title: Causal attributions to epidemiological risk factors and their associations to later psychological adjustment among Japanese breast cancer patients.
abstract: OBJECTIVE
  The objective of this study was to evaluate the causal attributions for breast cancer and their association with the subsequent psychological adjustment.
  
  
  METHODS
  Sixty-three Japanese patients newly diagnosed with breast cancer were asked by an interviewer about risk factors and explanations for the etiology of breast cancer using a four-point scale. The General Health Questionnaire (GHQ-28) and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered about 2 months later to measure psychological adjustment to the illness. The relationship between each causal attribution and measure of psychological adjustment was assessed with the Spearman rank correlation after adjusting for potential confounders (age, marital status, cancer stage at diagnosis, time between the day of diagnosis and follow-up, and physical symptoms at the follow-up).
  
  
  RESULTS
  Attributions to several explanations, including "stress" and "personal characteristics," were positively associated with the GHQ-28 measures. Of the attributions to risk factors, "body size" was significantly inversely (r = -0.29) associated and "never having children" was insignificantly and highly inversely (r = -0.77) associated with the GHQ-28 measures, indicating better adjustment to the illness. On the other hand, the attribution to "tobacco" was significantly and positively associated with the GHQ-28 measures (r = 0.34), indicating that the attributions antagonized adjustment to the illness.
  
  
  CONCLUSIONS
  The current study indicates that forming causal attributions influences the adjustment to the illness in Japanese breast cancer patients and attributions to certain risk factors for breast cancer may contribute to better adjustment.
authors.affiliation: Department of Prevention for Lifestyle-related Diseases, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan. obas@gifu-u.ac.jp
authors.forename: Shino
authors.initials: S
authors.lastname: Oba
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Takatsuka
authors.forename: Chisato
authors.initials: C
authors.lastname: Nagata
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Nagao
authors.forename: Satoru
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Chiken
authors.initials: C
authors.lastname: Shibuya
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Kashiki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors