The effects of major depression and phobia on stage at diagnosis of breast cancer
The effects of major depression and phobia on stage at diagnosis of breast cancer
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DOI：
10.2190/0c63-u15v-5nur-tvxe
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发表时间：
1999-01-01
影响因子：
2
通讯作者：
Kasl, SV
中科院分区：
文献类型：
--
作者：
Desai, MM;Bruce, ML;Kasl, SV
目的：探讨重度抑郁和恐惧症对乳腺癌后续诊断分期的纵向影响。方法：来自纽黑文流行病学集水区（ECA）研究的数据与康涅狄格州肿瘤登记处（CTR）相关联。样本包括72名在基线ECA研究访谈后诊断为原发性乳腺癌的妇女。在ECA研究中，使用基于DSM-III标准的诊断访谈表评估终生精神病史。乳腺癌的诊断阶段从CTR记录中提取，并分为早期（原位和局部肿瘤）和晚期（局部和远处肿瘤）。结果：在控制了样本的社会人口学特征的情况下，重度抑郁症阳性病史与晚期诊断乳腺癌的可能性增加相关（比值比[OR] = 9.81, p = 0.039），而恐惧症阳性病史与晚期诊断的可能性降低相关（OR = 0.01, p = 0.021）。结论：这些分析揭示了报告的终生精神病史与随后乳腺癌诊断阶段之间的纵向关联。恐惧症可能会促使女性坚持乳腺癌筛查建议，并及时向医生报告可疑症状。另一方面，重度抑郁被认为是晚期诊断的重要预测因素；在初级保健环境中正确认识和管理抑郁症可能对乳腺癌的发现和生存具有重要意义。
Objective: To examine the longitudinal effects of major depression and phobia on stage at diagnosis of subsequent breast cancer. Method: Data from the New Haven Epidemiologic Catchment Area (ECA) study were linked to the Connecticut Tumor Registry (CTR). The sample comprised of seventy-two women with a first primary breast cancer diagnosed sometime after their baseline ECA study interview. In the ECA study, lifetime psychiatric history was assessed using the Diagnostic Interview Schedule based on DSM-III criteria. Stage at diagnosis of breast cancer was taken from CTR records and dichotomized into early stage (in situ and localized tumors) versus late stage (regional and distant tumors). Results: A positive history of major depression was associated with an increased likelihood of late-stage diagnosis of breast cancer (odds ratio [OR] = 9.81, p = 0.039), whereas a positive history of phobic disorders was associated with a decreased likelihood of late-stage diagnosis (OR = 0.01, p = 0.021), controlling for sociodemographic characteristics of the sample. Conclusions: These analyses revealed a longitudinal association between reported lifetime psychiatric history and stage at diagnosis of subsequent breast cancer. Phobia may motivate women to adhere to breast cancer screening recommendations and to report suspicious symptoms to a physician without delay. Major depression, on the other hand, was identified as an important predictor of late-stage diagnosis; proper recognition and management of depression in the primary care setting may have important implications for breast cancer detection and survival.