Barriers to the Utilization of Mental Healthcare Resources Among Adolescent and Young Adult Childhood Cancer Survivors

Children diagnosed with pediatric cancers are now surviving at a much higher rate than in the past, and thus, increasing focus is being given to their long-term psychosocial well-being and health-related quality of life (Zeltzer et al., 2008). Some survivors report emotional distress several years post completion of medical therapy (Wenninger et al., 2012). Consequently, access to mental health care is important for adolescent and young adult (AYA) survivors. However, barriers may limit utilization of services. In the adult literature barriers to utilization of mental health services include negative personal attitudes and social norms (Andrykowski & Burris, 2010). In contrast there is a dearth of literature exploring potential barriers among AYA survivors of childhood cancer. The purpose of this study is to better understand barriers to the utilization of mental healthcare resources among AYA survivors of childhood cancer. Patients in a long-termsurvivorship clinic completed questionnaires, including items related to emotional distress. Those survivors endorsing mood issues (n = 39) completed additional surveys related to perceived access to mental healthcare, use of resources, and barriers including practical limitations (e.g., transportation, finances), personal attitudes, and social stigma. Twenty AYA survivors (51%) had talked to a psychologist, counselor, or other mental health professional about difficulties they had experienced as a result of their cancer diagnosis. Eight survivors (20%) had talked to someone in their place of worship, and 2 survivors (5%) had attended a support group. The greatest barriers reported by AYA survivors included cost of care (15%); difficulty scheduling around work or school (15%); knowledge about available resources (13%); distance to a provider (13%); and insurance (8%). Further, survivors were more likely to have seen a mental health professional if they were either on prescription medication for mood difficulties (χ^sup 2^ (1, 39) = 10.36, p = .001) or had government or no insurance (χ^sup 2^ (1, 39) = 4.74, p = .029). The use of mental health resources seems to be linked with AYA survivors who receive prescription medication and therefore are tied in to the healthcare system. Better understanding of potential barriers will enable survivorship programs to develop strategies to minimize barriers and increase survivors' access to mental health resources. Within the adult cancer survivorship literature, barriers to me