title: Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer.
abstract: Depression carries serious psychosocial, physical, and economic consequences for cancer survivors. Study goals were to characterize patterns and predictors of depressive symptoms and major depressive episodes in recently diagnosed breast cancer patients. Consecutively recruited women (N = 460) completed a validated interview (CIDI) and questionnaire measure (CES-D) of depression within 4 months after invasive breast cancer diagnosis and at six additional assessments across 12 months. Outcomes were major depressive episodes, continuous symptom scores, and latent symptom trajectory classes. Across 12 months, 16.6 % of women met criteria for a major depressive episode. Unemployment predicted depressive episodes after other correlates were controlled. Distinct trajectory classes were apparent: an estimated 38 % of women had chronically elevated symptoms (High trajectory), 20 % recovered from elevated symptoms (Recovery), and 43 % had lower symptoms (Low and Very Low trajectories). Although 96 % of episodes occurred in the High or Recovery classes, 66 % of women in the High trajectory did not have an episode. Women in the Low (vs High) trajectory were more likely to be older, retired, more affluent, and have fewer comorbid diseases and briefer oncologic treatment. Women in the Recovery trajectory (vs High) were more likely to be married and more affluent and have fewer comorbid diseases. Assuming available therapeutic resources, assessment of both depressive symptoms and episodes over several months after diagnosis is important. Identification of patients at risk for persistently high depressive symptoms (e.g., younger, longer treatment course) opens targeted opportunities to prevent and promote rapid recovery from depression.
authors.affiliation: Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA. astanton@ucla.edu.|Departments of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA. astanton@ucla.edu.|Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA. astanton@ucla.edu.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Stanton
authors.affiliation: Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Wiley
authors.affiliation: Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Krull
authors.affiliation: Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA.|Department of Biostatistics, University of California, Los Angeles, USA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Crespi
authors.affiliation: Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
authors.forename: Constance
authors.initials: C
authors.lastname: Hammen
authors.affiliation: Department of Psychology, University of Arizona, Tucson, USA.|University of Arizona Cancer Center, Tucson, USA.
authors.forename: John J B
authors.initials: JJ
authors.lastname: Allen
authors.affiliation: Departments of Psychiatry and Family & Community Medicine, University of Arizona, Tucson, USA.|University of Arizona Cancer Center, Tucson, USA.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Barrón
authors.affiliation: Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.|Departments of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jorge
authors.affiliation: Departments of Psychiatry and Family & Community Medicine, University of Arizona, Tucson, USA.|University of Arizona Cancer Center, Tucson, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Weihs
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
keywords: Breast cancer; Depression; Survivorship; Trajectory