title: Co-morbidity of depression, anxiety and fatigue in cancer patients receiving psychological care.
abstract: This study aimed to examine (1) subgroups of cancer patients with distinct co-morbidity patterns of depression, anxiety and fatigue; (2) how individuals transitioned between these patterns; and (3) whether socio-demographic, clinical and psychological care characteristics distinguished patients' transitions.
  
  
  
  This naturalistic, longitudinal study focused on 241 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1), 3 months (T2), and 9 months thereafter (T3). Latent transition analysis was performed examining research questions.
  
  
  
  Three distinct co-morbidity patterns were identified: class 1 ('mood disturbances and fatigue'), class 2 ('mood disturbances') and class 3 ('few symptoms of mood disturbances and fatigue'). Half of those in class 1 remained in this group from T1 to T3, a quarter transitioned to class 2 and another quarter to class 3. Baseline physical symptoms distinguished these transitions: those with more physical symptoms tended to remain stable. Half of patients in class 2 remained stable from T1 to T3, 46% moved into class 3 and 8% into class 1. Baseline physical symptoms and years after cancer diagnosis significantly distinguished these transitions: the 8% moving to class 1 had more physical symptoms and were longer after cancer diagnosis. Most patients in class 3 remained stable from T1 to T3, and predictors of transitions could not be examined.
  
  
  
  Three distinct co-morbidity patterns of depression, anxiety and fatigue were identified and exhibited different symptom courses longitudinally. Those with poor physical health tended to report elevated mood disturbances and fatigue during psychological care. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|School of Psychology, Shaanxi Normal University, Xi'an, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Adelita V
authors.initials: AV
authors.lastname: Ranchor
authors.affiliation: Centre for Psycho-Oncology, Helen Dowling Institute, Bilthoven, The Netherlands.
authors.forename: Marije
authors.initials: M
authors.lastname: van der Lee
authors.affiliation: Centre for Psycho-Oncology, Helen Dowling Institute, Bilthoven, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Garssen
authors.affiliation: Department of Health Sciences, Division of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Josué
authors.initials: J
authors.lastname: Almansa
authors.affiliation: Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Sanderman
authors.affiliation: Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Maya J
authors.initials: MJ
authors.lastname: Schroevers
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005221:Fatigue / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D009426:Netherlands; D010353:Patient Education as Topic
keywords: anxiety; cancer; depression; fatigue; oncology; psychological care