J Breast Cancer.  2008 Jun;11(2):83-88. 10.4048/jbc.2008.11.2.83.

Psychological Characteristics of Patients with Depressive Symptoms At The Initial Diagnosis of Breast Cancer: Preliminary Results

• Kim JH
• Seok JH
• Jon DI
• Hong HJ
• Hong N
• Kim SJ
• So YK
• Kim LS

• KMID: 2241936
• DOI: http://doi.org/10.4048/jbc.2008.11.2.83

Abstract

PURPOSE: Patients with breast cancer may exhibit signs of psychological distress upon initial diagnosis of cancer. Previous studies have reported that depressive symptoms in the patients with breast cancer may have a harmful effect on their prognosis. Psychological characteristics of patients with depressive symptoms were investigated, comparing them to those of patients without depressive symptoms.
METHODS
Thirty-eight patients initially diagnosed with breast cancer were recruited from the Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital. The psychological symptoms of the patients were assessed using the Beck Depression Inventory (BDI), the Montgomery- Asberg Depression Rating Scale (MADRS), the State-Trait Anxiety Inventory and the Self-Awareness Scale. Their mental coping was assessed using the Korean Mental Adjustment to Cancer scale (KMAC) and their health-related quality of life was assessed with the Short Form 36-item Health Survey (SF-36). The cut-off points of BDI and MADRS of the depressed subgroup were 13 and 10, respectively. Psychological characteristics of depressed patients were compared with non-depressed patients. Statistical analyses were performed using SPSS 13.0 packages.
RESULTS
Sociocultural variables, including age, education year and cancer stage, were not different between the two patient groups. The depressed group showed significantly higher state-anxiety and lower trait-anxiety and positive selfawareness scores compared to the non-depressed group. In the SF-36 Health Survey, the depressed group showed a significantly lower mental health component score of fightingspirit factor, in addition to a higher score of anxious-preoccupation factor in the KMAC compared to those of the nondepressed group.
CONCLUSION
When patients were diagnosed with breast cancer, depressed patients may suffer from a poorer quality of mental health and more psychological suffering. This suffering can lead to maladaptive compliance in following treatment. Therefore, depressive symptoms need to be investigated and managed at the initial step of breast cancer.

Keyword

Breast cancer; Depressive symptoms; Psychological change

MeSH Terms

Anxiety
Breast
Breast Neoplasms
Compliance
Depression
Health Surveys
Heart
Humans
Mental Health
Prognosis
Quality of Life
Stress, Psychological

Figure

• 

  Fig 1 Comparisons of three factor scores of the Korean mental adjustment to cancer scale between the depressed and non-depressed groups at the initial diagnosis of breast cancer. KMAC=Korean mental adjustment to cancer scale; FS=Fighting spirit; AP=Anxious preoccupation; HH=helpless-hopeless.

Reference

1. Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J Clin. 2003. 53:5–26.

2. Korea Central Center Registry. Annual report of the central cancer Psychology of Depressed Patients with Breast Cancer 87 registry, 2002. 2003. Gwacheon: Ministry of Health and Welfare Republic of Korea.

3. Ministry of Health and Welfare, Republic of Korea. Annual report of cancer registry programme in the Republic of Korea. 2002.

4. Sohn BH, Yoon HS, Kwak HS, Lee PC, Ko BK, Kim JS, et al. Clinical analysis of breast cancer surgeries in Korea. J Korean Surg Soc. 2001. 60:470–476.

5. Ahn SH. Personal experience of 1,000 breast cancer surgeries in Korea. J Korean Surg Soc. 2000. 32:68–75.

6. Korean Breast Cancer Society. Clinical characteristics of Korean breast cancer patients in 1998. J Korean Med Sci. 2000. 15:569–579.

7. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004. 32:57–71.

8. Ayres A, Hoon PW, Franzoni JB, Matheny KB, Cotanch PH, Takayanagi S. Influence of mood and adjustment to cancer on compliance with chemotherapy among breast cancer patients. J Psychsom Res. 1994. 38:393–402.

9. Colleoni M, Mandala M, Peruzzotti G, Robertson C, Bredart A, Goldhirsh A. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet. 2000. 356:1326–1327.

10. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet. 1999. 354:1331–1336.

11. Hjerl K, Andersen EW, Keiding N, Mouridsen HT, Mortensen PB, Jorqensen T. Depression as a prognostic factor for breast cancer mortality. Psychosomatics. 2003. 44:24–30.

12. Beck AT. Depression: cause and treatment. 1967. Pennsylvania: University of Pennsylvania Press.

13. Lee Y, Song J. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean J Clin Psychology. 1991. 10:98–113.

14. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Brit J Psychiatry. 1979. 134:382–389.

15. Ahn YM, Lee KY, Yi JS, Kang MH, Kim DH, Kim JL, et al. A validation study of the Korean-version of the Montgomery-Asberg depression rating scale. J Korean Neuropsychiatr Assoc. 2005. 44:466–476.

16. Spielberger CD, Gorsuch RL, Lushene RE. Manual for the statetrait anxiety inventory. 1970. Pal Alto, CA: Consulting Psychologist Press.

17. Hahn DW, Lee CH, Chon KK. Korean Adaptation of Spielberger's STAI (K-STAI). Korean J Health Psychology. 1996. 1:1–14.

18. Kim JH. Relations of perceived stress, cognitive set, and coping behaviors to depression: a focus on freshmen's stress experience. 1987. Seoul: Seoul National University;[dissertation].

19. Koh SB, Chang SJ, Kang MG, Cha BS, Park JK. Reliability and validity on measurement instrument for health status assessment in occupational workers. J Prev Med Pub Health. 1997. 30:251–266.

20. Watson M, Greer S, Young J, Inayat Q, Burqess C, Robertson B. Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psychol Med. 1988. 18:203–209.

21. Kim KI, Kim DH, Choi JH, Park YC, Lee JH, Ahn MJ, et al. A preliminary study on development of Korean version of mental adjustment to cancer scale. J Korean Assoc Soc Psychiatry. 2003. 8:133–140.

22. Hall A, A'Hern R, Fallowfield L. Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer? Eur J Cancer. 1999. 35:79–85.

23. Watson M, Greer S, Rowden L, Gorman C, Robertson B, Bliss JM, et al. Relationships between emotional control, adjustment to cancer and depression and anxiety in breast cancer patients. Psychol Med. 1991. 21:51–57.

24. Reardon KK, Buck R. Emotion, reason, and communication in coping with cancer. Health Commun. 1989. 1:41–54.