title: The importance of contextual factors and age in association with anxiety and depression in Black breast cancer patients.
abstract: OBJECTIVE
  Limited research exists on correlates of psychosocial distress in Black breast cancer patients. The goals of the study were to describe the prevalence of distress (anxiety and depression) in Black women with breast cancer and to examine the influence of demographic, clinical, contextual (e.g., self-efficacy, medical mistrust), and process of care factors (e.g., patient satisfaction) on women's level of anxiety and depression.
  
  
  METHODS
  Eighty-two Black women diagnosed with invasive non-metastatic breast cancer were interviewed by phone. Collected data included demographic, clinical, contextual, and process of care factors. Bivariate correlations were used to examine relationships between those variables. Multiple linear regressions were used to examine predictors of anxiety and depression.
  
  
  RESULTS
  About one-third of the women (32%) met cut-off thresholds for distress. Medical mistrust and positive attitude had significant influences on anxiety levels, whereas age and positive attitude were determinants of levels of depression. Participants with higher medical mistrust reported more anxiety (r = .379; p < .001) and depression (r = .337; p = .002), whereas women with higher self-efficacy reported less anxiety (r = -.401; p < .001) and depression (r = -.427; p < .001). Age was inversely related to both anxiety and depression (r = -.224; r = -.296, respectively; p < .05).
  
  
  CONCLUSIONS
  Findings support national recommendations for routine distress screening in the delivery of cancer care particularly in younger Black patients. Interventions targeted to boost self-efficacy or reduce medical mistrust through enhanced patient-provider interactions may decrease psychological distress. Psychosocial needs of younger patients warrant particular attention.
authors.affiliation: Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Breast Cancer Program, Washington, DC, USA.
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Sheppard
authors.forename: Felicity W K
authors.initials: FW
authors.lastname: Harper
authors.forename: Kimberly
authors.initials: K
authors.lastname: Davis
authors.forename: Fikru
authors.initials: F
authors.lastname: Hirpa
authors.forename: Kepher
authors.initials: K
authors.lastname: Makambi
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000367:Age Factors; D001007:Anxiety / Q000523:psychology*; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010358:Patient Participation; D012069:Religion and Psychology; D012307:Risk Factors; D020377:Self Efficacy; D013315:Stress, Psychological / Q000523:psychology*; D035502:Trust