title: The impact of diagnosis and trait anxiety on psychological distress in women with early stage breast cancer: a prospective study.
abstract: OBJECTIVE
  High trait anxiety (HTA) determines depressive symptoms and state anxiety in women with breast cancer (BC) or benign breast disease (BBD). Before implementing screening for psychological counselling in these women, it is important to evaluate whether high state anxiety and depressive symptoms are determined by (the threat of) having BC or solely by HTA. Therefore, we compared women with a lump in the breast with women with gallstone disease (GD).
  
  
  METHODS
  Women diagnosed with BC (n = 152), BBD (n = 205), and GD (n = 128) were included in a prospective longitudinal study. Questionnaires concerning trait anxiety (baseline), state anxiety, and depressive symptoms were completed before diagnosis was known (BC and BBD) or the laparoscopic cholecystectomy and 6 months later.
  
  
  RESULTS
  Pre-diagnosis BC patients scored higher on state anxiety (p = .001) and depressive symptoms (p < .001) compared with GD. At 6 months, scores on depressive symptoms in BC remained higher than GD (p = .005). In women with HTA, before being diagnosed with BC or BBD, scores on state anxiety were higher compared with HTA women with GD (p < .001, p = .040). State anxiety and depressive symptoms at 6 months were predicted by baseline depressive symptoms in women with BC.
  
  
  CONCLUSIONS
  The severity of diagnosis (BC) in combination with HTA determined the level of state anxiety and depressive symptoms. Therefore, we recommend identifying women with HTA and offering them a tailor-made follow-up protocol during and after the diagnostic process for BBD or BC.
  What is already known on this subject? Women diagnosed with BC or BBD experience high levels of anxiety and distress during the diagnostic process. These adverse psychological effects are strengthened by the personality characteristic trait anxiety. Before implementing screening for psychological counselling in women with high trait anixety, it is important to evaluate whether high state anxiety and depressive symptoms are determined by (the threat of) having BC or solely by HTA. What does this study add? To our knowledge, this is the first study comparing women who are confronted with the possibility of having a life-threatening disease, that is, BC, with women who were not suspected of having a life-threatening disease, that is, GD. This study reveals that the severity of diagnosis (BC) in combination with HTA determined the level of state anxiety and depressive symptoms. Therefore, we recommend identifying women with HTA and offering them a tailor-made follow-up protocol during and after the diagnostic process for BC or BBD.
authors.affiliation: Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands; Department of Paediatric Surgery, Beatrix Children's Hospital, University Medical Centre Groningen, The Netherlands.
authors.forename: Claudia M G
authors.initials: CM
authors.lastname: Keyzer-Dekker
authors.forename: Jolanda
authors.initials: J
authors.lastname: de Vries
authors.forename: Marlies C
authors.initials: MC
authors.lastname: Mertens
authors.forename: Jan A
authors.initials: JA
authors.lastname: Roukema
authors.forename: Alida F W
authors.initials: AF
authors.lastname: van der Steeg
mesh_terms: D001007:Anxiety / Q000523:psychology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D010551:Personality; D010552:Personality Assessment; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: benign breast disease; breast cancer; depressive symptoms; gallstone disease; high trait anxiety; state anxiety