Introduction

Cancer remains one of the leading causes of death in the United States [1,2] and occupies a prominent place in public discourse. Through media coverage, prevention campaigns, and personal stories shared in social circles, individuals are regularly exposed to information regarding cancer risk and survivorship. This cumulative exposure influences how the public perceive the disease, leading many to form strong impressions of what cancer means and, perhaps, how much control they might have over it [3,4]. Some may come to see cancer as something that can be prevented or treated, while others may perceive it as simply unavoidable.

These beliefs about controllability affect how people process cancer information. According to the Cognitive-Social Health Information Processing (C-SHIP) model, people do not interpret health threats in a vacuum; instead, they filter new information through their existing belief systems, which then dictate their emotional and behavioral reactions [5,6]. Within this framework, a belief that cancer cannot be controlled may evoke feelings of distress and helplessness [7]. One structured expression of this perceived lack of control is cancer fatalism, which includes the notion that everything causes cancer, that nothing can prevent it, or that a diagnosis inevitably leads to death [4,8,9].

Prior research shows that individuals who hold fatalistic beliefs about cancer are less likely to participate in screening or adopt preventive behaviors [4,7,9,10]. Some studies have also linked cancer fatalism to depression, though these investigations have primarily focused on college students or cancer survivors [11–13], leaving open the question of whether similar associations are present in the broader adult population. Fatalistic beliefs are not confined to individuals with a cancer diagnosis [4,14,15]. In fact, these beliefs can even form from seeing what others go through with cancer, which may foster feelings of helplessness, a core feature of depression [16]. As a result, it is reasonable to examine the emotional impact of fatalistic beliefs in the general adult population.

Aside beliefs, many people try to handle cancer concerns through communication. One common approach is information seeking. When cancer feels uncertain, people turn to online resources, news coverage, or health professionals to make sense of the situation. Uncertainty Management Theory (UMT) frames this behavior as an effort to reduce uncertainty by gaining understanding, reassurance, or a sense of control [17–21]. However, information seeking can sometimes backfire, leaving people more anxious if the information is frightening, conflicting, or unclear [10,19,22–25]. Another coping approach involves interpersonal health discussions with family and friends, which provide emotional and social support, and often promote understanding, hope and relief as individuals process concerns [26–28]. Despite these insights, it remains unclear how information seeking or health discussions with friends or family relate to depressive symptoms in the general adult population. It is also unknown whether discussions with friends or family can modify the relationship between fatalistic cancer beliefs and depression.

The present study examines the associations between cancer fatalism, cancer information seeking, interpersonal health discussions, and depressive symptoms in a nationally representative sample of U.S. adults. Consistent with the C-SHIP framework and prior research on cancer survivors, we hypothesize that endorsement of fatalistic cancer beliefs will be associated with higher odds of screening positive for depression (H1). Furthermore, we expect that the potential distress of encountering threatening information means that individuals seeking cancer-related information will have higher odds of depression (H2). In contrast, because interpersonal discussions can facilitate shared coping, we hypothesize that individuals who talk about their health with family or friends will have lower odds of screening positive for depression (H3). Finally, we hypothesize that talking about your health with family or friends will moderate the relationship between cancer fatalism and depression, such that the association will be weaker among individuals who engage in these conversations (H4).

Methods

Results

Sample characteristics

Table 1 summarizes weighted characteristics of the analytic sample (unweighted N = 6,826; weighted N = 248.3 million U.S. adults). Overall, 15.5% of respondents (weighted N = 38.6 million) screened positive for depression based on the PHQ-2. The median age of the total (weighted) sample was 49 years (IQR: 34–63), with those screening positive being significantly younger than those who screened negative (median = 40 vs. 50 years, p < 0.001). Educational attainment and income differed significantly by depression status. Only 24% of respondents who screened positive were college graduates, compared with 36% of those who screened negative (p < 0.001). Similarly, 31% of those with positive depression screening reported annual household incomes below $20,000, compared with 12% of those with negative screening (p < 0.001). Health insurance coverage followed a similar pattern: 85% of respondents who screened positive were insured, compared to 93% of those who screened negative (p < 0.001). Depression prevalence did not differ by personal cancer history (p = 0.80) but varied by family history: 59% of respondents who screened positive reported having a family history of cancer, compared with 66% of those who screened negative (p = 0.041). Although cancer information seeking did not differ significantly by depression screening status (48% vs. 52%, p = 0.20), differences were observed in interpersonal health communication: fewer respondents who screened positive reported discussing health with family or friends (74% vs. 82%, p = 0.001). Finally, a higher proportion of respondents who agreed with fatalistic cancer beliefs screened positive for depression.

