Skip to main content

Advertisement

Log in

Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: prevalence, course and determinants of outcome

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The purposes of this study are to examine the course and prevalence of anxiety and depression over 24 months in women with newly diagnosed breast and gynaecologic cancer and, controlling for demographic and clinical confounders, to test the role of neuroticism and psychiatric history in determining outcome 6, 12, 18 and 24 months post-diagnosis.

Methods

Participants completed the Hospital Anxiety and Depression Scale—anxiety subscale and Centre for Epidemiological Studies Depression Scale on an 8-weekly basis from diagnosis until 96 weeks. Changes over time were analyzed with repeated measures ANOVA. Hierarchical linear regression, adjusted a priori for age, chemotherapy and radiation treatment, living alone, education and tumour stream were used to predict anxiety and depression.

Results

Participants were 105 women (66 breast, 39 gynaecologic). Rates of anxiety (18.1 %) and depression (33.3 %) were highest at diagnosis. Average rates of anxiety and depression were 5.9 and 22.4 %, respectively. Average scores of anxiety and depression were highest at diagnosis, with improvement at 8 and 40 weeks, respectively, subsequently maintained. Morbidity at diagnosis was particularly acute among women with a treatment history of anxiety/depression or with high neuroticism. These three variables were the best and only predictors over 24 months.

Conclusions

Women are most vulnerable to anxiety and depression at diagnosis, with improvement over time. Morbidity rates are lower than reported elsewhere. Women with high neuroticism and a psychiatric history are at greatest risk for future morbidity after adjusting for confounders. Early identification of these women plus heightened surveillance or early referral to psychosocial services may protect against longer-term morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Australian Institute of Health (2012) Cancer in Australia: an overview 2012. AIHW, Canberra

    Google Scholar 

  2. Fallowfield L, Ratcliffe D, Jenkins V, Saul J (2001) Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 84:1011–1015

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncology 10:19–28

    Article  CAS  PubMed  Google Scholar 

  4. Fowler JM, Carpenter KM, Gupta P, Golden-Kreutz DM, Andersen BL (2004) The gynecologic oncology consult: symptom presentation and concurrent symptoms of depression and anxiety. Obstet Gynecol 103:1211–1217

    Article  PubMed Central  PubMed  Google Scholar 

  5. van Amstel FK P, van den Berg SW, van Laarhoven HW, Gielissen MF, Prins JB, Ottevanger PB (2013) Distress screening remains important during follow-up after primary breast cancer treatment. Support Care Cancer 21:2107–2115

    Article  Google Scholar 

  6. Den Oudsten BL, Van Heck GL, Van der Steeg AF, Roukema JA, De Vries J (2009) Predictors of depressive symptoms 12 months after surgical treatment of early-stage breast cancer. Psycho-Oncology 18:1230–1237

    Article  Google Scholar 

  7. Manne S, Rini C, Rubin S, Rosenblum N, Bergman C, Edelson M et al (2008) Long-term trajectories of psychological adaptation among women diagnosed with gynecological cancers. Psychosom Med 70:677–687

    Article  PubMed  Google Scholar 

  8. Stafford L, Judd F, Gibson P, Komiti A, Mann G, Quinn M (2013) Screening for depression and anxiety in women with breast and gynaecologic cancer: course and prevalence of morbidity over 12 months. Psycho-Oncology 22:2071–2078

    Article  PubMed  Google Scholar 

  9. Lindviksmoen G, Hofso K, Paul SM, Miaskowski C, Rustoen T (2013) Predictors of initial levels and trajectories of depressive symptoms in women with breast cancer undergoing radiation therapy. Cancer Nurs 36:E34–E43

    Article  PubMed  Google Scholar 

  10. Johnson RL, Gold MA, Wyche KF (2010) Distress in women with gynecologic cancer. Psycho-Oncology 19:665–668

    Article  PubMed  Google Scholar 

  11. Enns A, Waller A, Groff SL, Bultz BD, Fung T, Carlson LE (2013) Risk factors for continuous distress over a 12-month period in newly diagnosed cancer outpatients. J Psychosoc Oncol 31:489–506

    Article  PubMed  Google Scholar 

  12. Torres MA, Pace TW, Liu T, Felger JC, Mister D, Doho GH et al (2013) Predictors of depression in breast cancer patients treated with radiation: role of prior chemotherapy and nuclear factor kappa B. Cancer 119:1951–1959

    Article  PubMed Central  PubMed  Google Scholar 

  13. Iwatani T, Matsuda A, Kawabata H, Miura D, Matsushima E (2013) Predictive factors for psychological distress related to diagnosis of breast cancer. Psycho-Oncology 22:523–529

    Article  PubMed  Google Scholar 

  14. Hulbert-Williams L, Neal RD, Morrison V, Hood K, Wilkinson C (2012) Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust? Psycho-Oncology 21:857–867

    Article  PubMed  Google Scholar 

  15. Wong-Kim E, Bloom J (2005) Depression experienced by young women newly diagnosed with breast cancer. Psycho-Oncology 14:564–573

    Article  PubMed  Google Scholar 

  16. Kim JM, Jang JE, Stewart R, Kim SY, Kim SW, Kang HJ et al (2013) Determinants of suicidal ideation in patients with breast cancer. Psycho-Oncology 22:2848–2856

    Article  PubMed  Google Scholar 

  17. Van Esch L, Roukema JA, Ernst MF, Nieuwenhuijzen GA, De Vries J (2012) Combined anxiety and depressive symptoms before diagnosis of breast cancer. J Affect Disord 136:895–901

    Article  PubMed  Google Scholar 

  18. Osborn R, Demoncada A, Feuerstein M (2006) Psychosocial interventions for depression, anxiety and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36:13–34

    Article  PubMed  Google Scholar 

  19. Weiss A, Costa PT Jr (2005) Domain and facet personality predictors of all-cause mortality among Medicare patients aged 65 to 100. Psychosom Med 67:724–733

    Article  PubMed  Google Scholar 

  20. Watson D, Pennebaker J (1989) Health complaints, stress and distress: exploring the central role of negative affectivity. Psychol Rev 96:234–254

    Article  CAS  PubMed  Google Scholar 

  21. Krueger R, Caspi A, Moffitt T, Silva P, McGee R (1996) Personality traits are differentially linked to mental disorders: a multi-trait multi-diagnosis study of an adolescent birth cohort. J Abnorm Psychol 105:299–312

    Article  CAS  PubMed  Google Scholar 

  22. Scott J, Eccleston D, Boys R (1992) Can we predict the persistence of depression? Br J Psychiatry 161:633–637

    Article  CAS  PubMed  Google Scholar 

  23. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  PubMed  Google Scholar 

  24. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77

    Article  PubMed  Google Scholar 

  25. Radloff LS (1977) The CESD scale: a self report scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  26. Mitchell AJ, Meader N, Davies E, Clover K, Carter GL, Loscalzo MJ et al (2012) Meta-analysis of screening and case finding tools for depression in cancer: evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group. J Affect Disord 140:149–160

    Article  PubMed  Google Scholar 

  27. Luckett T, Butow PN, King MT, Oguchi M, Heading G, Hackl NA et al (2010) A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Support Care Cancer 18:1241–1262

    Article  PubMed  Google Scholar 

  28. Mulrow C, William J, Gerety M, Ramirez G, Montiel O, Kerber C (1995) Case-finding instruments for depression in primary care settings. Ann Intern Med 122:913–921

    Article  CAS  PubMed  Google Scholar 

  29. Goldberg L (2001) International personality item pool. www.ipip.ori.org

  30. Gow A, Whiteman M, Pattie A, Deary I (2005) Goldberg’s ‘IPIP’ Big-Five factor markers: internal consistency and concurrent validation in Scotland. Personal Individ Differ 39:317–329

    Article  Google Scholar 

  31. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  PubMed  Google Scholar 

  32. Ferrandina G, Mantegna G, Petrillo M, Fuoco G, Venditti L, Terzano S et al (2012) Quality of life and emotional distress in early stage and locally advanced cervical cancer patients: a prospective, longitudinal study. Gynecol Oncol 124:389–394

    Article  PubMed  Google Scholar 

  33. Hoey LM, Ieropoli SC, White VM, Jefford M (2008) Systematic review of peer-support programs for people with cancer. Patient Educ Couns 70:315–337

    Article  PubMed  Google Scholar 

  34. Hartl K, Engel J, Herschbach P, Reinecker H, Sommer H, Friese K (2010) Personality traits and psychosocial stress: quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psycho-Oncology 19:160–169

    Article  PubMed  Google Scholar 

  35. Linden W, Girgis A (2012) Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction? Psycho-Oncology 21:343–350

    Article  PubMed  Google Scholar 

  36. Greer J, Pirl W, Park E, Lynch TJ, Temel J (2008) Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer. J Psychosom Res 65:549–552

    Article  PubMed Central  PubMed  Google Scholar 

  37. Carlson LE, Bultz BD Benefits of psychosocial oncology care: improved quality of life and medical cost offset. Health Qual Life Outcomes 1:8

  38. Satin J, Linden W, Phillips M (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 115:5349–5361

    Article  PubMed  Google Scholar 

  39. Cuijpers P, Smit F, Penninx BW, de Graaf R, ten Have M, Beekman AT (2010) Economic costs of neuroticism: a population-based study. Arch Gen Psychiatry 67:1086–1093

    Article  PubMed  Google Scholar 

  40. Tamagawa R, Garland S, Vaska M, Carlson LE (2012) Who benefits from psychosocial interventions in oncology? A systematic review of psychological moderators of treatment outcome. J Behav Med 35:658–673

    Article  PubMed  Google Scholar 

  41. Nakaya N, Hansen PE, Schapiro IR, Eplov LF, Saito-Nakaya K, Uchitomi Y et al (2006) Personality traits and cancer survival: a Danish cohort study. Br J Cancer 95:146–152

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Kramer JA, Curran D, Piccart M, de Haes JC, Bruning PF, Klijn JG et al (2000) Randomised trial of paclitaxel versus doxorubicin as first-line chemotherapy for advanced breast cancer: quality of life evaluation using the EORTC QLQ-C30 and the Rotterdam symptom checklist. Eur J Cancer 36:1488–1497

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported in part by funding from the Western and Central Melbourne Integrated Cancer Service (WCMICS). The Centre for Women’s Mental Health is supported by the Pratt Foundation. The funding sources had no role in the study design, or collection, analysis and interpretation of data or in the decision to submit the work for publication. The authors wish to thank the breast care nurses Robyn Cordner, Monique Baldacchino, Kerry Shanahan, Bronwyn Flanagan and Claire Noonan for their assistance in recruiting patients to the study. Dr Chad Bousman is acknowledged for his statistical advice. We also thank the participating patients for their support of this research.

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lesley Stafford.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stafford, L., Judd, F., Gibson, P. et al. Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: prevalence, course and determinants of outcome. Support Care Cancer 23, 2215–2224 (2015). https://doi.org/10.1007/s00520-014-2571-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-014-2571-y

Keywords

Navigation