title: Predictive factors for psychological distress related to diagnosis of breast cancer.
abstract: OBJECTIVE
  The aims of the present study were as follows: (i) to clarify the proportion of women who experience psychological distress during breast cancer diagnosis and (ii) to identify the predictors of psychological distress related to the diagnostic process.
  
  
  METHODS
  This was a longitudinal prospective study of women who required further breast examination. Questionnaires were administered at pre-medical consultations (Time 1), after describing radiological examination (Time 2), and after explaining pathological findings (Time 3). All participants completed Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy--Breast, and Functional Assessment of Chronic Illness Therapy--Spiritual subscale at Time 1 to identify predictors. Participants also completed HADS at Times 2 and 3 to identify the presence or absence of psychological distress.
  
  
  RESULTS
  Of the 222 eligible patients, at Time 2, 31 (22.6%) participants with no clinical abnormalities and 39 (45.9%) participants with abnormal findings had HADS scores of ≥ 11 points (χ2 test, 13.14; p < 0.001). At Time 3, 14 (28.0%) participants with benign breast changes and 24 (68.6%) participants with breast cancer had scores of ≥ 11 (χ2 test, 13.71; p < 0.001). Higher HADS scores at Time 1 were associated with the presence of psychological distress at all stages of breast cancer diagnosis. Advanced tumor stage was a predictor of psychological distress for participants with breast cancer (odds ratios = 3.314, 95% confidence interval = 1.033-9.509; p = 0.044).
  
  
  CONCLUSIONS
  These results suggest that intensive psychological intervention is necessary for breast cancer patients with large tumors, as well as for women with suspected breast cancer with high HADS scores at pre-consultation.
authors.affiliation: Section Division of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. tsugu-200@goo.jp
authors.forename: Tsuguo
authors.initials: T
authors.lastname: Iwatani
authors.forename: Ayako
authors.initials: A
authors.lastname: Matsuda
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Kawabata
authors.forename: Daishu
authors.initials: D
authors.lastname: Miura
authors.forename: Eisuke
authors.initials: E
authors.lastname: Matsushima
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires