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Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer

Published online by Cambridge University Press:  14 October 2010

J. Hill ,
C. Holcombe ,
L. Clark ,
M. R. K. Boothby ,
A. Hincks ,
J. Fisher ,
S. Tufail  and
P. Salmon
J. Hill
Affiliation:
Child Psychiatry Research Group, The University of Manchester, Manchester, UK
C. Holcombe
Affiliation:
Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Liverpool, UK
L. Clark
Affiliation:
Division of Clinical Psychology, University of Liverpool, Liverpool, UK
M. R. K. Boothby
Affiliation:
Psychology Department, Istanbul Bilim University, Istanbul, Turkey
A. Hincks
Affiliation:
Division of Clinical Psychology, University of Liverpool, Liverpool, UK
J. Fisher
Affiliation:
Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Liverpool, UK
S. Tufail
Affiliation:
North Manchester General Hospital, Manchester, UK
P. Salmon*
Affiliation:
Division of Clinical Psychology, University of Liverpool, Liverpool, UK
*
*Address for correspondence: P. Salmon, D.Phil., Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK. (Email: psalmon@liv.ac.uk)
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Abstract

Background

Depression and anxiety are common after diagnosis of breast cancer. We examined to what extent these are recurrences of previous disorder and, controlling for this, whether shame, self-blame and low social support after diagnosis predicted onset of depression and anxiety subsequently.

Method

Women with primary breast cancer who had been treated surgically self-reported shame, self-blame, social support and emotional distress post-operatively. Psychiatric interview 12 months later identified those with adult lifetime episodes of major depression (MD) or generalized anxiety disorder (GAD) before diagnosis and onset over the subsequent year. Statistical analysis examined predictors of each disorder in that year.

Results

Of the patients, two-thirds with episodes of MD and 40% with episodes of GAD during the year after diagnosis were experiencing recurrence of previous disorder. Although low social support, self-blame and shame were each associated with both MD and GAD after diagnosis, they did not mediate the relationship of disorder after diagnosis with previous disorder. Low social support, but not shame or self-blame, predicted recurrence after controlling for previous disorder.

Conclusions

Anxiety and depression during the first year after diagnosis of breast cancer are often the recurrence of previous disorder. In predicting disorder following diagnosis, self-blame and shame are merely markers of previous disorder. Low social support is an independent predictor and therefore may have a causal role.

Keywords

Anxietybreast cancerdepressiononset
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 7 , July 2011 , pp. 1429 - 1436
Copyright
Copyright © Cambridge University Press 2010

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