{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:39:28Z","timestamp":1793399968395,"version":"4.5.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>There are more than 2.1 million adult survivors of cancer diagnosed in adolescence and young adulthood (AYA) in the US. Although the mental health burden during treatment has been well documented, the long-term mental health trajectories of survivors of AYA cancer into later adulthood have not been explored.<\/jats:p><\/jats:sec>Objective<\/jats:title>To understand the prevalence and trajectories of mental health challenges among middle-aged or older survivors of AYA cancer compared with those who received a diagnosis as adults or individuals without cancer.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used cross-sectional data from the Health and Retirement Study (HRS) to characterize mental health outcomes for US adults older than 50 years and longitudinal data to examine trajectories of mental health outcomes. The study started on September 1, 2023. HRS is a longitudinal, population-based national sample that interviews approximately 20\u202f000 participants every 2 years since 1992 on topics related to health, employment, income, and others.<\/jats:p><\/jats:sec>Exposure<\/jats:title>A diagnosis of cancer during AYA, defined as ages 15 to 39 years.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were lifetime prevalence of psychiatric issues, prescription medication for anxiety and\/or depression, meeting criteria for Major Depressive Disorder using Composite International Diagnostic Interview\u2013Short Form scoring, depression symptoms using the Center for Epidemiological Studies\u2013Depression measure, and anxiety symptoms using items from the Beck Anxiety Inventory.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 39\u202f668 respondents (22\u202f166 female [55.88%]; mean [SE] age at HRS entry, 59 [0.05] years; age range, 18-103 years; 7699 Black or African American [19.41%]; 28\u202f459 White [71.74%]; 3402 other race [8.58%], which includes American Indian and Asian; and 108 [0.27%] missing) were identified who reported having cancer as an AYA (374 respondents), receiving a first-time cancer diagnosis after study onset as adults (5045 respondents), or never having cancer (34\u202f249 respondents). Cross-sectional estimates revealed survivors of AYA cancer had the highest prevalence of lifetime psychiatric issues (16.36% [95% CI, 7.17%-25.55%] to 37.80% [95% CI, 26.55%-49.06%]), prescription anxiety and\/or depression medication (25.10% [95% CI, 17.09%-33.10%] to 33.78% [95% CI, 23.93%-43.64%]), and meeting major depression criteria (13.13% [95% CI, 6.08%-20.18%] to 20.96% [12.91%-29.01%]) versus other cohorts. Compared with adult cancer survivors and even after adjusting for demographic covariates, AYA cancer survivors had higher odds of lifetime psychiatric issues (in 4 of 14 waves), similar odds of taking anxiety or depression medications, and higher odds of meeting major depression criteria (in 3 of 7 waves). Linear mixed-effects growth models revealed age-dependent U-shaped trajectories for depression and anxiety symptoms but significantly higher mean levels of symptoms among AYA cancer survivors. A flattening of anxiety symptoms later in life was only observed for AYA cancer survivors.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, survivors of AYA cancer reported significantly worse mental health trajectories into middle or older adulthood, compared with individuals who experienced cancer as adults or never had it. Cancer clinicians should recognize the mental health burden for this population into middle age and older adulthood.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.11430","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T15:31:20Z","timestamp":1747668680000},"page":"e2511430","source":"Crossref","is-referenced-by-count":20,"title":["Mental Health Trajectories Among US Survivors of Adolescent and Young Adult Cancer as They Age"],"prefix":"10.1001","volume":"8","author":[{"given":"Anao","family":"Zhang","sequence":"first","affiliation":[{"name":"University of Michigan School of Social Work, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Urban-Wojcik","sequence":"additional","affiliation":[{"name":"University of Michigan Eisenberg Family Depression Center, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Seewald","sequence":"additional","affiliation":[{"name":"University of Michigan Eisenberg Family Depression Center, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Zebrack","sequence":"additional","affiliation":[{"name":"University of Michigan School of Social Work, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"issue":"49","key":"zoi250389r1","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1093\/jncimonographs\/lgu019","article-title":"Adolescent and young adult cancer survival.","volume":"2014","author":"Lewis","year":"2014","journal-title":"J Natl Cancer Inst Monogr"},{"issue":"1","key":"zoi250389r2","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.soncn.2014.11.006","article-title":"Emerging issues among adolescent and young adult cancer survivors.","volume":"31","author":"Patterson","year":"2015","journal-title":"Semin