title: Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: patterns of transiency and severity of the distress response.
abstract: BACKGROUND
  Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress.
  
  
  OBJECTIVE
  To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery.
  
  
  METHODS
  Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemar's test, and logistic regression.
  
  
  RESULTS
  There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness.
  
  
  CONCLUSIONS
  The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Red Cross University College, Stockholm, Sweden. Electronic address: Fredrik.Saboonchi@ki.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Saboonchi
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lena-Marie
authors.initials: LM
authors.lastname: Petersson
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University College, Stockholm, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Wennman-Larsen
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Brännström
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marjan
authors.initials: M
authors.lastname: Vaez
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000453:epidemiology; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology* / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D017741:Survivors / Q000523:psychology*; D013548:Sweden; D013997:Time Factors
keywords: Anxiety; Breast cancer; Depression; Distress; Life events; Sick leave