Correlates of depressive symptomatology in African-American breast cancer patients
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This study assessed the levels of depressive symptomatology in African-American women with breast cancer compared to those of women without breast cancer and examined demographic, psychosocial, and clinical factors correlated with depression.
A total of 152 African-American women were recruited from Washington, DC and surrounding suburbs. Breast cancer patients (n = 76 cases) were recruited from a health care center and women without cancer were recruited from health fairs (n = 76 comparison). We assessed depression, psychosocial variables (ego strength and social support), and sociodemographic factors from in-person interviews. Stage and clinical factors were abstracted from medical records. Independent sample t test, chi square test, analyses of variance, and multiple regression models were used to identify differences in depression and correlates of depression among the cases and comparison groups.
Women with breast cancer reported significantly greater levels of depression (m = 11.5, SD = 5.0) than women without breast cancer (m = 3.9, SD = 3.8) (p < 0.001). Higher cancer stage (beta = 0.91) and higher age (beta = 0.11) were associated with depression in the breast patients, explaining 84 % of the variance. In the comparison group, ego strength and tangible support were inversely associated with depressive symptoms, accounting for 32 % of the variance.
Women with more advanced disease may require interdisciplinary approaches to cancer care (i.e., caring for the whole person).
Implications for Cancer Survivors
Depression is often underrecognized and undertreated in African-American breast cancer patients. Understanding the factors related to depression is necessary to integrate psychosocial needs to routine cancer care to improve survivors’ quality of life.
- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics. CA Cancer J Clin. 2009;59:225–49. CrossRef
- Jatoi I, Anderson WF, Rao SR, Devesa SS. Breast cancer trends among Black and White women in the United States. J Clin Oncol. 2005;23:7836–41. CrossRef
- Fawzy FI, Fawzy NW, Arndt LA, Pasnau RO. Critical review of psychosocial interventions in cancer care. Arch Gen Psychiatry. 1995;52:100–13. CrossRef
- Wong-Kim EC, Bloom JR. Depression experienced by young women newly diagnosed with breast cancer. Psychooncology. 2005;14:564–73. CrossRef
- Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KR, et al. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry. 2005;58:175–89. CrossRef
- Hjerl K, Andersen EW, Keiding N, Mouridsen HT, Mortensen PB, Jorgensen T. Depression as a prognostic factor for breast cancer mortality. Psychosomatics. 2003;44:24–30. CrossRef
- Fann JR, Thomas-Rich AM, Katon WJ, Cowley D, Pepping M, McGregor BA, et al. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008;30:112–26. CrossRef
- Jacobsen PB, Wagner LI. A new quality standard: the integration of psychosocial care into routine cancer care. J Clin Oncol. 2012;30:1154–9. CrossRef
- Moore RJ. African American women and breast cancer: notes from a study of narrative. Cancer Nurs. 2001;24:35–42. quiz 43. CrossRef
- Culver JL, Arena PL, Antoni MH, Carver CS. Coping and distress among women under treatment for early stage breast cancer: comparing African Americans, Hispanics and non-Hispanic Whites. Psychooncology. 2002;11:495–504. CrossRef
- Deshields T, Tibbs T, Fan MY, Taylor M. Differences in patterns of depression after treatment for breast cancer. Psychooncology. 2006;15:398–406. CrossRef
- Golden-Kreutz DM, Andersen BL. Depressive symptoms after breast cancer surgery: relationships with global, cancer-related, and life event stress. Psychooncology. 2004;13:211–20. CrossRef
- Davey MP, Kissil K, Nino A, Tubbs CY. “They paid no mind to my state of mind”: African American breast cancer patients' experiences of cancer care delivery. J Psychosoc Oncol. 2010;28:683–98. CrossRef
- Goldstein E. Ego psychology and social work practice. New York: Free; 1995.
