Buffering the burden: health behaviors, mental distress, and sex disparities in U.S. cancer caregivers

Abstract Purpose Cancer caregivers experience heightened psychological distress, yet the cumulative impact of modifiable health behaviors on mental distress remains understudied. We evaluated the association between individual and cumulative protective factors and frequent mental distress (FMD) among U.S. cancer and non-cancer caregivers. Methods A cross-sectional analysis was conducted using data from the 2022 BRFSS data. Adult caregivers were identified and classified according to whether the individual provided care to an individual with cancer. FMD was defined as ≥ 14 days of poor mental health in the past 30 days. Protective factors included sufficient sleep, regular physical activity, non-smoking status, and adequate emotional support. A Cumulative Protective Factor Score (range, 0–4) was constructed. Results Among 10,923 caregivers, 1,483 (13.6%) were cancer caregivers. FMD was more prevalent in cancer caregivers than non-cancer caregivers (314 [21.6%] vs 1,227 [13.0%], p < 0.001), who also reported fewer protective factors. Each individual protective factor was associated with lower odds of FMD (all p < 0.001), although these associations were attenuated among cancer caregivers for sleep, physical activity, and emotional support. Predicted probabilities of FMD declined progressively with increasing cumulative protective factor scores in both cohorts. At the highest score (4), predicted FMD was similar in cancer and non-cancer caregivers (10% vs 7%, p = 0.12). Among cancer caregivers, females exhibited higher predicted FMD than males across all cumulative protective factor levels. Conclusion Cancer caregivers experience disproportionately high mental distress, particularly when protective resources are limited. However, the co-occurrence of multiple health-promoting behaviors and emotional support may offset this burden. Sex-based disparities persisted, underscoring the need for tailored, caregiver-centered support strategies. Implications for Cancer Survivors Supporting caregivers of cancer survivors through interventions that promote healthy behaviors and emotional support may reduce mental distress and improve survivorship care outcomes.