title: The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: A systematic review.
abstract: OBJECTIVE
  It is unclear whether breast cancer survivors have a higher risk of long-term symptoms of depression or anxiety. The aim of this study was to systematically review the evidence about long-term symptoms of depression and anxiety in breast cancer survivors.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  PubMed, Embase, Cochrane and PsycINFO were searched for studies with at least 100 survivors ≥1 year after diagnosis, and which used common questionnaires measuring symptoms of depression or anxiety, by two independent reviewers. The quality was assessed with the NIH 'Quality Assessment Tool' checklist. Prevalence of symptoms of depression and anxiety was compared to time since diagnosis, available control groups and a general female population.
  
  
  RESULTS
  Seventeen articles were included in this review with an average quality score of 57% (range 38-86%). The prevalence of symptoms of depression varied from 9.4% to 66.1% and of anxiety from 17.9% to 33.3%. The results on the depression scale suggested an increase in risk of symptoms of depression for breast cancer survivors at one year after diagnosis, which decreases over the ensuing years. Symptoms of anxiety were not more prevalent among the women with early stage breast cancer.
  
  
  CONCLUSIONS
  This review suggests a higher prevalence of symptoms of depression among breast cancer survivors than among the general female population, persistent over more than 5 years after diagnosis. Health care providers should be aware of this. There was no indication for an increased prevalence of symptoms of anxiety among breast cancer survivors.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands. Electronic address: S.W.M.C.Maass@umcg.nl.
authors.forename: S W M C
authors.initials: SW
authors.lastname: Maass
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Roorda
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Berendsen
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands; NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands.
authors.forename: P F M
authors.initials: PF
authors.lastname: Verhaak
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: G H
authors.initials: GH
authors.lastname: de Bock
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D017741:Survivors / Q000523:psychology*
keywords: Anxiety; Breast cancer; Depression; Long-term; Prevalence; Survivors