title: Early Childhood Adversity and its Associations With Anxiety, Depression, and Distress in Women With Breast Cancer.
abstract: BACKGROUND
  Certain vulnerability factors have been found to place patients at risk for depression and anxiety, especially within the context of medical illness.
  
  
  OBJECTIVE
  We sought to describe the relationships among early childhood adversity (ECA) and anxiety, depression and distress in patients with breast cancer.
  
  
  METHODS
  Patients with breast cancer (stages 0-IV) were assessed for ECA (i.e., the Risky Families Questionnaire subscales include Abuse/Neglect/Chaotic Home Environment), distress (i.e., Distress Thermometer and Problem List), anxiety (Hospital Anxiety and Depression Scale-Anxiety), depression (Hospital Anxiety and Depression Scale-Depression), meeting standardized cut-off thresholds for distress (Distress Thermometer and Problem List ≥4 or ≥7)/anxiety (Hospital Anxiety and Depression Scale-Anxiety ≥8)/depression (Hospital Anxiety and Depression Scale-Depression ≥8) and demographic factors.
  
  
  RESULTS
  A total of 125 participants completed the study (78% response rate). ECA was associated with depression (p <0.001), anxiety (p = 0.001), and distress (p = 0.006), meeting cut-off threshold criteria for distress (p = 0.024), anxiety (p = 0.048), and depression (p = 0.001). On multivariate analysis, only depression (p = 0.04) and emotional issues (i.e., component of Distress Thermometer and Problem List) (p = 0.001) were associated with ECA. Neglect, but not Abuse and Chaotic Home Environment, was associated with depression (β = 0.442, p < 0.001), anxiety (β = 0.342, p = 0.002), and self-identified problems with family (β = 0.288, p = 0.022), emotion (β = 0.345, p = 0.004), and physical issues (β = 0.408, p < 0.001).
  
  
  CONCLUSIONS
  ECA and neglect are associated with multiple psychologic symptoms, but most specifically depression in the setting of breast cancer. ECA contributes to psychologic burden as a vulnerability factor. ECA may help to explain individual patient trajectories and influence the provision of patient-centered care for psychologic symptoms in patients with breast cancer.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: danielcurtismcfarland@gmail.com.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: McFarland
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Charissa
authors.initials: C
authors.lastname: Andreotti
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL.
authors.forename: Kirk
authors.initials: K
authors.lastname: Harris
authors.affiliation: Department of Preventative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: John
authors.initials: J
authors.lastname: Mandeli
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
authors.forename: Amy
authors.initials: A
authors.lastname: Tiersten
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Jimmie
authors.initials: J
authors.lastname: Holland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires