Elsevier

The Breast

Volume 26, April 2016, Pages 100-105
The Breast

Original article
Predictors of depression and anxiety symptom trajectories in the 24 months following diagnosis of breast or gynaecologic cancer

https://doi.org/10.1016/j.breast.2016.01.008Get rights and content

Highlights

  • We identify characteristics predictive of psychological symptom severity over 2 years.

  • Women with previous anxiety/depression treatment had worse depression and anxiety profiles.

  • Women with high neuroticism had worse anxiety and depression profiles.

  • Anxiety severity decreased as a function of neuroticism.

  • Women with these characteristics should be the initial target of screening initiatives.

Abstract

Objective

To identify predictors of anxiety and depression symptom trajectories, as distinct from general distress, in the 96 weeks following diagnosis of breast or gynaecologic cancer.

Methods

Participants completed the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) and Centre for Epidemiological Studies Depression Scale (CES-D) at diagnosis and at 8-weekly intervals for 96 weeks. Linear mixed models were used to determine the effects of age, relationship status, tumour stream, cancer stage, living situation, residential area, educational status, current and previous anxiety/depression treatment and neuroticism on symptom trajectories.

Results

Participants were 264 women with a mean (SD) age of 54 (12) years. Compared to non-treatment-receiving counterparts, women who received anxiety/depression treatment in the past had depression and anxiety symptom severity scores that were 4.58 and 1.24 higher, respectively. Women receiving such treatment at cancer diagnosis had depression and anxiety scores that were 4.34 and 2.35 points higher, respectively, than their counterparts. Compared to women with the lowest neuroticism scores, women with the highest scores scored 8.48 and 3.82 higher on the CES-D and HADS-A, respectively. Depressive severity remained stable but anxiety severity decreased as a function of neuroticism.

Conclusions

In settings with limited resources, women with high neuroticism or a depression/anxiety treatment history should be the initial target of psychological screening. Identification of women with these characteristics at the earliest point of entry into the oncology service followed by heightened surveillance and/or referral to psychosocial services may be useful to prevent chronic psychological morbidity.

Section snippets

Background

Breast and gynaecologic cancers collectively account for the majority of cancer diagnoses among Australian women [1]. Cross-sectional studies show that 30–40% of these women report sufficient number or severity of anxiety or depressive symptoms to warrant clinical diagnosis [2], [3]. A key clinical imperative is to identify, as early as possible, those individual characteristics that predispose women to experience a poorer trajectory of psychological health. In doing so, women at greatest risk

Participants

The sample comprised women with newly diagnosed breast or gynaecologic cancer attending a specialist women's hospital in metropolitan Australia, with a stand-alone gynaecology oncology unit and a co-located breast oncology service shared with another major teaching hospital. Women excluded were those younger than 18 years of age, with ductal carcinoma in situ, previously diagnosed invasive carcinoma, cognitive impairment affecting ability to consent or participate, or poor English language

Study participation

During the recruitment period, 996 patients presented to the breast and gynaecologic units. Among these individuals, 609 were excluded due to language (n = 133), cognitive impairment (n = 24), non-invasive/benign pathology (n = 316), previous cancer diagnosis (n = 122) and for other reasons (e.g., male, overseas visitor, n = 14). Seventy-eight women declined participation. A total of 309 women consented to participate of whom 9 withdrew before baseline data were collected and a further 36 were

Discussion

We undertook a 2-year longitudinal study in a heterogeneous sample of women with newly diagnosed cancer, with 8-weekly measurement of anxiety and depression symptoms. We sought to identify, from a range of clinical, demographic and psychological characteristics that are available on entry to the oncology service, those variables that would predict poorer anxiety and depressive symptom experience. Consistent with our hypothesis, the psychological variables of neuroticism and past or pre-existing

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest statement

The authors have no conflict of interest to declare.

Acknowledgements

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

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