title: Patient reporting pain intensity immediately after surgery can be associated with underlying depression in women with breast cancer.
abstract: OBJECTIVE
  The aims of this study were to determine the prevalence of severe, definite depression symptoms, as measured using the Center for Epidemiological Studies Depression Scale (CES-D), and the association between high CES-D scores (i.e., ≥25) and sociodemographic and perioperative factors during perioperative period.
  
  
  METHODS
  Among 1690 consecutive breast cancer patients who were admitted for definitive breast surgery during the study period, 1499 patients were included in this study. Patients with a past medical history of psychiatric medication or support, a plan for elective surgery due to locoregional recurrence, or any metastatic disease were excluded. The CES-D score was checked 1 day before definitive surgeries. The sociodemographic data and perioperative data were analyzed.
  
  
  RESULTS
  The mean CES-D score was 18.5, with 24.1% (362/1499) and 56.7% (850/1499) having high CES-D scores of ≥25 and ≥16, respectively. Multivariate analysis revealed that the number of family members with any malignancy (≥2 vs. 0), sedative medication (yes vs. no), and postoperative numeric rating scale scores (persistent, severe pain vs. stably mild pain) were significantly associated factors for severe, definite depression symptoms [CES-D score of ≥25: adjusted odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.10-2.21, p = 0.013; adjusted OR = 1.65, 95% CI = 1.00-2.71, p = 0.048; and adjusted OR = 2.14, 95% CI = 1.15-3.95, p = 0.016, respectively].
  
  
  CONCLUSIONS
  Depression may increase the intensity of postoperative acute pain. Self-reporting of persistent postoperative pain intensity is potentially useful in detecting hidden depression symptoms in breast cancer patients during the perioperative period.
authors.affiliation: Department of Surgery, Chosun University College of Medicine, Gwangju, Korea.
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Nursing, Asan Medical Center, Seoul, Korea.
authors.forename: Hyuigyung
authors.initials: H
authors.lastname: Do
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Nursing, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Jaesim
authors.initials: J
authors.lastname: Jeong
authors.affiliation: Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Yong Wook
authors.initials: YW
authors.lastname: Shin
authors.affiliation: Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Kikyoung
authors.initials: K
authors.lastname: Yi
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jisun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Sae Byul
authors.initials: SB
authors.lastname: Lee
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Guiyun
authors.initials: G
authors.lastname: Sohn
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Nuri
authors.initials: N
authors.lastname: Yang
authors.affiliation: Department of Nursing, Asan Medical Center, Seoul, Korea.
authors.forename: Youngkyung
authors.initials: Y
authors.lastname: Oh
authors.affiliation: Department of Nursing, Asan Medical Center, Seoul, Korea.
authors.forename: Leeyoung
authors.initials: L
authors.lastname: Kim
authors.affiliation: Department of Nursing, Asan Medical Center, Seoul, Korea.
authors.forename: Yeonhee
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jong Han
authors.initials: JH
authors.lastname: Yu
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Ko
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Hee Jeong
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Son
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Sei Hyun
authors.initials: SH
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003866:Depressive Disorder; D005190:Family; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D010146:Pain / Q000523:psychology*; D010149:Postoperative Pain / Q000453:epidemiology / Q000523:psychology*; D059035:Perioperative Period; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index