title: ICF, quality of life, and depression in breast cancer: perceived disability in disease-free women 6 months after mastectomy.
abstract: OBJECTIVE
  Aim of the present observational study is to focus on health-related quality of life (HRQL), mood and everyday life of breast cancer affected women disease-free 6 months after mastectomy, paying particular attention to the International Classification of Functioning, Disability and Health (ICF) framework contribution.
  
  
  METHODS
  Sixty-five breast cancer-affected women disease-free 6 months after mastectomy hospitalized for reconstructive surgery (mean age 46.3 ± 7.3) were enrolled. Their depressive symptoms (Beck Depression Inventory-BDI-II), HRQL, and every day life functioning/barriers and facilitators (ICF) were assessed.
  
  
  RESULTS
  At the BDI-II, 6 patients (9.2 %) reported mild depression and 6 (9.2 %) severe depression; when the subscales were considered, 7 (10.8%) resulted depressed at the somatic-affective factor and 16 (24.6 %) at the cognitive factor. Compared to normative data no differences emerged at the HRQL Physical Component Summary (46.4 ± 9.3 vs 49.1 ± 10.1), whereas patients reported lower scores at the Mental HRQL Component Summary (45.9 ± 10.1 vs 51.5 ± 9.1; p = 0.00001 t = -4.3). As for the activity and participation domain, 11 of the 42 categories investigated were compromised in at least 20% of the sample: lifting and carrying objects (d430), acquisition of goods and services (d620), doing housework (d640), remunerative employment (d850), and many categories relating to interpersonal relationships; moreover the caregiver seems to be perceived as an important and positive modulator of disability.
  
  
  CONCLUSIONS
  The addition of the ICF evaluation to the usual psychological assessment gives a more complete picture, enabling a broader perspective of the psychological-clinical implications. Mainly, the women that we have evaluated continue to function in their everyday lives, thanks in part to their ability to accept help from their own families. However, they inevitably carry signs of their disease which some translating into problems with interpersonal relationships, depressive thoughts and negative ideation. Only the synergistic use of all these assessment instruments can one truly perceive all the nuances relating to the social and psychological conditions of the assessed patients' life, overcoming a binomial vision of well-being and ill-being.
authors.forename: Anna
authors.initials: A
authors.lastname: Giardini
authors.affiliation: Servizio di Psicologia, Istituto Scientifico di Montescano (PV), Fondazione Salvatore Maugeri-IRCCS, via per Montescano, 27040 Montescano, Italy. anna.giardini@fsm.it
authors.forename: Giardini
authors.initials: G
authors.lastname: Anna
authors.forename: Camilla
authors.initials: C
authors.lastname: Pisoni
authors.forename: Pisoni
authors.initials: P
authors.lastname: Camilla
authors.forename: Ines
authors.initials: I
authors.lastname: Giorgi
authors.forename: Giorgi
authors.initials: G
authors.lastname: Ines
authors.forename: Veronica
authors.initials: V
authors.lastname: Borelli
authors.forename: Borelli
authors.initials: B
authors.lastname: Veronica
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Scoccia
authors.forename: Scoccia
authors.initials: S
authors.lastname: Elisabetta
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Majani
authors.forename: Majani
authors.initials: M
authors.lastname: Giuseppina
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008408:Mastectomy / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D011795:Surveys and Questionnaires