title: Depression and Anxiety Disorders among Hospitalized Women with Breast Cancer.
abstract: OBJECTIVE
  To document the prevalence of depression and anxiety disorders, and their associations with mortality among hospitalized breast cancer patients.
  
  
  METHODS
  We examined the associations between breast cancer diagnosis and the diagnoses of anxiety or depression among 4,164 hospitalized breast cancer cases matched with 4,164 non-breast cancer controls using 2006-2009 inpatient data obtained from the Nationwide Inpatient Sample database. Conditional logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CI) for the associations between breast cancer diagnosis and diagnoses of anxiety or depression. We also used binary logistic regression models to examine the association between diagnoses of depression or anxiety, and in-hospital mortality among breast cancer patients.
  
  
  RESULTS
  We observed that breast cancer cases were less likely to have a diagnosis of depression (OR=0.63, 95% CI: 0.52-0.77), and less likely to have a diagnosis of anxiety (OR=0.68, 95% CI: 0.52-0.90) compared with controls. This association remained after controlling for race/ethnicity, residential income, insurance and residential region. Breast cancer patients with a depression diagnosis also had lower mortality (OR=0.69, 95% CI: 0.52-0.89) compared with those without a depression diagnosis, but there was no significant difference in mortality among those with and without anxiety diagnoses.
  
  
  CONCLUSIONS
  Diagnoses of depression and anxiety in breast cancer patients were less prevalent than expected based on our analysis of hospitalized breast cancer patients and matched non-breast cancer controls identified in the NIS dataset using ICD-9 diagnostic codes. Results suggest that under-diagnosis of mental health problems may be common among hospitalized women with a primary diagnosis of breast cancer. Future work may fruitfully explore reasons for, and consequences of, inappropriate identification of the mental health needs of breast cancer patients.
authors.affiliation: Rocky Mountain Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado, United States of America.
authors.forename: Neomi
authors.initials: N
authors.lastname: Vin-Raviv
authors.affiliation: Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama, United States of America.
authors.forename: Tomi F
authors.initials: TF
authors.lastname: Akinyemiju
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.affiliation: Biobehavioral Oncology Program, Department of Psychiatry, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America; Biobehavioral Oncology Program, Department of Psychology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America; Biobehavioral Oncology Program, Department of Behavioral & Community Health Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Dana H
authors.initials: DH
authors.lastname: Bovbjerg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged