Identification of Distinct Depressive Symptom Trajectories in Women Following Surgery for Breast Cancer
Identification of Distinct Depressive Symptom Trajectories in Women Following Surgery for Breast Cancer
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DOI：
10.1037/a0024366
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发表时间：
2011-11-01
影响因子：
4.2
通讯作者：
Miaskowski, Christine
中科院分区：
文献类型：
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作者：
Dunn, Laura B.;Cooper, Bruce A.;Miaskowski, Christine
目的：乳腺癌患者常见的抑郁症状在治疗过程中可能增加、减少或保持稳定。大多数纵向研究报告的平均症状评分往往会模糊症状经历的个体间异质性。识别不同的抑郁症状轨迹可能有助于识别需要干预的患者。本研究旨在确定不同亚组的乳腺癌患者在手术后六个月内抑郁症状的不同轨迹。方法：在398例乳腺癌患者中，使用生长混合模型来识别具有不同抑郁症状特征的患者的潜在类别。这些特征是根据流行病学研究中心抑郁量表（CES-D）在手术前和手术后1、2、3、4、5和6个月完成的评分来确定的。结果：确定了具有明显抑郁症状轨迹的乳腺癌患者的四个潜在类别：低减速（38.9%），中级（45.2%），晚期加速（11.3%）和抛物线（4.5%）类别。平均而言，中级组患者比低减速组患者更年轻。与低减速组相比，中间加速组、后期加速组和抛物线组的平均基线焦虑得分更高。结论：乳腺癌患者术后抑郁症状的发展轨迹不同。值得注意的是，这些女性中超过60%的人被分为三个不同的亚组之一，具有临床显著的抑郁症状。癌症治疗后这些抑郁症状轨迹的表型和基因型预测因子的鉴定需要进一步的研究。
Objective: Depressive symptoms, common in breast cancer patients, may increase, decrease, or remain stable over the course of treatment. Most longitudinal studies have reported mean symptom scores that tend to obscure interindividual heterogeneity in the symptom experience. The identification of different trajectories of depressive symptoms may help identify patients who require an intervention. This study aimed to identify distinct subgroups of breast cancer patients with different trajectories of depressive symptoms in the first six months after surgery. Method: Among 398 patients with breast cancer, growth mixture modeling was used to identify latent classes of patients with distinct depressive symptom profiles. These profiles were identified based on Center for Epidemiological Studies-Depression (CES-D) scale scores completed just prior to surgery, and 1, 2, 3, 4, 5, and 6 months after surgery. Results: Four latent classes of breast cancer patients with distinct depressive symptom trajectories were identified: Low Decelerating (38.9%), Intermediate (45.2%), Late Accelerating (11.3%), and Parabolic (4.5%) classes. Patients in the Intermediate class were younger, on average, than those in the Low Decelerating class. The Intermediate, Late Accelerating, and Parabolic classes had higher mean baseline anxiety scores compared to the Low Decelerating class. Conclusions: Breast cancer patients experience different trajectories of depressive symptoms after surgery. Of note, over 60% of these women were classified into one of three distinct subgroups with clinically significant levels of depressive symptoms. Identification of phenotypic and genotypic predictors of these depressive symptom trajectories after cancer treatment warrants additional investigation.