- Weisman AD. Early diagnosis of vulnerability in cancer patients. Am J Med Sci. 1976;271:187–96. CrossRef
- Sobel HJ, Worden JW. The MMPI as a predictor of psychosocial adaptation to cancer. J Consult Clin Psychol. 1979;47:716–24. CrossRef
- Edgar L, Rosberger Z, Nowlis D. Coping with cancer during the first year after diagnosis. Assessment and intervention. Cancer. 1992;69:817–28. CrossRef
- Berkman LLF. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51:843–57. CrossRef
- Al-Azri M, Al-Awisi H, Al-Moundhri M. Coping with a diagnosis of breast cancer-literature review and implications for developing countries. Breast J. 2009;15:615–22. CrossRef
- Ashida S, Palmquist AE, Basen-Engquist K, Singletary SE, Koehly LM. Changes in female support network systems and adaptation after breast cancer diagnosis: differences between older and younger patients. Gerontologist. 2009;49:549–59. CrossRef
- Beder J. Perceived social support and adjustment to mastectomy in socioeconomically disadvantaged Black women. Soc Work Health Care. 1995;22:55–71. CrossRef
- Chantler M, Podbilewicz-Schuller Y, Mortimer J. Change in need for psychosocial support for women with early stage breast cancer. J Psychosoc Oncol. 2005;23:65–77. CrossRef
- Gass JS, Weitzen S, Clark M, Dizon DS. Defining social support systems for women with breast cancer. Am J Surg. 2007;194:501–3. CrossRef
- Kang SH, Bloom JR. Social support and cancer screening among older Black Americans. J Natl Cancer Inst. 1993;85:737–42. CrossRef
- Koopman C, Hermanson K, Diamond S, Angell K, Spiegel D. Social support, life stress, pain and emotional adjustment to advanced breast cancer. Psychooncology. 1998;7:101–11. CrossRef
- Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol. 2006;24:1105–11. CrossRef
- Lee MK, Park S, Lee ES, Ro J, Kang HS, Shin KH, et al. Social support and depressive mood 1 year after diagnosis of breast cancer compared with the general female population: a prospective cohort study. Support Care Cancer. 2011;19:1379–92. CrossRef
- Liao MMN. Effect of supportive care on the anxiety of women with suspected breast cancer. J Adv Nurs. 2010;66:49–59. CrossRef
- Herndon 2nd AB, Kornblith JE, Zuckerman E, Viscoli CM, Horwitz RI, Cooper MR, et al. Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer. 2001;91:443–54. CrossRef
- Alloway R, Bebbington P. The buffer theory of social support—a review of the literature. Psychol Med. 1987;17:91–108. CrossRef
- Den Oudsten BL, Van Heck GL, Van der Steeg AF, Roukema JA, De Vries J. Personality predicts perceived availability of social support and satisfaction with social support in women with early stage breast cancer. Support Care Cancer. 2010;18:499–508. CrossRef
- Simpson JS, Carlson LE, Beck CA, Patten S. Effects of a brief intervention on social support and psychiatric morbidity in breast cancer patients. Psychooncology. 2002;11:282–94. CrossRef
- Bourjolly JJN. Similarities in coping strategies but differences in sources of support among African American and White women coping with breast cancer. J Psychosoc Oncol. 2001;19:17–38. CrossRef
- Anonymous. NCCN practice guidelines for the management of psychosocial distress. National Comprehensive Cancer Network. Oncology (Huntingt). 1999;13:113–147
- Shavers VL, Harlan LC, Stevens JL. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer. 2003;97:134–47. CrossRef
- Ford LA. Predictors of psychological functioning in African American women with breast cancer. Unpublished Doctoral Dissertation. 2002.
- Beck AT, Rial WY, Rickels K. Short form of depression inventory: cross-validation. Psychol Rep. 1974;34:1184–6.
- Beck AT, Steer RA. Internal consistencies of the original and revised Beck Depression Inventory. J Clin Psychol. 1984;40:1365–7. CrossRef
- Furlanetto LM, Mendlowicz MV, Romildo Bueno J. The validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients. J Affect Disord. 2005;86:87–91. CrossRef
- Schuldberg D. Ego-strength revised: a comparison of the MMPI-2 and MMPI-1 versions of the Barron Ego-strength scale. J Clin Psychol. 1992;48:500–5. CrossRef
- Norbeck JS, Lindsey AM, Carrieri VL. The development of an instrument to measure social support. Nurs Res. 1981;30:264–9.
- Norbeck JS, Lindsey AM, Carrieri VL. Further development of the Norbeck Social Support Questionnaire: normative data and validity testing. Nurs Res. 1983;32:4–9. CrossRef
- Eskelinen M, Ollonen P. Beck Depression Inventory (BDI) in patients with breast disease and breast cancer: a prospective case–control study. In Vivo. 2011;25:111–6.
- Bell RJ, Lijovic M, La China M, Schwarz M, Fradkin P, Bradbury J, et al. Psychological well-being in a cohort of women with invasive breast cancer nearly 2 years after diagnosis. Support Care Cancer. 2010;18:921–9. CrossRef
- Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, et al. The prevalence of psychiatric disorders among cancer patients. JAMA. 1983;249:751–7. CrossRef
- Karademas EC, Argyropoulou K, Karvelis S. Psychological symptoms of breast cancer survivors: a comparison with matched healthy controls and the association with cancer-related stress and coping. J Psychosoc Oncol. 2007;25:59–74. CrossRef
- Lehto US, Ojanen M, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Baseline psychosocial predictors of survival in localised breast cancer. Br J Cancer. 2006;94:1245–52. CrossRef
- Massie MJ, Holland JC. Depression and the cancer patient. J Clin Psychiatry. 1990;51 Suppl:12–7. discussion 18–9.