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Table 1. Descriptive characteristics of respondents by depression screening outcome^a.

https://doi.org/10.1371/journal.pone.0346262.t001

Adjusted associations between cancer beliefs, information behaviors, and depression screening

Across all three belief items, fatalistic views of cancer were linked to higher odds of depression (Table 2, Overall sample). The odds of screening positive for depression among respondents who agreed that cancer prevention is not possible were 1.69 times the odds among those who disagreed (OR = 1.69, 95% CI: 1.25–2.28). Similarly, respondents who agreed that everything causes cancer had 1.86 times the odds of screening positive for depression compared with those who disagreed (OR = 1.86, 95% CI: 1.39–2.48), and those who endorsed that cancer automatically means death had 1.75 times the odds of screening positive compared with those who disagreed (OR = 1.75, 95% CI: 1.31–2.34). In contrast, cancer information seeking was not significantly associated with depression screening (OR = 1.12, 95% CI: 0.83–1.51). Likewise, the odds of screening positive for depression did not differ significantly between respondents who talked with family or friends about health and those who did not (OR = 0.90, 95% CI: 0.62–1.30).

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Table 2. Survey-weighted logistic regression models of associations between fatalistic beliefs, information seeking, interpersonal communication, and depression screening among U.S. adults and non-cancer adults.

https://doi.org/10.1371/journal.pone.0346262.t002

In the moderation analyses (Table 2, Interaction model), none of the interaction terms were statistically significant. The interaction between talking with family or friends and the belief that cancer prevention is not possible was positive but not significant (OR = 1.33, 95% CI: 0.61–2.88), while the interactions for “everything causes cancer” (OR = 0.95, 95% CI: 0.50–1.80) and “cancer automatically means death” (OR = 0.79, 95% CI: 0.38–1.66) were negative but not significant.

Sensitivity analyses using multiple imputation and limiting the analyses to only non-cancer adults showed consistent results with the complete-case models, and the overall sample. Associations between fatalistic beliefs and depression remained positive and statistically significant, while the direction and magnitude of estimates for information seeking and interpersonal communication were largely unchanged (see S1 Table).

Discussion

This study examined how people’s beliefs about cancer, their information-seeking behaviors, and conversations with family or friends about health relate to depressive symptoms, using nationally representative data from HINTS 7. Consistent with past research, those who held fatalistic cancer beliefs, particularly the perceptions that everything causes cancer, that prevention is not possible, or that cancer automatically means death, had higher odds of screening positive for depression, controlling for socio-demographics and cancer history. In contrast, neither cancer information seeking nor talking with family or friends about health showed a significant association with depression, though the latter exhibited a suggestive (non-significant) buffering pattern, slightly weakening the association between some fatalism items and depression screening. Sensitivity analyses using multiple imputation for missing data and analyses restricted to respondents without a personal cancer history yielded substantively identical results, reinforcing the stability of these findings.

The significant positive association between fatalistic cancer beliefs and depressive symptoms shows the emotional toll of perceiving cancer as uncontrollable or inevitable. Fatalistic thinking captures elements that overlap conceptually with core depressive cognitions [9,10,42,43]; this plausibly links fatalistic outlooks to sustained negative emotion, withdrawal, and reduced problem-focused coping. Such beliefs not only discourage preventive actions but also erode perceived control and optimism, limiting people’s ability to cope adaptively. Empirically, our findings extend prior literature that ties fatalism to lower screening and prevention [7,8] by demonstrating that these cognitions also map onto mental health in the broader population, including those without a cancer diagnosis, reinforcing the idea that cancer beliefs are simultaneously behavioral and emotional determinants. Similar patterns appear in other areas of health research, where fatalistic determinism are linked to higher depression and lower resilience [11,44].

