Originally published as JCO Early Release 10.1200/JCO.2005.02.0081 on May 1 2006

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Objective Cancer-Related Variables Are Not Associated With Depressive Symptoms in Women Treated for Early-Stage Breast Cancer

Wayne A. Bardwell, Loki Natarajan, Joel E. Dimsdale, Cheryl L. Rock, Joanne E. Mortimer, Kathy Hollenbach, John P. Pierce

From the Department of Psychiatry, the Rebecca and John Moores University of California San Diego Cancer Center, and Department of Family and Preventive Medicine, University of California, San Diego, CA; for the Women's Healthy Eating and Living (WHEL) Study Group

Address reprint requests to Wayne A. Bardwell, PhD, Department of Psychiatry, 9500 Gilman Dr, Mail Code 0804, University of California San Diego, La Jolla, CA 92093-0804; e-mail: wabardwell{at}ucsd.edu

PURPOSE: Women with breast cancer are thought to be vulnerable to depression for reasons associated with impact of diagnosis, treatment, and metabolic/endocrine changes. While the literature shows that most of these women do not become clinically depressed, 15% to 30% report elevated depressive symptoms that may be clinically important. The purpose was to identify and determine the relative importance of predictors of depressive symptoms in women treated for early-stage breast cancer.

PATIENTS AND METHODS: A total of 2,595 women ( 4 years following completion of initial treatment for early-stage breast cancer) provided data on cancer-related variables, personal characteristics, health behaviors, physical functioning/symptoms, and psychosocial variables. Participants were divided into high or low depressive groups using the Center for Epidemiologic Studies Depression Scale screening form.

RESULTS: Results of the binary logistic regression analysis were significant (overall R² = 32.4%). Before entry of psychosocial variables, younger age, being unmarried, poorer physical functioning, and more vasomotor and gastrointestinal symptoms were significant risk factors for elevated depressive symptoms (R² = 16.1%), but objective cancer-related variables were not. After inclusion of psychosocial variables in the model (R² = 16.3%), none of the preceding variables remained significant. Greater risk for depressive symptoms was associated with stressful life events, less optimism, ambivalence over expressing negative emotions, sleep disturbance, and poorer social functioning.

CONCLUSION: Depressive symptoms in women treated for early-stage breast cancer are not associated with objective cancer-related factors. Rather, they are most strongly linked with many subjective psychosocial variables.

Supported by Grants No. NCI CA69375; NIH M01-RR00070, M01-RR00079, M01-RR00827; the Walton Family Foundation; UCOP BCRP 7KB-0097; the Lance Armstrong Foundation; the Susan G. Komen Foundation POP0504026.

Presented in part at the 2003 California Breast Cancer Research Program Conference, San Diego, CA, September 12-14, 2003, and the Academy of Psycho-Somatic Medicine Conference, Coronado, CA, November 19-23, 2003.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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• Really, Disease Doesn't Matter? A Commentary on Correlates of Depressive Symptoms in Women Treated for Early-Stage Breast Cancer
  Michael F. Scheier and Vicki S. Helgeson
  JCO 2006 24: 2407-2408 [Full Text]

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