title: Prevalence of depression, anxiety and their risk factors in German women with breast cancer in general and gynecological practices.
abstract: OBJECTIVE
  To analyze the prevalence of depression, anxiety and their risk factors in German women with breast cancer (BC) in general and gynecological practices (GP, GYP).
  
  
  METHODS
  Women initially diagnosed with BC between 2009 and 2013 were identified by 1202 general practitioners and 244 gynecologists in the IMS Disease Analyzer database. They were included only if they had not suffered from depression or an anxiety disorder within the 12 months prior to the index date. The main outcome was the first diagnosis of depression or an anxiety disorder within 5 years after index date. A multivariate Cox regression model was used to predict these diagnoses on the basis of patient characteristics.
  
  
  RESULTS
  A total of 24,537 patients in GP were available for the study, as well as 20,018 patients in GYP. The mean age was 65.8 and 62.5 years in GP and GYP, respectively (p value <0.0001). The proportions of depressive or anxiety episodes in the past and the proportion of metastases were higher in GP than in GYP (7.9 vs. 3.6%, and 10.1 vs. 8.6%, p values <0.0001). Within 5 years of follow-up, 36.9% of GP patients and 35.1% of GYP patients had been diagnosed with depression or anxiety. There was a significantly higher risk of depression and/or anxiety in women in the age groups 51-60, 61-70 and >70 years than in women = <50 years (OR between 1.05 and 1.27, all p values lower than 0.0359). Patients with metastases or with previous episodes of depression/anxiety had a higher risk of depression/anxiety (OR = 1.21 and 1.97, p values <0.0001). Finally, women with private health insurance had a lower risk of depression and anxiety (OR = 0.45, p value <0.0001).
  
  
  CONCLUSIONS
  The present study indicates that levels of depression and anxiety increase in German women after diagnosis of BC and may be predicted on the basis of several demographic and clinical characteristics.
authors.affiliation: Department of Biology, École Normale Supérieure de Lyon, Lyon, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Jacob
authors.affiliation: Department of Gynecology and Obstetrics, Philipps-Universität Marburg, 35043, Marburg, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Bleicher
authors.affiliation: Real World Evidence Solutions, IMS Health GmbH & Co. OHG, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany. kkostev@de.imshealth.com.
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
authors.affiliation: Department of Gynecology and Obstetrics, Philipps-Universität Marburg, 35043, Marburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kalder
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006176:Gynecology / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged
keywords: Anxiety; Breast cancer; Depression