Oncol Nurs"},{"issue":"8","key":"zoi250389r3","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27789","article-title":"Psychosocial issues for adolescent and young adult cancer patients in a global context: a forward-looking approach.","volume":"66","author":"Levin","year":"2019","journal-title":"Pediatr Blood Cancer"},{"issue":"6","key":"zoi250389r4","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s11764-017-0613-4","article-title":"Patterns of unmet needs in adolescent and young adult (AYA) cancer survivors: in their own words.","volume":"11","author":"Wong","year":"2017","journal-title":"J Cancer Surviv"},{"issue":"5","key":"zoi250389r5","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1002\/pbc.24446","article-title":"Antidepressant use among survivors of childhood, adolescent and young adult cancer: a report of the Childhood, Adolescent and Young Adult Cancer Survivors (CAYACS) Research Program.","volume":"60","author":"Deyell","year":"2013","journal-title":"Pediatr Blood Cancer"},{"issue":"5","key":"zoi250389r6","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1002\/cncr.30417","article-title":"Mental distress and health care use among survivors of adolescent and young adult cancer: a cross-sectional analysis of the National Health Interview Survey.","volume":"123","author":"Kaul","year":"2017","journal-title":"Cancer"},{"issue":"6","key":"zoi250389r7","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1002\/ijc.31337","article-title":"Mental health of long-term survivors of childhood and young adult cancer: a systematic review.","volume":"143","author":"Friend","year":"2018","journal-title":"Int J Cancer"},{"issue":"2","key":"zoi250389r8","doi-asserted-by":"publisher","first-page":"171","DOI":"10.31887\/DCNS.2015.17.2\/epark","article-title":"Depression in adolescents and young adults with cancer.","volume":"17","author":"Park","year":"2015","journal-title":"Dialogues Clin Neurosci"},{"issue":"17","key":"zoi250389r9","doi-asserted-by":"publisher","first-page":"18354","DOI":"10.1002\/cam4.6435","article-title":"Prevalence and risk of psychological distress, anxiety and depression in adolescent and young adult (AYA) cancer survivors: a systematic review and meta-analysis.","volume":"12","author":"Osmani","year":"2023","journal-title":"Cancer Med"},{"key":"zoi250389r10","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jad.2020.09.065","article-title":"Depression reported by US adults in 2017-2018 and March and April 2020.","volume":"278","author":"Daly","year":"2021","journal-title":"J Affect Disord"},{"issue":"13","key":"zoi250389r11","doi-asserted-by":"publisher","first-page":"1952","DOI":"10.1016\/j.ejca.2007.05.031","article-title":"Health-related quality of life, anxiety and depression among adolescents and young adults with cancer: a prospective longitudinal study.","volume":"43","author":"J\u00f6rng\u00e5rden","year":"2007","journal-title":"Eur J Cancer"},{"issue":"15","key":"zoi250389r12","doi-asserted-by":"publisher","first-page":"10073","DOI":"10.1200\/JCO.2016.34.15_suppl.10073","article-title":"Death anxiety, psychological distress, and quality of life (QOL) in adolescent and young adult (AYA) cancer patients with hematologic malignancies in early survivorship.","volume":"34","author":"Hlubocky","year":"2016","journal-title":"J Clin Oncol"},{"issue":"3","key":"zoi250389r13","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1093\/jnci\/djae250","article-title":"Prevalence of cancer survivors diagnosed during adolescence and young adulthood in the United States.","volume":"117","author":"Page","year":"2025","journal-title":"J Natl Cancer Inst"},{"issue":"3","key":"zoi250389r14","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1093\/jnci\/djae284","article-title":"Life after cancer matters: supporting 2.1 million survivors of adolescent and young adult cancer.","volume":"117","author":"Williams","year":"2025","journal-title":"J Natl Cancer Inst"},{"issue":"7","key":"zoi250389r15","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1007\/s00520-023-07822-3","article-title":"Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors?","volume":"31","author":"Wu","year":"2023","journal-title":"Support Care Cancer"},{"issue":"57","key":"zoi250389r16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1093\/jncimonographs\/lgab003","article-title":"Survivorship in adolescents and young adults with cancer.","volume":"2021","author":"Yarbrough","year":"2021","journal-title":"J Natl Cancer Inst Monogr"},{"issue":"2","key":"zoi250389r17","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1093\/ije\/dyu067","article-title":"Cohort profile: the Health and Retirement Study (HRS).","volume":"43","author":"Sonnega","year":"2014","journal-title":"Int J Epidemiol"},{"issue":"9596","key":"zoi250389r18","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"1","key":"zoi250389r19","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1745-0179-4-8","article-title":"Development, reliability and factor analysis of a self-administered questionnaire which originates from the World Health Organization\u2019s Composite International Diagnostic Interview: Short Form (CIDI-SF) for assessing mental disorders.","volume":"4","author":"Gigantesco","year":"2008","journal-title":"Clin Pract Epidemiol Ment Health"},{"issue":"3","key":"zoi250389r20","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D Scale: a self-report depression scale for research in the general population.","volume":"1","author":"Radloff","year":"1977","journal-title":"Appl Psychol Meas"},{"issue":"1","key":"zoi250389r21","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/0887-6185(92)90026-4","article-title":"Reliability and validity of the Beck Anxiety Inventory.","volume":"6","author":"Fydrich","year":"1992","journal-title":"J Anxiety Disord"},{"issue":"9","key":"zoi250389r22","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1093\/jnci\/djae119","article-title":"Survivorship after adolescent and young adult cancer: models of care, disparities, and opportunities.","volume":"116","author":"Berkman","year":"2024","journal-title":"J Natl Cancer Inst"},{"key":"zoi250389r23","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-024-01597-0","article-title":"Health-related conditions among long-term cancer survivors diagnosed in adolescence and young adulthood (AYA): results of the SURVAYA Study.","author":"Janssen","year":"2024","journal-title":"J Cancer Surviv"},{"issue":"27","key":"zoi250389r24","doi-asserted-by":"publisher","first-page":"3161","DOI":"10.1200\/JCO.20.00722","article-title":"Chronic comorbidities among survivors of adolescent and young adult cancer.","volume":"38","author":"Chao","year":"2020","journal-title":"J Clin Oncol"},{"issue":"6","key":"zoi250389r25","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkac077","article-title":"Psychiatric disorder incidence among adolescents and young adults aged 15-39 with cancer: population-based cohort.","volume":"6","author":"Rosgen","year":"2022","journal-title":"J Natl Cancer Inst Cancer Spectr"},{"issue":"8","key":"zoi250389r26","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1001\/jamapsychiatry.2013.193","article-title":"The trajectory of depressive symptoms across the adult life span.","volume":"70","author":"Sutin","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"zoi250389r27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2019.100399","article-title":"Changes in depressive symptoms over age among older Americans: differences by gender, race\/ethnicity, education, and birth cohort.","volume":"7","author":"Abrams","year":"2019","journal-title":"SSM Popul Health"},{"key":"zoi250389r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2022.101125","article-title":"A life course view on depression: social determinants of depressive symptom trajectories over 25 years of Americans\u2019 changing lives.","volume":"18","author":"Sinkewicz","year":"2022","journal-title":"SSM Popul Health"},{"issue":"17","key":"zoi250389r29","doi-asserted-by":"publisher","first-page":"18381","DOI":"10.1002\/cam4.6444","article-title":"Mental health patient-reported outcomes among adolescents and young adult cancer survivors: a systematic review.","volume":"12","author":"Tanner","year":"2023","journal-title":"Cancer Med"},{"issue":"9","key":"zoi250389r30","doi-asserted-by":"publisher","first-page":"1596","DOI":"10.1016\/j.ejca.2010.03.001","article-title":"Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence.","volume":"46","author":"Seitz","year":"2010","journal-title":"Eur J Cancer"},{"issue":"1","key":"zoi250389r31","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.annepidem.2015.11.001","article-title":"Role of survivor bias in pancreatic cancer case-control studies.","volume":"26","author":"Hu","year":"2016","journal-title":"Ann Epidemiol"},{"key":"zoi250389r32","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.canep.2018.12.005","article-title":"Bias in survival estimates created by a requirement for consent to enter a clinical breast cancer registry.","volume":"58","author":"Elwood","year":"2019","journal-title":"Cancer Epidemiol"},{"issue":"8","key":"zoi250389r33","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1093\/gerona\/glab126","article-title":"Advancing survivorship in older adults with cancer.","volume":"76","author":"Dumontier","year":"2021","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"1","key":"zoi250389r34","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1002\/pon.5788","article-title":"Challenges experienced and resources identified by young to midlife couples 1-3 years post-cancer diagnosis.","volume":"31","author":"Lyons","year":"2022","journal-title":"Psychooncology"},{"issue":"8","key":"zoi250389r35","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1093\/jnci\/djj154","article-title":"Cancer survivorship: the interface of aging, comorbidity, and quality care.","volume":"98","author":"Rowland","year":"2006","journal-title":"J Natl Cancer Inst"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2834242\/zhang_2025_oi_250389_1747078174.24378.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T15:31:20Z","timestamp":1747668680000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2834242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.11430","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]}}}