Theoretically, these results align with the C-SHIP model, which emphasizes how cognitive and emotional systems interact to shape responses to health threats. Fatalistic beliefs operate as maladaptive cognitive schemas that bias attention and appraisal toward threat and helplessness rather than solutions. Repeatedly interpreting cancer information through this lens can deplete coping resources, undermine perceived control, and reinforce hopeless affect. This parallels Beck’s cognitive theory of depression [45], which describes how enduring negative schemas sustain depression cognition. In this sense, fatalistic cancer beliefs represent a cognitive, emotional pattern that traps individuals in cycles of fear and resignation, increasing vulnerability to depression.

Given the emotional burden of fatalistic beliefs, seeking information may represent a potential coping strategy, yet its impact on depressive symptoms is complex and not always beneficial. Results indicated that the association between information seeking, and depression screening was not statistically significant, though the positive direction of the OR suggests a subtle pattern worth considering. Information seeking is typically portrayed as an empowering behavior that enhances knowledge and self-efficacy [20], yet its emotional consequences may vary across individuals and contexts. According to UMT [17–19], people seek information not merely to gain facts but to regulate uncertainty, an effort that can either reduce or heighten distress depending on their perceptions of control and the nature of the information encountered [25,46]. The modern information environment, however, is noisy and emotionally charged; people are bombarded with alarming headlines, conflicting risk statistics, and fear-evoking narratives that can amplify worry rather than reassurance [47]. For individuals who already hold fatalistic or anxious views about cancer, this constant exposure may intensify emotional fatigue, offsetting the potential benefits of seeking information. The nonsignificant finding could therefore reflect these competing processes: while some use information seeking to regain a sense of control, others experience cognitive overload, producing an overall null effect at the population level. Future research using more detailed measures of information quality, credibility, and emotional tone could help clarify when seeking health information helps individuals versus when it overwhelms them.

A similar story may explain the lack of a significant main effect for interpersonal communication. Social interactions with family and friends are commonly viewed as a potential buffer against emotional distress [48], yet simply reporting that one talks about health may be insufficient; the content and tone of those conversations likely matter more. Supportive discussions can help people process emotions and find reassurance, but conversations filled with fear or misinformation can have the opposite effect [49,50]. Our moderation analyses add nuance to these dynamics. The pattern of results (showing ORs slightly below 1 for some fatalism items when interpersonal talk was included) suggest that interpersonal communication may buffer emotional distress. In other words, discussing health with trusted others may weaken the distressing effect of fatalism, but our study lacked sufficient precision to confirm it. This buffering effect may not have been detected statistically, likely because the present data captured only whether people discussed health, not how often or how constructively they did so. Future studies should explore this potential moderation using richer measures of conversation frequency and quality, continuous fatalism scales, and larger samples designed for adequate interaction power.

Taken together, these findings have important implications for health communication practice. Public health messages should not only share information but also attend to how people interpret and feel about that information. Messages that focus too much on risk or uncertainty without emphasizing prevention or recovery, can unintentionally reinforce fatalistic thinking and feelings of overload or distress [51]. More effective campaigns should balance honesty about risk with clear, hopeful, and actionable guidance. Including stories of survival, progress in treatment, and examples of control may help people feel capable rather than doomed, as narrative communication has been shown to reduce resistance and emotional barriers to cancer prevention [52]. Finally, communicators must consider inequities in literacy and access. People with limited resources or lower health literacy may experience complex cancer messages as confusing or threatening, necessitating a shift toward emotionally sensitive and accessible design for all audiences [53–55].

Despite the study’s contributions, it has some limitations. Because the data is cross-sectional, it is not possible to determine cause and effect: depression might also lead people to develop more fatalistic beliefs, or both could reinforce each other. Also, self-reported measures may include recall bias or social desirability effects, and the PHQ-2 identifies depressive symptoms but does not diagnose clinical depression. Fatalism items captured only a certain facet of fatalistic belief and do not include factors such as medical distrust or perceptions of randomness. Moreover, it is also possible that unmeasured factors like overall social support, media exposure, or baseline anxiety, contributed to the observed relationships. Future research should use longitudinal or experimental designs, more detailed measures of fatalism and communication quality, and qualitative methods to better understand how people emotionally navigate conflicting cancer information.

In conclusion, this study shows that how people think and talk about cancer can affect how they feel. Fatalistic beliefs were consistently associated with depression, while interpersonal communication showed hints of being protective. These findings highlight that accurate information alone is not sufficient; health messages must also foster hope, confidence, and emotional safety. When communication acknowledges fear and also offers clarity and control, it can help people feel informed without feeling defeated.

Supporting information