- Spiegel D. Cancer and depression. Br J Psychiatry Suppl. 1996;30:109–16.
- Sheppard VB, Harper FW, Davis K, Hirpa F, Makambi K. The importance of contextual factors and age in association with anxiety and depression in Black breast cancer patients. Psychooncology. 2013 (in press)
- Ell K, Sanchez K, Vourlekis B, Lee PJ, Dwight-Johnson M, Lagomasino I, et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. J Clin Oncol. 2005;23:3052–60. CrossRef
- Osborne RH, Elsworth GR, Hopper JL. Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry. Eur J Cancer. 2003;39:755–62. CrossRef
- Kornblith AB, Powell M, Regan MM, Bennett S, Krasner C, Moy B, et al. Long-term psychosocial adjustment of older vs younger survivors of breast and endometrial cancer. Psychooncology. 2007;16:895–903. CrossRef
- Siegel KDK. Age-related distress among young women with breast cancer. J Psychosoc Oncol. 1999;17:1–20. CrossRef
- Connell SS. Issues and concerns of young Australian women with breast cancer. Support Care Cancer. 2006;14:419–26. CrossRef
- Das AK, Olfson M, McCurtis HL, Weissman MM. Depression in African Americans: breaking barriers to detection and treatment. J Fam Pract. 2006;55:30–9.
- Huang CY, Guo SE, Hung CM, Shih SL, Lee LC, Hung GC, et al. Learned resourcefulness, quality of life, and depressive symptoms for patients with breast cancer. Oncol Nurs Forum. 2010;37:E280–7. CrossRef
- Popoola AO, Adewuya AO. Prevalence and correlates of depressive disorders in outpatients with breast cancer in Lagos, Nigeria. Psychooncology. 2012;21:675–9. CrossRef
- Fulton C. The prevalence and detection of psychiatric morbidity in patients with metastatic breast cancer. Eur J Cancer Care (Engl). 1998;7:232–9. CrossRef
- Kissane DW, Clarke DM, Ikin J, Bloch S, Smith GC, Vitetta L, et al. Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey. Med J Aust. 1998;169:192–6.
- Maly RC, Umezawa Y, Leake B, Silliman RA. Mental health outcomes in older women with breast cancer: impact of perceived family support and adjustment. Psychooncology. 2005;14:535–45. CrossRef
- Manning-Walsh J. Social support as a mediator between symptom distress and quality of life in women with breast cancer. J Obstet Gynecol Neonatal Nurs. 2005;34:482–93. CrossRef
- Pedersen SS, van Domburg RT, Theuns DA, Jordaens L, Erdman RA. Type D personality is associated with increased anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator and their partners. Psychosom Med. 2004;66:714–9. CrossRef
- Hamilton JB, Sandelowski M. Types of social support in African Americans with cancer. Oncol Nurs Forum. 2004;31:792–800. CrossRef
- Royak-Schaler R, Passmore SR, Gadalla S, Hoy MK, Zhan M, Tkaczuk K, et al. Exploring patient-physician communication in breast cancer care for African American women following primary treatment. Oncol Nurs Forum. 2008;35:836–43. CrossRef
- Sheppard VB, Adams IF, Lamdan R, Taylor KL. The role of patient–provider communication for black women making decisions about breast cancer treatment. Psychooncology. 2011;20:1309–16. CrossRef
- Henderson PD, Gore SV, Davis BL, Condon EH. African American women coping with breast cancer: a qualitative analysis. Oncol Nurs Forum. 2003;30:641–7. CrossRef
- Heilemann MV, Lee KA, Kury FS. Strengths and vulnerabilities of women of Mexican descent in relation to depressive symptoms. Nurs Res. 2002;51:175–82. CrossRef
- Conner KO, Lee B, Mayers V, Robinson D, Reynolds CF, Albert S, et al. Attitudes and beliefs about mental health among African American older adults suffering from depression. J Aging Stud. 2010;24:266–77. CrossRef
- Gonzalez HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW. Depression care in the United States: too little for too few. Arch Gen Psychiatry. 2010;67:37–46. CrossRef
- Correlates of depressive symptomatology in African-American breast cancer patients
Journal of Cancer Survivorship
Volume 7, Issue 3 , pp 292-299
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Breast cancer
- Ego strength
- Social support
- Industry Sectors
- Author Affiliations
- 1. Department of Oncology, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St., NW Suite 4100, Washington, DC, 20007, USA
- 5. Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St., NW Suite 4100, Washington, DC, 20007, USA
- 2. Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, 1590 N. High Street, Suite 525, Columbus, OH, 43201, USA
- 4. Howard University Cancer Center, 2041 Georgia Avenue, NW, Washington, DC, 20060, USA
- 3. Lombardi Comprehensive Cancer Center, Research Building E 501, 3970 Reservoir Road, NW, Washington, DC, 20057, USA