title: A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer.
abstract: OBJECTIVE
  Sleep disturbances are common among women with breast cancer and can have serious consequences. The present study examined depression, pain, life stress, and participation in group therapy in relation to sleep disturbances in a sample of women with metastatic breast cancer.
  
  
  METHODS
  Ninety-three women with metastatic breast cancer participated in a large intervention trial examining the effect of the group therapy on their symptoms. They completed measures of depression, pain, life stress, and sleep disturbance at baseline, 4, 8 and 12 months.
  
  
  RESULTS
  The results showed that higher initial levels of depression at baseline predicted problems associated with getting up in the morning, waking up during the night, and daytime sleepiness. Increases in depression over the course of 12 months were associated with fewer hours of sleep, more problems with waking up during the night and more daytime sleepiness. Higher levels of pain at baseline predicted more problems getting to sleep. Increases in pain predicted more difficulty getting to sleep and more problems waking up during the night. Greater life stress at baseline predicted more problems getting to sleep and more daytime sleepiness.
  
  
  CONCLUSIONS
  Depression, pain, and life stress scores were each associated with different types of negative change in self-reported sleep disturbances. Depression, especially worsening depression, was associated with the greatest number of types of negative change. The relationships found between sleep disturbance and depression, pain, and life stress suggest specific ways to address the problem of sleep disturbance for women with metastatic breast cancer and show how different types of disturbed sleep may be clinical markers for depression, pain, or life stress in this population.
authors.affiliation: University of Rochester, Rochester, NY 14642, United States. Oxana_Palesh@urmc.rochester.edu
authors.forename: Oxana Gronskaya
authors.initials: OG
authors.lastname: Palesh
authors.forename: Kate
authors.initials: K
authors.lastname: Collie
authors.forename: Daniel
authors.initials: D
authors.lastname: Batiuchok
authors.forename: Jackie
authors.initials: J
authors.lastname: Tilston
authors.forename: Cheryl
authors.initials: C
authors.lastname: Koopman
authors.forename: Michael L
authors.initials: ML
authors.lastname: Perlis
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Butler
authors.forename: Robert
authors.initials: R
authors.lastname: Carlson
authors.forename: David
authors.initials: D
authors.lastname: Spiegel
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000523:psychology / Q000556:secondary*; D001943:Breast Neoplasms / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010147:Pain Measurement; D011615:Psychotherapy, Group; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications*