title: Anxiety, depression, and the history of psychiatric symptoms in patients with breast disease: a prospective case-control study in Kuopio, Finland.
abstract: BACKGROUND
  Many case-control studies have investigated the association between anxiety, depression, the history of psychiatric symptoms and risk of breast cancer. However, findings are inconsistent, and results may be explained by the fact that most of the epidemiological data available come from retrospective case-control studies. We have conducted this case-control study with a so-called "limited prospective study design" to reduce the potential for recall bias.
  
  
  METHODS
  This study is an extension of the Kuopio Breast Cancer Study. Women with breast symptoms were referred by physicians to the Kuopio University Hospital (Finland) and were asked to participate in this study. These subjects were interviewed and all study variables were obtained before any diagnostic procedures were carried out, so neither the investigator nor the subject knew the final diagnosis of breast symptoms at the time of the interview. The research method used was the semistructured in-depth interview method. The Montgomery-Asberg Depression rating scale (MADRS) was used to evaluate the depression of the study subjects. All study subjects were also asked to complete standardised questionnaires (Beck Depression Inventory and Spielberger Trait Inventory). The Forsen Inventory was used to evaluate the history of psychiatric symptoms of the subjects in the six years prior to admission.
  
  
  RESULTS
  Clinical examination and biopsy showed breast cancer (BC) in 34 patients, benign breast disease (BBD) in 53 patients, while 28 study subjects were healthy (HSS). The mean "Forsen-score 2-6 yrs" of the BC group was lower (9.8) than the scores of the BBD group (11.8) and the HSS group (12.5) (p = 0.4). The investigator-characterized variables, "MADRS"- and "depression"-variables correlated significantly (p-value under 0.001) with those variables reported by the study subjects, "BDT", "A-trait" and "Forsen-score". The "anxiety"-variables characterized by the investigator correlated to the "A-trait"-variable and "Forsen-score"-variable reported by the study subjects (p-value under 0.05).
  
  
  CONCLUSIONS
  Our results do not support an overall association between anxiety, depression, history of psychiatric symptoms and increased breast cancer risk. However, the exact effects of psychological factors on the various hormones relevant to the development of breast cancer are at present poorly defined.
authors.affiliation: Department for Social and Health Affairs, State Office in Eastern Finland, P.O. Box 1741, FIN-70101 Kuopio, Finland. paula.ollonen@islh.intermin.fi
authors.forename: Paula
authors.initials: P
authors.lastname: Ollonen
authors.forename: Johannes
authors.initials: J
authors.lastname: Lehtonen
authors.forename: Matti
authors.initials: M
authors.lastname: Eskelinen
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications*; D001943:Breast Neoplasms / Q000209:etiology / Q000523:psychology*; D016022:Case-Control Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires