title: Socio-demographic and clinical variables associated with psychological distress 1 and 3 years after breast cancer diagnosis.
abstract: A large group of women (20-30 %) report psychological distress shortly after breast cancer diagnosis, and some experience continued or increased symptoms over time. The aim of this study was to investigate socio-demographic and clinical variables associated with sustained psychological distress in this patient group.
  
  
  
  Women with breast cancer (n = 833) completed self-report questionnaires regarding socio-demographic and clinical variables shortly after (T1) and 3 years after diagnosis (T2) while data on illness severity were collected from a quality register. The Hospital Anxiety and Depression Scale was used as a measure of psychological distress at both time points.
  
  
  
  The number of participants who reported elevated levels of anxiety was 231 (28 %) at T1 and 231 (28 %) at T2 while elevated depressive symptoms was reported by 119 (14 %) women at T1 and 92 (11 %) at T2. Despite non-significant differences in mean scores over time, 91 (15 %) participants reported increased anxiety symptoms and 47 (7 %) reported increased depressive symptoms. Poor financial situation, lack of social support, previous psychiatric treatment, and high levels of fatigue were associated with both anxiety and depressive symptoms. Reporting high levels of fatigue was the variable most strongly associated with increased psychological distress over time.
  
  
  
  Most participants reported decreased psychological distress over time, but there were subgroups of women who experienced sustained or increased symptoms of anxiety or depression. Participants with poor financial status, previous psychological problems, or high levels of fatigue may be at increased risk of psychological distress. Such individuals may benefit most from psychosocial interventions.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. sven.alfonsson@pubcare.uu.se.
authors.forename: Sven
authors.initials: S
authors.lastname: Alfonsson
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Olsson
authors.affiliation: Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.
authors.forename: Timo
authors.initials: T
authors.lastname: Hursti
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.|Department of Nursing, Metropolitan University College, 2200, Copenhagen N, Denmark.
authors.forename: Marie Høyer
authors.initials: MH
authors.lastname: Lundh
authors.affiliation: Department of Immunology, Genetics and Pathology, Uppsala University Hospital, 751 85, Uppsala, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Johansson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D003710:Demography; D005260:Female; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Anxiety; Breast cancer; Depression; Distress; Longitudinal