| BackgroundBreast cancer is the most prevalent cancer among women.It not only impairs physical health of women but also induces psychological disorders.Depression is one of the most common psychological disorders,with up to 66.1%of patients with breast cancer experiencing depressive symptoms.Among patients with breast cancer,depression not only affects their quality of life,reduces treatment adherence,but also shortens survival time,affects husband and wife relationship and caregivers’ health,and increases social burden.Therefore,it is urgent to pay attention to depression of breast cancer patients.Early detection and early intervention will be helpful for alleviating the harm caused by depression to patients and families,and reducing the increased social burden.Based on the theory that stress events are important predisposing factors for depression,breast cancer patients may experience depressive symptoms after undergoing a stressful event such as breast cancer diagnosis.However,the current research on depressive symptoms in breast cancer patients mostly focuses on the period of treatment and long-term survival.There are few reports on the depression of patients who have not been treated,and there is a lack of comparative study with healthy control women.Therefore,the extent to which the patient’s depressive symptoms are severer and the risk of depression is higher than healthy women are difficult to clarify.In addition,patients need to face more stressful events such as surgery and chemotherapy.However,the current characteristics of depressive symptoms in breast cancer patients at critical time points(pre-treatment,post-surgery,and post-chemotherapy)are still unclear.Identifying the key psychological adjustment processes in breast cancer patients’response to breast cancer diagnosis and treatment-related stress can help develop targeted interventions to prevent and reduce depression.Based on the cognitivephenomenological theory of emotions and cognitive-phenomenological-transactional model of stress,cognitive reappraisal played a key role for patients responsing to the stress of diagnosis and treatment.Individuals with higher levels of cognitive reappraisal and individuals with higher psychological resilience showed lower levels of depression.According to existing research findings and theories,psychological resilience may play a mediating role between cognitive reappraisal and depression,and may also play a moderating role,which needs to be further tested.Based on the Biopsychosocial Model,psychosocial factors and physical disease are correlated with each other via processes involving neuroendocrine and immune mechanisms.It has been found that depression was associated with both neuroendocrine and immune systems,including hypothalamic-pituitary-adrenal axis and hypophyseal-pituitary-gonadal axis which was indicated by cortisol and oxytocin,and interleukin-1β in the immune systems.Recently,accumulating evidence showed that the onset,progression,and outcomes of breast cancer were correlated with cortisol,oxytocin,and interleukin-1β.Based on this,it is speculated that the higher incidence of depression in breast cancer patients may be due to the common pathophysiological basis of the two,but there is no clear evidence to support it,and further research is needed.Research 1:Depression and its changes in the early stage of breast cancerPurposesTo identify the severity of depression and its changes in the early stage of breast cancer among the patients.MethodsThe cross-sectional(case-control)design and longitudinal design were used.Patients with breast cancer prior to treatment were selected as the case group.Matched patients with benign breast diseases and healthy women were selected as control groups.The sample size was computed to be 118 at least.The 9-item depression module of the Patient Health Questionnaire(PHQ-9)was used to evaluate the depressive symptoms of depression.The longitudinal study was conducted pre-treatment,post-surgery,and post-chemotherapy.The effect size Cohen’s d,odds ratio(OR)and their 95%confidence intervals(CIs)were computed to test the extent of severity and the risk of depressive symptoms in patients with breast cancer than healthy control and patients with benign breast diseases.Repeated measurement analysis of variance was used to analyze the differences of depression in three time points:pre-treatment,post-surgery,and post-chemotherapy.A generalized linear model was used to test the differences in the prevalence of depression in those three time points.ResultsA total of 360 patients(120 patients with breast cancer,120 patients with breast benign disease,and 120 healthy controls)completed the survey.The score of depressive symptoms in patients with breast cancer were significantly moderately higher than the score of patients with benign breast disease(mean difference=1.38,95%CI:0.352.40,P=0.026;Cohen’s d=0.69,95%CI 0.43-0.95)and mildly significantly higher than the score of healthy controls(mean difference=2.82,95%CI:1.79 to 3.84,P<0.001;Cohen’s d=0.30,95%CI:0.04-0.55).The proportion of women with breast cancer who had depressive symptoms was the highest(49.3%),and that of benign and healthy controls were 39.3%and 20.8%,respectively.Compared with women in the healthy control group,the risk of depressive symptoms was 2.68 times higher in women with breast cancer(OR=3.68,95%CI:2.08-6.48,P<0.001).Breast cancer patients were more likely to suffer from depression,with the risk of 1.62 times higher than those with benign breast disease(OR=2.62,95%CI:1.15-5.98,P=0.023).A total of 115 breast cancer patients completed the investigation at the three time points during the early stage of breast cancer(pre-treatment,post-surgery,and post-chemotherapy).The scores of depressive symptoms pre-treatment,post-surgery,and post-chemotherapy increased gradually,which were 4.12±3.74,5.01±3.81,5.15±3.79,respectively,and the difference was statistically different(F=3.339,P=0.037).The level of depressive symptoms in patients post-surgery was mildly higher than the score pre-treatment(Cohen’s d=0.29,95%CI:0.02-0.55).The level of depressive symptoms in patients post-chemotherapy was mildly higher than that pre-treatment(Cohen’s d=0.32,95%CI:0.05-0.58).The prevalence of depressive symptoms pre-treatment,post-surgery,and post-chemotherapy was 43.5%,54.8,52.2%,respectively(Wald