Mental Health Distress in Nonmelanoma Skin Cancer Largely Driven by Sociodemographic, Comorbid Factors

Adults with nonmelanoma skin cancer reported higher unadjusted levels of day-to-day mental distress, but adjusted analyses showed no significant association with depression and a slight decrease in poor mental health days, according to a study published in JMIR Dermatology.¹

Mental Health Knowledge Gaps in Nonmelanoma Skin Cancer

Mental health is increasingly recognized as closely intertwined with physical illness, including cancer.² Nonmelanoma skin cancer, in particular, poses serious mental health complications, yet the researchers noted that it has received relatively little attention.³

Although recent studies have begun to explore the complex relationship between nonmelanoma skin cancer and mental health, limited data exist regarding the demographic or socioeconomic factors that shape mental health outcomes across nonmelanoma skin cancer subtypes.¹

To address these gaps, the researchers examined the association between nonmelanoma skin cancer diagnosis, clinical depression, and the number of poor mental health days. They used information from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), which includes data on health conditions, behaviors, and preventive health practices among US adults aged 18 or older.⁴ Responses from the 2023 survey related to nonmelanoma skin cancer, mental health, and sociodemographic characteristics were included.¹

For their analysis, they used logistic regression to evaluate the association between nonmelanoma skin cancer and depression, while Poisson regression modeled the number of poor mental health days. Analyses were adjusted for age, sex, comorbid conditions, income, education, body mass index, and race and ethnicity.

Mental Health Burden Largely Explained by Sociodemographic, Comorbid Factors

Of the 433,323 respondents to the 2023 BRFSS survey, 312,317 individuals (72.07%) had complete demographic and disease information and were included in the analysis. The majority were women (50.62%; n = 158,087), and nearly two-thirds were aged 18 to 64 years (63.52%; n = 198,394).

The sample was predominantly White (81.21%; n = 253,634), followed by Asian (8.62%; n = 26,936), Black (2.10%; n = 6551), American Indian or Alaska Native (2.84%; n = 8865), Native Hawaiian or Pacific Islander (0.65%; n = 2041), and multiracial (1.84%; n = 5742) individuals; an additional 8548 respondents (2.74%) identified with the “other” race and ethnicity category.

Most respondents did not report having nonmelanoma skin cancer, as only 8.50% (n = 26,552) indicated a diagnosis. Common comorbid conditions included lung disease (19.55%; n = 61,054), another form of cancer (11.74%; n = 36,672), heart disease (11.03%; n = 34,461), and kidney disease (4.72%; n = 14,733).

Overall, 88,524 individuals (21.31%) reported experiencing depression. Among the 26,552 patients with nonmelanoma skin cancer, 5086 (19.15%) reported depression. However, after adjusting for covariates, a nonmelanoma skin cancer diagnosis was not significantly associated with depression (adjusted OR, 1.01; 95% CI, 0.98-1.05).

Similarly, respondents with a history of nonmelanoma skin cancer reported a higher unadjusted mean (SD) number of poor mental health days than those without a diagnosis (4.54 [8.37] vs 3.20 [7.37] days). After adjustment, however, individuals with nonmelanoma skin cancer experienced a slight reduction in poor mental health days vs those without the disease (adjusted rate ratio, 0.94; 95% CI, 0.91-0.97).

“These findings suggest that the differences in mental health burden are largely explained by sociodemographic and comorbid factors instead of the nonmelanoma skin cancer itself,” the authors wrote.

Better Addressing the Mental Health Burden in Patients With Nonmelanoma Skin Cancer

The researchers acknowledged several limitations, including the cross-sectional design of the BRFSS dataset, which may have prevented them from establishing the direction of the relationship between nonmelanoma skin cancer and mental health outcomes. Additionally, all variables were self-reported, introducing the potential for misclassification of both exposure and outcome measures. Nonetheless, they expressed confidence in their findings.

“Ultimately, recognizing and addressing the mental health burden associated with nonmelanoma skin cancer can lead to more holistic, equitable, and patient-centered care strategies,” the authors concluded.

References

1. Ray R, Nguyen M. Association of skin cancer with clinical depression and poor mental health days: cross-sectional analysis. JMIR Dermatol. 2026;9:e80710. doi:10.2196/80710
2. Hewitt M, Rowland JH. Mental health service use among adult cancer survivors: analyses of the National Health Interview Survey. J Clin Oncol. 2002;20(23):4581-4590. doi:10.1200/JCO.2002.03.077
3. Ernstmann N, Neumann M, Ommen O, et al. Determinants and implications of cancer patients' psychosocial needs. Support Care Cancer. 2009;17(11):1417-1423. doi:10.1007/s00520-009-0605-7
4. CDC – 2023 BRFSS survey data and documentation. CDC. Last reviewed February 28, 2025. Accessed January 31, 2026. https://www.cdc.gov/brfss/annual_data/annual_2023.html