Prevalence and psychosocial factors of anxiety and depression in breast cancer patients

Peeraphon Lueboonthavatchai
Journal of the Medical Association of Thailand 2007, 90 (10): 2164-74

BACKGROUND: Breast cancer is the most common cancer in women. It is seen as a terrifying disease due to a high mortality rate, its impacts on self-image, and the sexual relationship. Many patients experience psychological reactions, and may have psychiatric morbidities, especially anxiety and depressive disorders. Although anxiety and depressive disorders are common in breast cancer and worsen the disease course and treatment outcomes, these psychiatric disorders are ignored and left untreated. Understanding these common psychiatric disorders and associated psychosocial factors can help to plan for treatment and may result in more treatment success.

OBJECTIVES: The present study was aimed to identify the prevalence and associated psychosocial factors of anxiety and depressive disorders in breast cancer patients. The psychosocial factors in the present study focused on social support, family relationship and functioning, and problem and conflict solving.

MATERIAL AND METHOD: Three hundred female breast cancer patients, aged above 18 years old from the Surgical Outpatient Department, King Chulalongkorn Memorial Hospital, were recruited into the study from December 2006 to May 2007. All samples completed five questionnaires; 1) Demographic data and history form, 2) Thai Hospital Anxiety and Depression Scale (Thai HADS), 3) Social Support Questionnaire, 4) Family Relationship and Functioning Questionnaire, 5) Problem and Conflict Solving Questionnaire. The prevalence of anxiety and depressive disorders was reported in percentage. The association between psychosocial, demographic, and clinical factors and anxiety and depression was analyzed by ANOVA test (for continuous data) and chi-square test (for categorical data). Logistic regression was performed to identify the potential predictors of anxiety and depression. A p-value of less than 0.05 was considered statistically significant.

RESULTS: The prevalence of anxiety disorder was 16.0%, and that of anxiety symptoms was 19.0%. The prevalence of depressive disorder was 9.0%, and that of depressive symptoms was 16.7%. Factors associated to anxiety and depression were psychosocial factors (social support, family relationship and functioning, and problem and conflict solving) (p < 0.01), number of hospital admissions, and presence of disturbing symptoms: pain, respiratory symptoms, and fatigue (p < 0.01). By regression analysis, the significant predictors of anxiety and depression were poor family relationship and functioning (p < 0.05), maladaptive problem and conflict solving (p < 0.05), and symptoms of pain (p < 0.01) and fatigue (p < 0.05).

CONCLUSION: Anxiety and depressive disorders are two common psychiatric disorders in breast cancer. Strong predictors of anxiety and depression in breast cancer patients were poor family relationship and functioning, maladaptive problem and conflict solving, and presence of pain and fatigue. Promoting patients' social support, especially emotional support from family, and enhancing patient's coping skills may reduce the patients' psychological stress and psychiatric morbidities. Treatment of breast cancer patients should focus on reduction of patients' disturbing symptoms such as adequate pain control, and lessening the treatment complications. Moreover being alert on patients' emotional reactions and potential psychiatric disorders is essential.

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