title: Trajectories of psychological distress among Chinese women diagnosed with breast cancer.
abstract: BACKGROUND
  The distinct trajectories of psychological distress over the first year of the diagnosis with breast cancer (BC) and its determinants have not been explored.
  
  
  METHODS
  285 of 405 Chinese women receiving surgery for BC were assessed at 5-day, 1-month, 4-month, and 8-month post-surgery on measures of psychological distress, optimism, treatment decision-making (TDM) difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, and physical symptom distress. Latent growth mixture modelling identified trajectories of psychological response to BC. Multinominal logistic regression compared TDM difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, optimism, and physical symptom distress, by distress pattern adjusted for age, education, employment status, and stage of disease.
  
  
  RESULTS
  Four distinct trajectories of distress were identified, namely, resilience (66%), chronic distress (15%), recovered (12%), and delayed-recovery (7%). TDM difficulties, optimism, satisfaction with consultation, and physical symptom distress predicted distress trajectories. Psychologically resilient women had less physical symptom distress at early post-surgery compared with women with other distress patterns. Compared with the resilient group, women in the recovered or chronic distress groups experienced greater TDM difficulties, whereas women in the delayed-recovery group reported greater dissatisfaction with the initial medical consultation. Women in the chronic distress group reported greater pessimistic outlook.
  
  
  CONCLUSIONS
  Optimism and better early post-operative treatment outcomes predicted resilience to distress. Pre-operative interventions helping women to establish a realistic expectation of treatment outcome may minimize disappointment with treatment outcome and resultant distress, whereas post-operative rehabilitation should focus on symptom management.
authors.affiliation: Centre for Psycho-Oncology Research & Training, Department of Community Medicine & Unit for Behavioural Sciences, The University of Hong Kong, Pokulam, Hong Kong. wwtlam@hku.hk
authors.forename: Wendy W T
authors.initials: WW
authors.lastname: Lam
authors.forename: George A
authors.initials: GA
authors.lastname: Bonanno
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Mancini
authors.forename: Samuel
authors.initials: S
authors.lastname: Ho
authors.forename: Miranda
authors.initials: M
authors.lastname: Chan
authors.forename: Wai Ka
authors.initials: WK
authors.lastname: Hung
authors.forename: Amy
authors.initials: A
authors.lastname: Or
authors.forename: Richard
authors.initials: R
authors.lastname: Fielding
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D044466:Asian People / Q000523:psychology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology* / Q000601:surgery; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D055809:Illness Behavior; D016015:Logistic Models; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D015233:Models, Statistical; D011594:Psychometrics / Q000706:statistics & numerical data; D055500:Resilience, Psychological; D013315:Stress, Psychological / Q000208:ethnology*; D016896:Treatment Outcome