Health behavior buffering the spillover effect of cancer on spousal depressive symptoms: causal evidence from a multicountry analysis.

Authors

Yanshang Wang, Yiqi Xia, Chang Cai, Zhenyu Shi, Ping He

Published in

International journal of epidemiology. Volume 55. Issue 5. Aug 18, 2026.

Abstract

Cancer, often described as a "family disease," can negatively affect the mental health of spouses or partners through negative spillover effects. However, there is a lack of rigorous causal evidence regarding the spillover effects of cancer onset, and the dynamic pattern remains unclear. This study aims to assess the spillover effects of cancer onset on spousal depressive symptoms using a multicohort approach and examine the moderating role of a healthy lifestyle.
We conducted a pooled multicountry analysis utilizing 21 countries datasets. We employed a causal inference research design, combining matching with difference-in-differences (DID) as the primary identification strategy to analyze the causal effect and its heterogeneity. Moreover, we conducted the interaction term analysis to explore the role of health lifestyles. Using an event study methodology, we examined the dynamic pattern and validated the parallel trends assumption.
Our findings reveal a robust causal link between cancer onset and spousal depressive symptoms. Further analysis indicates that healthy lifestyles serve as a buffer against this adverse spillover effect, particularly reflected in moderate alcohol use (β = -0.052, 95% confidence interval [CI] [-0.099, -0.005]), physical exercise (β = -0.116, 95% CI [-0.183, -0.049]), social activities (β = -0.126, 95% CI [-0.181, -0.071]), and tobacco use (β  =  0.100, 95% CI [0.029-0.171]). Additionally, the spillover effect exhibits a "bimodal" pattern, manifesting primarily in the short term (within 2 years) and later stages (4-5 years) of cancer.
This study reveals a dynamic negative impact of cancer on spousal mental health, closely related to the cancer trajectory and spousal behaviors. It underscores the imperative for establishing a family-based integrated care model for cancer. Future research should explore the underlying mechanisms of these spillover effects as well as develop care models to conduct prospective impact assessments.

PMID:
42771855
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

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