Depression and anxiety in women with early breast cancer: five year observational cohort study
Depression and anxiety in women with early breast cancer: five year observational cohort study
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DOI：
10.1136/bmj.38343.670868.d3
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发表时间：
2005-03-26
影响因子：
--
通讯作者：
Ramirez, A
中科院分区：
文献类型：
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作者：
Burgess, C;Cornelius, V;Ramirez, A
目的研究早期乳腺癌患者在确诊后5年内抑郁和焦虑的患病率及其危险因素。设计观察性队列研究。地点：伦敦NHS乳腺诊所。参与者：222名早期乳腺癌患者：170人（77%）提供了诊断或复发后5年的完整访谈数据。主要结果测量临床重要抑郁症的患病率和焦虑（结构化精神访谈标准化诊断标准）和临床和患者的危险因素，包括紧张的生活经历（贝德福德学院生活事件和困难时间表）。结果近50%的妇女与早期乳腺癌有抑郁，焦虑，或两者兼而有之，在诊断后的一年，25%，在第二，第三和第四年，15%，在第五年。诊断时的点患病率为33%，一年后降至15%。45%的复发患者在诊断后三个月内经历了抑郁，焦虑或两者兼而有之。先前的心理治疗可以预测诊断前后（诊断前一个月至诊断后四个月）的抑郁、焦虑或两者兼而有之。长期的抑郁和焦虑与以前的心理治疗，缺乏亲密的信任关系，年轻，以及严重的压力非癌症生活经历有关。临床因素与抑郁和焦虑在任何时候都不相关。缺乏亲密的倾诉支持也预测更持久的抑郁症和anxiets.Conclusion抑郁症和焦虑的水平增加，在第一年后的早期乳腺癌的诊断突出需要专门的服务提供在这段时间。对乳腺癌患者的心理干预，谁保持无病应该考虑到癌症发生的更广泛的社会背景，重点是改善社会支持。
Objective To examine the prevalence of, and risk factors for, depression and anxiety in women with early breast cancer in the five years after diagnosis.Design Observational cohort study.Setting NHS breast clinic, London.Participants 222 women with early breast cancer: 170 (77%) provided complete interview data up to either five years after diagnosis or recurrence.Main outcome measures Prevalence of clinically important depression and anxiety (structured psychiatric interview with standardised diagnostic criteria) and clinical and patient risk factors, including stressful life experiences (Bedford College life events and difficulties schedule).Results Nearly 50% of the women with early breast cancer had depression, anxiety, or both in the year after diagnosis, 25% in the second, third, and fourth years, and 15% in the fifth year. Point prevalence was 33% at diagnosis, falling to 15% after one year. 45% of those with recurrence experienced depression, anxiety, or both within three months of the diagnosis. Previous psychological treatment predicted depression, anxiety, or both in the period around diagnosis (one month before diagnosis to four months after diagnosis). Longer term depression and anxiety were associated with previous psychological treatment, lack of an intimate confiding relationship, younger age, and severely stressful non-cancer life experiences. Clinical factors were not associated with depression and anxiety at any time. Lack of intimate confiding support also predicted more protracted episodes of depression and anxiety.Conclusion Increased levels of depression and anxiety in the first year after a diagnosis of early breast cancer highlight the need for dedicated service provision during this time. Psychological interventions for women with breast cancer who remain disease free should take account of the broader social context in which the cancer occurs, with a focus on improving social support.