χ2=4.119,P=0.128).The incidence of the depression caseness was 7.8%,8.7%,13.9%,respectively(Waldχ2=2.523,P=0.283).ConclusionBreast cancer patients who have not been treated have had severe depressive symptoms than patients with benign breast disease and healthy women.The risk of depressive symptoms in breast cancer patients is 3.68 times that of healthy women,and the risk of depressive symptoms at the level of depression is 2.62 times of patients with benign diseases.The level of depressive symptoms in breast cancer patients has gradually increased from pre-treatment to the post-surgery,and then to the early stage of chemotherapy.Research 2:The path of cognitive reappraisal,psychological resilience in reducing depression in patients with breast cancerPurposesTo explore the role of psychological resilience and cognitive reappraisal in reducing depressive symptoms in breast cancer patients.MethodsA cross-sectional survey was conducted among patients with breast cancer who were hospitalized for treatment of breast cancer.The required sample size was computed to be 304.Depressive symptoms,cognitive reappraisal,and psychological resilience of the subjects were assessed using the 9-item depression module of the Patient Health Questionnaire,the Emotional Regulation Scale,and the Connor-David Resilience Scale.Analyses of mediating and moderating effects of resilience were conducted using Mplus 7.ResultsThe level of depressive symptoms in breast cancer patients was significantly negatively correlated with the levels of cognitive reappraisal(r=-0.31,P<0.001)and psychological resilience(r=-0.46,P<0.001),that is,the higher the level of cognitive reappraisal and the higher the level of psychological resilience,the lower the level of depressive symptoms in patients with breast cancer.A positive correlation between cognitive reappraisal and psychological resilience was found(r=0.32,P<0.001),that is,the higher the level of cognitive reappraisal,the higher the level of psychological resilience.The mediating effect of psychological resilience between cognitive reappraisal and depressive symptoms was significant(standardized effect size=-0.13,95%CI=-0.19--0.08).The direct effect of cognitive reappraisal on depressive symptoms was also significant(standardized effect size=-0.19,95%CI:-0.29--0.07).After controlling for age and education level,both of the indirect effects in the model(standardized effect size=-0.06,95%CI:-0.10--0.02)and direct effects(standardized effect size=-0.39,95%CI:-0.47--0.28)were significant.There was no significantly moderate effect of psychological resilience between cognitive reappraisal and depressive symptoms(standardized effect size=0.01,95%CI:-0.15-0.12).ConclusionThe role of cognitive reappraisal and psychological resilience in reducing depression in breast cancer patients is that cognitive reappraisal can directly reduce depressive symptoms,and can also reduce depressive symptom through improving psychological resilience.Research 3:Association of cortisol,oxytocin,and interleukin-1β with breast cancer and depressionPurposesTo exploring the relationship of cortisol,oxytocin,and interleukin-1β with breast cancer and depression.MethodsA cross-sectional survey was conducted among four groups of women based on the presence or existence of breast cancer and depression.The four groups were a group of women with both breast cancer and depression,a group of women with breast cancer but no depression,a group of women with depression but no breast cancer,and a group of women with neither breast cancer nor depression(healthy women).The required sample size was 31 cases per group.The 9-item depression module of the Patient Health Questionnaire was used to evaluate the women’s depressive symptoms.The fasting peripheral blood was collected,and plasma cortisol,oxytocin,and interleukin-1βconcentrations were measured by enzyme-linked immunosorbent assay.The multiple logistic regression was used to analyze the association of cortisol,oxytocin,and interleukin-1β with breast cancer and depression.ResultsA total of 170 valid questionnaires and blood samples were collected to exclude abnormal values of cortisol,oxytocin,and interleukin-1β(outside the mean ±2 standard deviation range),and finally 165 were included in the analysis.The multiple logistic regression analysis showed that cortisol concentration was significantly independently associated with group(χ2=13.112,P=0.004).When the healthy control group was used as a reference,women with a higher cortisol concentration were more likely to be in the group of women with breast cancer but no depression(OR=1.006,P=0.003),suggesting that depression is associated with higher cortisol concentration.The association bewteen breast cancer and cortisol levels was not significant.The oxytocin level was significantly independently associated with group(χ2=26.218,P<0.001).When the healthy control group was used as a reference,women with a higher level of oxytocin were more likely to be in the group of wome with both breast cancer and depression(OR=1.017,P=0.005),in the group of women with breast cancer but no depression(OR=1.014,P=0.017),and in the group of women with depression but no breast cancer(OR=1.026,P<0.001),suggesting that both depression and breast cancer were associated with higher oxytocin levels.The asociation of interleukin-1βlevel with group was statistically significant(χ2=31.030,P<0.001).When setting the healthy control group as the reference,women with a lower interleukin-1β level were more likely to be in the group of women with breast cancer but no depression(OR=0.990,P=0.006),suggesting that breast cancer is associated with lower interleukin-1βlevel;women with a higher interleukin-1β level were associated with a higher risk of women to be in the group of women with depression but no breast cancer(OR=1.010,P=0.035),suggesting that depression is associated with higher interleukin-1β levels.ConclusionDepression is associated with higher cortisol concentration,higher oxytocin concentration,and higher interleukin-1β concentration.Breast cancer is associated with lower interleukin-1β concentration and higher oxytocin concentration,but not related to cortisol concentration.The results suggest that both breast cancer and depression may be associated with hypophyseal-pituitary-gonadal axis and immune system dysfunction. |
PDF Full Text Request