title: The role of social position in anxiety and depressive symptoms among Danish cancer survivors.
abstract: BACKGROUND
  Anxiety and depressive symptoms are common among cancer survivors. Studies of a possible association with social position have had divergent results. We examined these associations, social position being measured by education, in Danish cancer survivors approximately two years after diagnosis.
  
  
  METHODS
  People aged over 18, living in Denmark and registered for a first cancer in the Danish National Patient Registry between 1 May and 31 August 2010 were contacted; 4346 returned a questionnaire shortly after diagnosis, and 2568 were followed up in 2012. Age, sex and cancer site were derived from the registry; all other information was self-reported, with that on education from the 2010 questionnaire and responses to the Hospital Anxiety and Depression Scale from the 2012 questionnaire. General linear models were used, with adjustment for demographic factors, cancer-specific factors, and comorbidity.
  
  
  RESULTS
  The study population consisted of 1667 people (response rate, 51%). The mean symptom scores were 4.34 (SD 3.77) for anxiety and 2.94 (SD 3.25) for depression. People with medium and higher education had slightly higher anxiety symptom scores (mean differencemedium = 0.41, 95% CI 20.07; 0.88, mean differencehigher = 0.19, 95% CI 20.27; 0.65). Depressive symptom scores were slightly elevated for people with medium education and reduced for those with higher education (mean differencemedium = 0.34, 95% CI 20.07; 0.75, mean differencehigher = 20,11, 95% CI 20.50; 0.29). Female sex, smoking-related cancers and chemotherapy were significantly associated with higher scores for both anxiety and depressive symptoms, but somatic comorbidity and mental disorders at the time of treatment were most strongly, significantly associated with elevated anxiety and depressive symptom scores.
  
  
  CONCLUSIONS
  No overall significant differences in anxiety or depressive symptom scores were found with length of education. Previous mental disorders and somatic comorbidity are the strongest indicators of higher levels of anxiety and depressive symptoms.
authors.affiliation: Survivorship, Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Hanna B
authors.initials: HB
authors.lastname: Hovaldt
authors.forename: Ingelise
authors.initials: I
authors.lastname: Andersen
authors.forename: Mette
authors.initials: M
authors.lastname: Sandager
authors.forename: Cecilie
authors.initials: C
authors.lastname: Sperling
authors.forename: Kirsten
authors.initials: K
authors.lastname: Frederiksen
authors.forename: Pernille E
authors.initials: PE
authors.lastname: Bidstrup
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Susanne O
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000209:etiology / Q000523:psychology*; D012042:Registries / Q000706:statistics & numerical data; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D055815:Young Adult