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Abstract

Background: Current literature suggests an association between colorectal cancer (CRC) and mental disorders, primarily anxiety and depression. However, gaps in understanding the lived mental health experiences of patients with CRC exist. This thesis aims to explore mental health experiences among patients with CRC across the phases of the CRC care continuum. Objective: 1) To evaluate the risk of mental disorders, namely anxiety and depression, in patients with CRC; 2) to understand and contextualize the specific mental health experiences from the patient perspective at every phase of the CRC care continuum (i.e., acute “treatment” phase, extended “follow-up” phase, permanent “beyond” phase). Methods: For objective 1, I conducted a systematic review and meta-analysis of peer-reviewed studies that: used an epidemiologic design; included patients with CRC and a comparator group of individuals without cancer; and evaluated anxiety and depression as outcomes. For objective 2, I employed a constructivist grounded theory design and conducted semi-structured interviews with participants with CRC to explore their experiences with mental health as well as receiving mental health care, across the phases of the CRC care continuum. Data collection and analysis were iterative, employed theoretical sampling, and culminated in a patient-oriented theoretical model. Results: 1) I quantified the risks and impacts of CRC on anxiety and depression, particularly an increased risk of depression after CRC diagnosis. 2) I constructed a patient-oriented constructivist grounded theory that comprised of these four themes: journeying through CRC, experiencing mental health, receiving care for mental health, and self-identity. Conclusion: This thesis provides novel insight into patients’ mental health experiences in the context of living with CRC. These insights have important implications for comprehensive CRC care, as healthcare providers and cancer care centers can leverage these understandings to provide meaningful change and improve mental health care provision for this patient population.