title: Depression, anxiety and disease-related distress in couples affected by advanced lung cancer.
abstract: OBJECTIVE
  Lung cancer patients and their partners are prone to high levels of depression and anxiety or severe distress related to the poor prognosis of the illness. However, there remain doubts regarding the extent to which this distress exceeds levels in the general population. This study explored levels of depression and generalized anxiety for comparison with matched data of a representative sample from the general population. Additionally, covariance of distress between the two partners, together with disease-specific components and differences were investigated.
  
  
  METHODS
  In a cross-sectional survey, 54 pairs of lung cancer patients and their partners (n=108) were assessed for depression and anxiety, cancer-related distress, unmet needs and disclosure in communication. Comparisons between distress levels of participating couples and matched community-comparisons (n=162) were conducted. Additionally, multilevel analysis for estimating intra-dyadic associations of anxiety and depression was computed. Components of distress, needs and aspects of communication were explored via item mean values.
  
  
  RESULTS
  Lung cancer patients as well as their partners exhibited significantly higher levels of depression and anxiety when compared to community-based comparison subjects (patients: mean difference of 1.01 for depression with a relative risk (RR) of 4.5 and 0.84 for anxiety with RR=6.1; partners: 1.17 for depression with RR=4.6 and 1.59 for anxiety with RR=7.6). Partial intraclass correlations between patients and partners were weak (PIC=.29 for depression; PIC=.21 for anxiety). Fear of progression emerged as main component of distress for both patients and partners, although differing stressors were described.
  
  
  CONCLUSIONS
  Lung cancer-affected couples exhibit levels of depression and anxiety far exceeding those of the general community. In clinical practice, patients and partners should be assessed separately for distress against the background of weak intra-dyadic associations. In cases of significant depression or anxiety, referral for psychosocial treatment is indicated and has been shown to improve quality of life.
authors.affiliation: Department of General Internal Medicine & Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany; Soteria Bern, University Hospital of Psychiatry Bern, Buehlstrasse 19a, CH-3012 Bern, Switzerland. Electronic address: markus.haun@med.uni-heidelberg.de.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Haun
authors.affiliation: Department of General Internal Medicine & Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
authors.forename: Halina
authors.initials: H
authors.lastname: Sklenarova
authors.affiliation: Department of Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Amalienstraße 5, D-69126 Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Villalobos
authors.affiliation: Department of Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Amalienstraße 5, D-69126 Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Division of Psycho-Oncology, National Centre for Tumour Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Brechtel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf and Hamburg-Eilbek (Schön Clinics), Martinistraße 52, Gebaeude Ost 25 (O 25), D-20246 Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
authors.affiliation: Department of General Internal Medicine & Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Department of General Internal Medicine & Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Hartmann
mesh_terms: D000368:Aged; D001007:Anxiety; D003863:Depression; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D012307:Risk Factors; D013315:Stress, Psychological
keywords: Communication; Couples; Depression; Distress; Lung cancer; anxiety