Correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer

School of Social Work, University of Maryland, Baltimore, Baltimore, Maryland, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 06/2005; 23(13):3052-60. DOI: 10.1200/JCO.2005.08.041
Source: PubMed


To assess the prevalence of depression among low-income, ethnic minority women with breast or gynecologic cancer, receipt of antidepressant medications or counseling services, and correlates of depression.
Study patients were 472 women receiving cancer care in an urban public medical center. Women had a primary diagnosis of breast (stage 0 to III) or gynecologic cancer (International Federation of Gynecology and Obstetrics stage 0 to IIIB). A diagnostic depression screen and baseline questionnaire were administered before or during active treatment or during active follow-up. Self-report data were collected on receipt of depression treatment, use of supportive counseling, pain and receipt of pain medication, functional status and well-being, and perceived barriers to cancer care.
Twenty-four percent of women reported moderate to severe levels of depressive disorder (30% of breast cancer patients and 17% of gynecologic cancer patients). Only 12% of women meeting criteria for major depression reported currently receiving medications for depression, and only 5% of women reported seeing a counselor or participating in a cancer support group. Neither cancer stage nor treatment status was correlated with depression. Primary diagnosis of breast cancer, younger age, greater functional impairment, poorer social and family well-being, anxiety, comorbid arthritis, and fears about treatment side effects were correlated with depression.
Findings indicate that depressive disorder among ethnic minority, low-income women with breast or gynecologic cancer is prevalent and is correlated with pain, anxiety, and health-related quality of life. Because these women are unlikely to receive depression treatment or supportive counseling, there is a need for routine screening, evaluation, and treatment in this population.

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Available from: Laila I Muderspach
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    • "Indeed, in 2005, a Japanese study showed that the risk of developing psychiatric diseases , including major depressive and generalized anxiety disorders, was 16 times higher in BC patients with a history of depression than in women without previous episodes of depression (Okamura et al. 2005). Furthermore, other authors have demonstrated that the lack of an intimate relationship, neuroticism and low incomes correlates with depression in women with BC (Golden-Kreutz and Andersen 2004; Ell et al. 2005; Den et al. 2009). All these results suggest that depression and anxiety are predicted mainly on the basis of the demographic and clinical characteristics of BC patients. "
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    ABSTRACT: Aims: To analyze the prevalence of depression, anxiety and their risk factors in German women with breast cancer (BC) in general and gynecological practices (GP, GYP). Methods: Women initially diagnosed with BC between 2009 and 2013 were identified by 1202 general practitioners and 244 gynecologists in the IMS Disease Analyzer database. They were included only if they had not suffered from depression or an anxiety disorder within the 12 months prior to the index date. The main outcome was the first diagnosis of depression or an anxiety disorder within 5 years after index date. A multivariate Cox regression model was used to predict these diagnoses on the basis of patient characteristics. Results: A total of 24,537 patients in GP were available for the study, as well as 20,018 patients in GYP. The mean age was 65.8 and 62.5 years in GP and GYP, respectively (p value <0.0001). The proportions of depressive or anxiety episodes in the past and the proportion of metastases were higher in GP than in GYP (7.9 vs. 3.6 %, and 10.1 vs. 8.6 %, p values <0.0001). Within 5 years of follow-up, 36.9 % of GP patients and 35.1 % of GYP patients had been diagnosed with depression or anxiety. There was a significantly higher risk of depression and/or anxiety in women in the age groups 51-60, 61-70 and >70 years than in women = <50 years (OR between 1.05 and 1.27, all p values lower than 0.0359). Patients with metastases or with previous episodes of depression/anxiety had a higher risk of depression/anxiety (OR = 1.21 and 1.97, p values <0.0001). Finally, women with private health insurance had a lower risk of depression and anxiety (OR = 0.45, p value <0.0001). Conclusion: The present study indicates that levels of depression and anxiety increase in German women after diagnosis of BC and may be predicted on the basis of several demographic and clinical characteristics.
    Full-text · Article · Sep 2015 · Journal of Cancer Research and Clinical Oncology
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    • "The available studies examining racial differences in mental health among those diagnosed with cancer have many characteristics that do not permit assessment of racial ethnic differences at the population level. First, the vast majority of studies of those with cancer do not compare racial/ethnic groups [33, 34], focus on the comparison of only two groups [8, 27, 31, 35] or have small sample sizes that may prohibit accurate multi-group comparisons [29, 36]. Second, studies often focus on cancer of a specific site [28, 37], or among a certain age group [31, 38, 39], which can skew the prevalence of mental illness away from the population means. "
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    ABSTRACT: Background Little research has examined the interactive effect of cancer status and race/ethnicity on mental health. As such, the present study examined the mental health of adults, 18 and over, diagnosed with cancer. This study examined the extent to which a cancer diagnosis is related to poorer mental health because it erodes finances and the extent to which the mental health impact of cancer differs across racial/ethnic groups. Furthermore, this study aimed to test the stress process model, which posits that the proliferation of stress can lead to mental illness and this process can differ across racial/ethnic groups. Methods Data from the 2005 Adult California Health Interview Survey was used (N = 42,879). The Kessler 6, a validated measure of psychological distress, was used to measure mental health, with higher scores suggesting poorer mental health. Scores on the Kessler 6 ranged from 0 to 24. Linear regression models estimating psychological distress tested each aim. The mediating effect of income and the race by cancer interaction were tested. Results After controlling for gender, age, insurance status, education and race/ethnicity, cancer was associated with higher Kessler 6 scores. About 6% of this effect was mediated by household income (t = 4.547; SE = 0.011; p < 0.001). The mental health impact of cancer was significantly worse for Latinos and Blacks than for non-Hispanic Whites. Conclusions The mental health impact of cancer is not uniform across groups. Future work should explore reasons for these disparities. Efforts to increase access to mental health services among minorities with cancer are needed.
    Full-text · Article · Sep 2014 · BMC Public Health
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    • "Depression and anxiety are psychological reactions that are frequently experienced in breast cancer patients (Ell et al., 2005; Sollner, Maislinger, Konig, Devries, & Lukas, 2004), and some studies suggest that African American women are especially likely to report high levels of cancer-specific distress (Hughes, Lerman, & Lustbader, 1996; McBride, Clipp, Peterson, Lipkus, & Demark-Wahnerfried, 2000). "
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    ABSTRACT: Abstract Our study examined the relationships of biological and psychosocial predictors as contributing factors to the psychological functioning among breast cancer survivors. A sample of (N = 155) African American breast cancer survivors were recruited from California. A general linear model was utilized to examine the relationships. Biological and psychosocial risk factors were significant predictors for anxiety and depression. These predictors can be viewed as contributing factors to the psychological well-being of this cohort. Anxiety and depression are often under-recognized and subsequently under-treated in survivors. Understanding the predictors of depression and anxiety is necessary for incorporating a multidisciplinary approach to address this problem.
    Full-text · Article · Jul 2014 · Journal of Psychosocial Oncology
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