title: Early psychological adjustment in breast cancer patients: a prospective study.
abstract: OBJECTIVE
  A significant proportion of breast cancer patients experiences psychiatric morbidity in the first year after a breast cancer diagnosis and/or beginning of treatment. This study attempted to identify and understand the risk factors for developing such problems.
  
  
  METHODS
  A consecutive series of 87 patients, aged 40-75 years, was assessed prior to diagnosis of breast cancer and followed-up approximately 8 weeks after beginning of cancer treatment and again 9 months after first follow-up. Assessments included measures of psychiatric morbidity using the General Health Questionnaire (GHQ-12), coping style using the Mental Adjustment to Cancer (MAC) Scale, symptom attribution, beliefs about breast cancer, social support, socio-demographic and clinical variables.
  
  
  RESULTS
  A total of 85.1% of patients completed both follow-ups. Pre-diagnostically, 32.2% of breast cancer patients scored as a GHQ-12 'case.' GHQ scores fell significantly between pre-diagnostic and both post-diagnostic assessments, especially in women who had thought they had cancer. Predictors of psychological morbidity at first follow-up included pre-diagnostic GHQ-12 score, lack of social support and feelings of 'personal responsibility/avoidance.' GHQ-12 'caseness' at second follow-up was predicted by lack of social support alone.
  
  
  CONCLUSIONS
  Overall, psychiatric morbidity is higher prior to, than following, a definitive diagnosis of breast cancer. Early reactions of this kind are predictive of post-treatment adjustment. However, only the presence of social support in this study seems to be associated with successful adjustment in the first year following a breast cancer diagnosis. Women at increased risk of psychological morbidity after a breast cancer diagnosis may be thus identifiable and targeted therapeutically.
authors.affiliation: Division of Psychological Medicine, Department of Psychiatry, The Guy's, King's and St. Thomas' School of Medicine and Institute of Psychiatry, De Crespigny Park, London, UK. c.nosarti@iop.kcl.ac.uk
authors.forename: Chiara
authors.initials: C
authors.lastname: Nosarti
authors.forename: Jonathan V
authors.initials: JV
authors.lastname: Roberts
authors.forename: Timothy
authors.initials: T
authors.lastname: Crayford
authors.forename: Kwame
authors.initials: K
authors.lastname: McKenzie
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support