Abstract
One hundred and six patients with operable breast cancer were studied at intervals one day before surgery, and at six weeks and one year post-operatively by means of taped clinical interviews and self-report questionnaires (Impact of Event Scale (IES) and General Health Questionnaire (GHQ-28)). A year after surgery, 9%reported a high level of intrusive symptoms and 10% of avoidance symptoms compared to 18% and 14% after six weeks, respectively. Based on questionnaire data, a year after surgery, thirteen patients (12%) were estimated to have a posttraumatic stress disorder (PTSD) compared to fifteen patients (14%) after six weeks. Severity of posttraumatic stress symptoms (PTSS) after one year was significantly associated with impaired psychosocial functioning over the last year previous to surgery (p < 0.05), negative life events during the year before surgery (p < 0.05), health problems during the previous ten years (p < 0.01), and a personality trait characterized by high emotional reactivity (p < 0.001). Crisis support in the acute situation, type of surgery, axillary-node metastases, and postoperative adjuvant chemotherapy did not predict subsequent PTSS. Premorbid health variables, personality, and level of distress six weeks after surgery were most important risk factors for persistent PTSS in our patients with operable breast cancer stage I and II.
Similar content being viewed by others
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Association, Washington, DC, 1994
Horowitz MJ: Stress-response syndromes: A review of posttraumatic and adjustment disorders. Hosp Com Psychiat 37: 241–249, 1986
Lazarus RS, Folkman S: Stress, Appraisal and Coping. Springer, New York, 1984
Alter CL, Pelcovitz D, Axelrod A, Goldenberg B, Harris H, Meyers B, Grobois B, Mandel F, Septimus A, Kaplan S: Identification of PTSD in cancer survivors. Psychosomatics 37: 137–143, 1996
Cella DF, Mahon SM, Donovan ML: Cancer recurrence as a traumatic event. Behav Med 16: 15–22, 1990
Cordova MJ, Andrykowsky MA, Kenady DE, McGrath PC, Sloan DA, Redd WH: Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer. J Consult Clin Psychol 63: 981–986, 1995
Kelly B, Raphael B, Smithers M, Swanson C, Reid C, McLeod R, Thomson D, Walpole E: Psychological responses to malignant melanoma. An investigation of traumatic stress reactions to life-threatening illness. Gen Hosp Psychiatry 17: 126–136, 1995
Tjemsland L, Søreide JA, Malt UF: Traumatic distress symptoms in early breast cancer I: Acute response to diagnosis. Psycho-Oncology 5: 1–8, 1996
Tjemsland L, Søreide JA, Malt UF: Traumatic distress symptoms in early breast cancer II: Outcome six weeks post surgery. Psycho-Oncology 5: 295–303, 1996
Horowitz MJ, Wilner N, Alvarez MA: Impact of event scale: A measure of subjective stress. Psychosom Med 41: 209–218, 1979
Goldberg D, Williams P: A User's Guide to the General Health Questionnaire. NFR-Nelson, Windsor, 1988
Horowitz MJ: Stress response syndromes and their treatment. In: Goldenberger L, Breznitz S (eds) Handbook of Stress. Theoretical and Clinical Aspects. Free Press, New York, 1982, pp 711–732
Goldberg DP, Hiller VF: A scaled version of the General Health Questionnaire. Psychol Med 9: 139–145, 1979
Ibbotson T, Maguire P, Selby P, Priestman T, Wallace L: Screening for anxiety and depression in cancer patients: The effect of disease and treatment. Eur J Cancer 30A: 1: 37–40, 1994
Holmen J, Midthjell K, Bjartveit K, Hjort PF, Lund-Larsen PG, Moum T, Næss S, Waaler HT: The Nord-Trøndelag Health Survey, 1984–86. Report no. 4. 1990
Spitzer RL, Williams JB, Gibbon M, First MB: Structured Clinical Interview for DSM-IIIR – Non-Patient Edition (SCID-NP, Version 1.0). American Psychiatric Press, 1990
Leon AC, Shear MK, Portera L, Klerman GL: Assessing impairment in patients with panic disorder: the Sheehan Disability Scale. Soc Psychiatr Epidemiol 27: 78–82, 1992
Eysenck HJ, Eysenck SBG: Manual of the Eysenck Personality Questionnaire. Hodder and Stoughton Ltd., Fourth impression, 1987
Tjemsland L, Haslerud J, Søreide JA, Malt UF: Measuring social support. An interrater reliability study of 18 patients with breast cancer assessed with a shortened version of the Self-Evaluation and Social Support (SESS) schedule. Nord J Psychiatry 48: 97–101, 1994
Jenkins PL, May VE, Hughes LE: Psychological morbidity associated with local recurrence of breast cancer. Int J Psychiat Med 21: 149–155, 1991
Vinokur AD, Threatt BA, Vinokur-Kaplan D, Satariano WA: The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer 65: 1242–1254, 1990
Penman DT, Bloom JR, Fotopoulos S, Cook MR, Holland JC, Gates C, Flamer D, Murawski B, Ross R, Brandt U, Muenz LR, Pee D: The impact of mastectomy on self-concept and social function: A combined cross-sectional and longitudinal study with comparison groups. Women and Health 11: 101–130, 1987
Bloom JR: Social support, accomodation to stress, and adjustment to breast cancer. Soc Sci Med 16: 1329–1338, 1982
Northouse LL: Social support in patients' and husbands' adjustment to breast cancer. Nursing Res 37: 91–95, 1988
Kulik JA, Moore PJ, Mahler HIM: Stress and affiliation: Hospital roommate effects on preoperative anxiety and social interaction. Health Psychol 12: 118–124, 1993
Fallowfield LJ, Baum M, Maguire GP: Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. Br Med J 293: 1331–1334, 1986
Pozo C, Carver CS, Noriega V, Harris SD, Robinson DS, Ketcham AS, Legaspi A, Moffat FL, Clark KC: Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: A prospective study of the first year postsurgery. J Clin Oncol 10: 1292–1298, 1992
Malt UF, Olafson OM: Psychological appraisal and emotional response to physical injury: a clinical, phenomenological study of 109 adults. Psychiatric Med 10: 117–134, 1992
Karlehagen S, Malt UF, Hoff H, Tibell E, Herrstromer U, Hildingson K, Leyman H: The effect of major railway accidents on the psychological health of train drivers – II. A longitudinal study of the one-year outcome after the accident. J Psychosom Res 37: 807–817, 1993
Malt UF: The long-term psychiatric consequences of accidental injury. A longitudinal study of 107 adults. Br J Psychiatry 153: 810–818, 1988
Lundin T: The treatment of acute trauma. Post-traumatic stress disorder prevention. Psychiatr Clin North Am 17: 385–391, 1994
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tjemsland, L., Søreide, J.A. & Malt, U.F. Posttraumatic distress symptoms in operable breast cancer III:. Breast Cancer Res Treat 47, 141–151 (1998). https://doi.org/10.1023/A:1005957302990
Issue Date:
DOI: https://doi.org/10.1023/A:1005957302990