title: Prevalence of depression in breast cancer survivors: a systematic review of observational studies.
abstract: BACKGROUND
  Depression is common in breast cancer patients. The aim of this paper was to make a systematic review of its prevalence and associated factors oin breast cancer survivors.
  
  
  METHODS
  An extensive systematic electronic review (PUBMED, CINAHL, PsyINFO and Ovid) and handsearch were carried out to retrieve published articles up to November 2012, using Depression OR Dysthymia AND (Cancer OR Tumor OR Neoplasms as the keywords. Information about the design of the studies, measuring scale, characteristics of the participants, prevalence of depression and its associated factors from the included studies were extracted and summarized.
  
  
  RESULTS
  We identified 32 eligible studies that recruited 10,826 breast cancer survivors. Most were cross-sectional or prospective designed. The most frequent instrument used to screen depression was the Center for Epidemiological Studies for Depression (CES-D, n=11 studies) followed by the Beck Depression Inventory (BDI, n=6 studies) and the Hospital Anxiety and Depression Scale (HADS, n=6 studies). CES-D returned about similar prevalence of depression (median=22%, range=13-56%) with BDI (median=22%, range=17-48%) but higher than HADS (median=10%, range=1-22%). Depression was associated with several socio-demographic variables, cancer-related factors, treatment-related factors, subject psychological factors, lifestyle factors, social support and quality of life.
  
  
  CONCLUSIONS
  Breast cancer survivors are at risk for depression so that detection of associated factors is important in clinical practice.
authors.affiliation: Psychological Medicine Research Group of University Malaya (PARADIGM), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. zuraida@ummc.edu.my
authors.forename: Nor Zuraida
authors.initials: NZ
authors.lastname: Zainal
authors.forename: Nik Ruzyanei
authors.initials: NR
authors.lastname: Nik-Jaafar
authors.forename: Azlin
authors.initials: A
authors.lastname: Baharudin
authors.forename: Zuraida Ahmad
authors.initials: ZA
authors.lastname: Sabki
authors.forename: Chong Guan
authors.initials: CG
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human