Risk Factors for Depression in Breast Cancer Survivors: An Update

By Bardwell, Wayne A.; Fiorentino, Lavinia | International Journal of Clinical and Health Psychology, May 1, 2012 | Go to article overview

Risk Factors for Depression in Breast Cancer Survivors: An Update


Bardwell, Wayne A., Fiorentino, Lavinia, International Journal of Clinical and Health Psychology


ABSTRACT. Depression is the most common affective disorder in cancer patients. Understanding risk factors for depression or elevated depressive symptoms is key to early intervention and tailoring of treatment. In 2006, we published a study of risk factors for elevated depressive symptoms in breast cancer survivors. Our sample was sufficiently large to allow us determine the relative importance of 26 different candidate risk factors in a single hierarchical bivariate logistic regression analysis (N = 2,595). We reported that cancer-related variables were not meaningful risk factors for elevated depressive symptoms in this sample. Rather, this was better explained by distressing life events, less optimism, ambivalence over negative emotional expression, insomnia, and poorer social functioning. While our study was well-powered and examined a large array of candidate risk factors, we still only explained 32.4% of the variance in levels of depressive symptoms; thus, there is ample opportunity for the identification of other risk factors. In this paper, we examine subsequent studies to see what other potential risk factors have been identified in the literature and how they confirm, disconfirm or add to our 2006 findings.

KEYWORDS. Depression. Breast cancer. Risk factors. Theoretical study.

RESUMEN. La depresión es el trastorno más común en los pacientes con cáncer. Es fundamental entender los factores de riesgo para la depresión o síntomas depresivos elevados para las intervenciones tempranas y diseños de tratamientos. En 2006 publicamos un estudio sobre los factores de riesgo para síntomas depresivos elevados en supervivientes de cáncer de mama. La muestra era suficientemente grande como para permitir determinar la importancia relativa de 26 diferentes posibles factores de riesgo en un único análisis de la regresión logística jerárquico bivariado (N = 2595). Se encontró que las variables relacionadas con cáncer no eran factores de riesgo significativos para síntomas depresivos elevados en dicha muestra. Más bien se explicaba mejor por eventos vitales estresantes, menor optimismo, ambivalencia sobre expresiones emocionales negativas, insomnio y pobre funcionamiento social. Aunque nuestro estudio era potente y examinaba un gran conjunto de posibles factores de riesgo, sólo se alcanzó explicar un 32,4% de la varianza en los niveles de síntomas depresivos. Por ello, hay una amplia posibilidad de identificar otros factores de riesgo. En este trabajo, se examinan estudios posteriores para ver qué otros posibles factores de riesgo se han identificado en la literatura y cómo confirman, refutan o añaden información a nuestros hallazgos del año 2006.

PALABRAS CLAVE. Depresión. Cáncer de mama. Factores de riesgo. Estudio teórico.

Breast cancer survivors (BCS) may experience elevated prevalence of depression for a number of reasons. These include the distressing effects of a cancer diagnosis, metabolic/endocrine and emotional sequelae of treatment, fears of recurrence or living with a challenged sense of 'invulnerability', and job/financial repercussions. Most evidence suggests that the majority of these individuals do not develop Major Depressive Disorder. However, a significant subset (15-30%) complain of depressive symptoms of clinical importance. Depression is the most common mood disorder in cancer and can have a significant impact on the patient's quality of life (Bardwell et al., 2006). Of late, the potential impact of subsyndromal levels of depressive symptoms has become a growing area of research interest (Bardwell, Moore, Ancoli-Israel, and Dimsdale, 2003). When leftuntreated, depression can result in diminished adherence to medical treatment (Colleoni et al., 2000) extended inpatient admissions, and greater morbidity and even mortality in patients treated for breast cancer (BC) (Hjerl et al., 2003).

A wide range of risk factors for depression or elevated depressive symptoms in BC have been reported. These include cancer severity (Aapro and Cull, 1999), type of treatment (Duffy, Greenberg, Younger, and Ferraro, 1999; Monti, Mago, and Kunkel, 2005), pain (Aapro and Cull, 1999; Wong-Kim and Bloom, 2005), time since diagnosis, age (Golden-Kreutz and Andersen, 2004; Wong-Kim and Bloom, 2005; Yeter et al. …

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