title: Combined anxiety and depressive symptoms before diagnosis of breast cancer.
abstract: OBJECTIVE
  To determine the relationship between pre-diagnosis state anxiety, depressive symptoms, and combined state anxiety and depressive symptoms (CADS) with quality of life (QOL), fatigue, state anxiety and depressive symptoms one and two years after surgery in women with breast cancer.
  
  
  METHODS
  Women with breast problems referred to a Dutch outpatient clinic were recruited for the study. Participants (N=428) completed a set of questionnaires before diagnosis (Time0) and the women with breast cancer subsequently received questionnaires at 12 (Time1) and 24 months (Time2) after surgical treatment. The questionnaire set consisted of questionnaires on demographics, state anxiety, depressive symptoms, fatigue, QOL, neuroticism, and trait anxiety. Chi-square tests, independent samples T-tests, and multivariate linear regression analyses were used to do the analyses.
  
  
  RESULTS
  Before their diagnosis of breast cancer, 111 women (28%) had CADS. Of the CADS-group, a higher percentage had elevated levels of anxiety, depressive symptoms, and CADS at all follow-up moments than of the non-CADS-group. CADS-score at before diagnosis and neuroticism were the most important predictors of outcome measures at Time1 and Time2.
  
  
  CONCLUSIONS
  More than one in four women, who later received the diagnosis breast cancer, had elevated levels of both state anxiety and depressive symptoms (CADS) just before diagnosis. This factor was also a major predictor of QOL, state anxiety, depressive symptoms, and fatigue 12 and 24 months after surgery. This implies that women with a higher score on both state anxiety and depressive symptoms should be identified as soon as possible in the process of diagnosis and treatment of breast cancer using validated questionnaires or screening instruments. Only by identifying this group of patients, tailored psychological care can be accomplished.
authors.affiliation: CoRPS--Center of Research on Psychology in Somatic Diseases, Tilburg University, and Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Lotje
authors.initials: L
authors.lastname: Van Esch
authors.forename: Jan A
authors.initials: JA
authors.lastname: Roukema
authors.forename: Miranda F
authors.initials: MF
authors.lastname: Ernst
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: Jolanda
authors.initials: J
authors.lastname: De Vries
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D003863:Depression / Q000523:psychology*; D005221:Fatigue; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life