Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: patterns of transiency and severity of the distress response.
BACKGROUND
Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress.


AIM
To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery.


METHODS
Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemar's test, and logistic regression.


RESULTS
There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness.


DISCUSSION
The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.
['Saboonchi|Fredrik|F|', 'Petersson|Lena-Marie|LM|', 'Wennman-Larsen|Agneta|A|', 'Alexanderson|Kristina|K|', 'Brännström|Richard|R|', 'Vaez|Marjan|M|']
D000223:Adaptation, Psychological D000328:Adult D001007:Anxiety D001008:Anxiety Disorders D001943:Breast Neoplasms D015331:Cohort Studies D015897:Comorbidity D003863:Depression D003866:Depressive Disorder D005260:Female D005500:Follow-Up Studies D006801:Humans D016015:Logistic Models D008875:Middle Aged D015995:Prevalence D011569:Psychiatric Status Rating Scales D012044:Regression Analysis D012307:Risk Factors D012959:Socioeconomic Factors D013315:Stress, Psychological D017741:Survivors D013548:Sweden D013997:Time Factors
Anxiety Depression Breast cancer Distress Life events Sick leave