Depression and anxiety in women with early breast cancer: five year observational cohort study

Abstract

Objective To examine the prevalence of, and risk factors for, depression and anxiety in women with early breast cancer in the five years after diagnosis. Design Observational cohort study. Setting NHS breast clinic, London. Participants 222 women with early breast cancer: 170 (77%) provided complete interview data up to either five years after diagnosis or recurrence. Main outcome measures Prevalence of clinically important depression and anxiety (structured psychiatric interview with standardised diagnostic criteria) and clinical and patient risk factors, including stressful life experiences (Bedford College life events and difficulties schedule). Results Nearly 50% of the women with early breast cancer had depression, anxiety, or both in the year after diagnosis, 25% in the second, third, and fourth years, and 15% in the fifth year. Point prevalence was 33% at diagnosis, falling to 15% after one year. 45% of those with recurrence experienced depression, anxiety, or both within three months of the diagnosis. Previous psychological treatment predicted depression, anxiety, or both in the period around diagnosis (one month before diagnosis to four months after diagnosis). Longer term depression and anxiety, were associated with previous psychological treatment, lack of an intimate confiding relationship, younger age, and severely stressful non-cancer life experiences. Clinical factors were not associated with depression and anxiety, at any time. Lack of intimate confiding support also predicted more protracted episodes of depression and anxiety. Conclusion Increased levels of depression, anxiety, or both in the first year after a diagnosis of early breast cancer highlight the need for dedicated service provision during this time. Psychological interventions for women with breast cancer who remain disease free should take account of the broader social context in which the cancer occurs, with a focus on improving social support.

Evaluation of screening instruments for depression and anxiety in breast cancer survivors

“…There is some evidence that after an initial rise, the prevalence of depression decreases over time following the diagnosis of breast cancer [1]. It would have been interesting to investigate the relationship between the prevalence of depression and the time since completion of treatment in this cohort.…”

“…Similarly, higher rates of anxiety are found where studies report cumulative incidence over the course of the disease rather than point prevalence as reported in this study. Moreover, in relation to higher rates of anxiety and depression reported in older studies, it has been suggested that a diagnosis of breast cancer may be less likely to provoke clinically important distress today because of improvements in prognosis, treatment, patient support, and reduced stigma [1].…”

“…However, for most women, symptoms will decrease dramatically the longer the time elapsed since diagnosis. Depression is more than three times as likely to occur in women when first diagnosed than in the general population, but levels among women in remission from breast cancer have been found to be comparable to those of the general female population [1,2]. As the likelihood a patient will suffer from depression decreases, efforts to identify new cases can move down the agenda of patient care and it has been suggested that in focusing on the medical management of a patient's cancer, the psychological aspects may be neglected [3].…”

“…Rates of depression and anxiety among patients recently diagnosed with breast cancer are high, with prevalence rates of depression, anxiety, or both reaching up to 50% in the year after diagnosis [1]. However, for most women, symptoms will decrease dramatically the longer the time elapsed since diagnosis.…”

Prevalence and risk of depressive symptoms 3–4 months post-surgery in a nationwide cohort study of Danish women treated for early stage breast-cancer

“…The available data indicate that cancer-related distress generally diminishes with time after diagnosis [10,[30][31][32], increasing again after a possible recurrence [33,34].…”