title: Examining pain, body image, and depressive symptoms in patients with lymphedema secondary to breast cancer.
abstract: OBJECTIVE
  Depression and reduced quality of life are often reported in patients with upper-extremity lymphedema secondary to breast cancer treatment. Little is known about how pain and body image influence depression in patients with lymphedema. The current study examined the association of pain intensity and body integrity beliefs with depressive symptoms and the extent to which body image dissatisfaction mediated these associations.
  
  
  METHODS
  A cross-sectional sample of patients with lymphedema secondary to breast cancer treatment completed self-report questionnaires of pain, body image, and depressive symptoms. Hierarchical regression analyses and tests of mediation were conducted to examine the associations among the variables of interest.
  
  
  RESULTS
  Pain intensity and body integrity beliefs were positively associated with depressive symptoms. Further, body image dissatisfaction mediated the relationship between pain and depressive symptoms, indicating that higher levels of pain led to higher states of body image dissatisfaction, which, in turn, led to greater depressive symptoms. Body image dissatisfaction also mediated the relationship between body integrity beliefs and depressive symptoms, suggesting that greater body integrity beliefs led to higher dissatisfaction with one's body and subsequently to greater depressive symptoms.
  
  
  CONCLUSIONS
  Our findings provide preliminary evidence that pain intensity and body image are important factors in understanding depressive symptoms in patients with lymphedema. Clinical implications include screening for pain and body image concerns in this population to identify patients who are in distress. Counseling interventions targeting body image dissatisfaction can also be potentially helpful for patients with lymphedema.
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Teo
authors.affiliation: Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Novy
authors.affiliation: Department of Surgery, University of Chicago Medicine & Biological Sciences, Chicago, IL, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Cox
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michelle Cororve
authors.initials: MC
authors.lastname: Fingeret
mesh_terms: D000368:Aged; D001828:Body Image / Q000523:psychology*; D001943:Breast Neoplasms / Q000150:complications*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000523:psychology*; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000523:psychology*; D010147:Pain Measurement; D010549:Personal Satisfaction; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: body image; body integrity; breast cancer; depression; lymphedema; pain