect overall mortality in low-income Black and White men with prostate cancer?

P
Population
1,367 men (1,058 Black and 309 White) aged 40 to 79 from predominantly low-income backgrounds diagnosed with prostate cancer during follow-up in the Southern Community Cohort Study across 12 southeastern states.
I
Intervention
Self-reported major depressive symptoms and inability to control important things in life (ITC)
C
Comparator
Absence of self-reported major depressive symptoms and ITC
O
Outcome
Overall mortality over 18 years of follow-uphard clinical

Psychosocial factors such as depressive symptoms and perceived lack of control are associated with increased mortality in White men with prostate cancer, but associations differ significantly by race.

Main Result

Effect estimate: aHR 2.56 (95% CI 1.13-5.77)

p-value: p=0.01

Abstract

INTRODUCTION: Psychosocial factors may influence PCa survival, but evidence is limited for low-income populations. METHODS: This study utilized data from the Southern Community Cohort Study (SCCS), a prospective cohort of ∼85,000 individuals aged 40 to 79, from predominantly low-income backgrounds, enrolled between 2002 to 2009 across 12 southeastern states. A total of 1,367 men (1,058 Black and 309 White) found with PCa during the follow-up of 34,313 men were included. The Kaplan-Meier method was used to generate 5-year survival rates with log-rank tests for statistical significance. Multivariable Cox models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for psychosocial-mortality associations. RESULTS: Over 18-years of follow-up, 291 Black (27.5%) and 59 White (19.1%) PCa patients died (P=0.03). White men self-reporting major depressive symptoms and their inability to control important things in life (ITC) had an 11% (Psurvival = 0.01) and 12% (Psurvival = 0.01) lower 5-year survival compared to those that didn't, with aHR of 2.56, (95% CI = 1.13-5.77) and 2.30 (95% CI = 1.07-4.95), respectively. Inverse associations were found for per SD increase in depression score (aHR = 0.84, 95%CI = 0.74-0.96.) among black patients. Testing for multiplicative interaction was significant for race-depression (Pinteraction = 0.02) and race-ITC (Pinteraction 0.04). The associations were mainly seen among PCa cases diagnosed within 5 years after baseline survey. CONCLUSION: Psychosocial-mortality associations among PCa patients are complex and may not affect individuals equally. Programs aiming to reduce mortality for individuals with PCa should consider their psychosocial needs and demographic background.

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Cite This Study

DeMoulin et al. (2026) conducted a cohort in Prostate cancer (n=1,367). Major depressive symptoms and inability to control important things vs. Absence of these symptoms was evaluated on Overall mortality (aHR 2.56, 95% CI 1.13-5.77, p=0.01). Major depressive symptoms were associated with increased mortality in White prostate cancer patients (aHR 2.56; 95% CI 1.13-5.77), with a significant race-depression interaction (P=0.02).

synapsesocial.com/papers/69fd7f25bfa21ec5bbf078c2https://doi.org/10.1093/jncics/pkag029
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