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Risk factors for psychological morbidity and the protective role of coping self-efficacy in young women with breast cancer early in diagnosis: a national multicentre cohort study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Young women with breast cancer (YWBC) are an understudied population and there are limited data on risk factors for psychological morbidity early in diagnosis. We examined psychological morbidity (anxiety, depression, stress symptoms), well-being and associated risk factors.

Methods

A total of 845 women from a pan-Canadian, multicentre inception cohort study of YWBC (age ≤ 40) who completed Patient Reported Outcome Measures (PROMs) after their initial surgical consultation and prior to surgical or other treatments were included. Multivariate regression analyses identified risk factors (i.e. parenting young children) associated with psychological morbidity and whether coping self-efficacy was protective.

Results

Rates of clinically significant anxiety (n = 683, 69.1%) and depression (n = 422, 42.7%) were high but lower for stress symptoms (n = 67, 6.8%). Probability of anxiety was high for women with a previous history of depression (OR 2.02, P = 0.03, CI 1.09–3.74) and working full-time (OR 1.76, P = 0.05 CI 1.02–2.77). Whereas, pre-existing depression (OR 2.91, P = 0.01, CI 1.36–6.01), younger children (age ≤ 10) (OR 1.69, P = 0.05, CI 1.01–2.93), and income > $100,000 (OR 2.06, P = 0.02, CI 1.18–3.64) were risk factors for depression. Coping self-efficacy was protective with a decreased risk of anxiety (OR 0.11, P ≤ 0.01 CI 0.04–0.28), depression (OR 0.03, P ≤ .01, CI 0.01–0.16), stress symptoms (OR 0.17, P ≤ .01, CI 0.04–0.65) and higher psychosocial well-being with a gain of 19.68 points (P < 0.01) for high levels of CSE (> mean plus 1 SD). Those with lower levels of neurosis had less negative outcomes.

Conclusion

Young women with breast cancer are vulnerable to psychological morbidity early in diagnosis, particularly those with low coping self-efficacy and may benefit from earlier supportive care.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to privacy issues but are available upon reasonable request and with permission of the senior author.

Code availability

Not applicable.

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Funding

The Ruby Cohort Study is jointly funded by the Canadian Institute for Health Research and the Canadian Breast Cancer Foundation (now Canadian Cancer Society) Research, Canada.

Author information

Authors and Affiliations

  1. Division of Supportive Care, Princess Margaret Cancer Research Institute (University Health Network) & Lawrence S. Bloomberg Faculty of Nursing, 610 University Ave. Room 15-617, Toronto, ON, M5G2M9, Canada

    Doris M. Howell

  2. Genetics, Research and External Affairs, Lawrence S. Bloomberg Faculty of Nursing and Women’s College Research Institute, University of Toronto, Toronto, ON, Canada

    Kelly Metcalfe

  3. Department of Surgery, Alberta Health Services, Calgary, AB, Canada

    Shiying Kong

  4. Clinical Neurosciences Program, Alberta Health Services, Calgary, AB, Canada

    Joanne Stephen

  5. Division of Radiation Oncology, Tom Baker Cancer Centre and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Ivo A. Olivotto

  6. Department of Surgery, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada

    Nancy Baxter

  7. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia

    Nancy Baxter

  8. Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada

    Christine M. Friedenreich

  9. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Christine M. Friedenreich

  10. Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Ellen Warner

  11. Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Mohammed Reza Akbari

  12. MAP Centre for Urban Health Solutions, Unity Health, Toronto, ON, Canada

    Kristine McBain

  13. Familial Breast Cancer Research Unit, Women’s College Research Institute and Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Steven Narod

  14. Department of Surgery, University of Calgary, Alberta, ON, Canada

    May Lynne Quan

Authors
  1. Doris M. Howell
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  2. Kelly Metcalfe
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  3. Shiying Kong
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  4. Joanne Stephen
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  5. Ivo A. Olivotto
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  6. Nancy Baxter
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  7. Christine M. Friedenreich
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  8. Ellen Warner
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  9. Mohammed Reza Akbari
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  10. Kristine McBain
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  11. Steven Narod
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  12. May Lynne Quan
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Contributions

All authors contributed to the conception of the study and its analyses and contributed to revisions and final review of the manuscript prior to submission.

Corresponding author

Correspondence to Doris M. Howell.

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Conflict of interest

All authors report no conflict or competing interests related to this study.

Ethical approval

Ethics approval was obtained from the University of Calgary and all respective multicenter sites ethics boards.

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All participants provided consent to participation at enrollment into the study.

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All authors reviewed the final copy of the paper prior to submission.

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Howell, D.M., Metcalfe, K., Kong, S. et al. Risk factors for psychological morbidity and the protective role of coping self-efficacy in young women with breast cancer early in diagnosis: a national multicentre cohort study. Breast Cancer Res Treat 194, 91–102 (2022). https://doi.org/10.1007/s10549-022-06576-6

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  • DOI: https://doi.org/10.1007/s10549-022-06576-6

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