title: Psychological distress, optimism and general health in breast cancer survivors: a data linkage study using the Scottish Health Survey.
abstract: OBJECTIVE
  The aim of this study is to examine the association between optimism and psychological distress in women with breast cancer after taking into account their self-rated general health.
  
  
  METHODS
  Data were aggregated from the Scottish Health Survey (2008 to 2011) to derive a nationally representative sample of 12,255 women (11,960 cancer-free controls, and 295 breast cancer cases identified from linked cancer registry data). The explanatory variables were optimism and general health, and the outcome variable was symptoms of psychological distress. Logistic regression analyses were conducted, with optimism entered in step 1 and general health entered in step 2.
  
  
  RESULTS
  In an unadjusted model, higher levels of optimism were associated with lower odds of psychological distress in both the control group (OR = 0. 57, 95 % CI = 0.51-0.60) and breast cancer group (OR = 0. 64, 95 % CI = 0.47-0.88). However, in a model adjusting for general health, optimism was associated with lower odds of psychological distress only in the control group (OR = 0.50, 95 % CI = 0.44-0.57), but not significantly in the breast cancer group (OR = 1.15, 95 % CI = 0.32-4.11). In the breast cancer group, poor general health was a stronger associate of psychological distress (OR = 4. 98, 95 % CI = 1.32-18.75). Results were consistent after adjusting for age, years since breast cancer diagnosis, survey year, socioeconomic status, education, marital status, body mass index, smoking status, and alcohol consumption.
  
  
  CONCLUSIONS
  This research confirms the value of multicomponent supportive care interventions for women with breast cancer. Specifically, it suggests that following breast cancer diagnosis, health care professionals need to provide advice and signpost to services that assist women to maintain or improve both their psychological and general health.
authors.affiliation: School of Public Health, The University of Queensland, Herston, QLD, Australia. j.leung1@uq.edu.au.|Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia. j.leung1@uq.edu.au.|Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. j.leung1@uq.edu.au.
authors.forename: Janni
authors.initials: J
authors.lastname: Leung
authors.affiliation: School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, EH14 1DJ, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Atherton
authors.affiliation: School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, EH14 1DJ, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Kyle
authors.affiliation: School of Health Sciences, University of Stirling, Scotland, Stirling, FK9 4LA, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Hubbard
authors.affiliation: School of Public Health, The University of Queensland, Herston, QLD, Australia.
authors.forename: Deirdre
authors.initials: D
authors.lastname: McLaughlin
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology*; D016022:Case-Control Studies; D059026:Diagnostic Self Evaluation; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D016247:Information Storage and Retrieval; D017533:Marital Status; D008875:Middle Aged; D000067656:Optimism / Q000523:psychology*; D012606:Scotland / Q000453:epidemiology; D012923:Social Class; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D013997:Time Factors
keywords: Breast cancer; Mental health; Optimism; Psychological distress; Psychosocial; Self-rated health