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Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer

  • J. Hill (a1), C. Holcombe (a2), L. Clark (a3), M. R. K. Boothby (a4), A. Hincks (a3), J. Fisher (a2), S. Tufail (a5) and P. Salmon (a3)...



Depression and anxiety are common after diagnosis of breast cancer. We examined to what extent these are recurrences of previous disorder and, controlling for this, whether shame, self-blame and low social support after diagnosis predicted onset of depression and anxiety subsequently.


Women with primary breast cancer who had been treated surgically self-reported shame, self-blame, social support and emotional distress post-operatively. Psychiatric interview 12 months later identified those with adult lifetime episodes of major depression (MD) or generalized anxiety disorder (GAD) before diagnosis and onset over the subsequent year. Statistical analysis examined predictors of each disorder in that year.


Of the patients, two-thirds with episodes of MD and 40% with episodes of GAD during the year after diagnosis were experiencing recurrence of previous disorder. Although low social support, self-blame and shame were each associated with both MD and GAD after diagnosis, they did not mediate the relationship of disorder after diagnosis with previous disorder. Low social support, but not shame or self-blame, predicted recurrence after controlling for previous disorder.


Anxiety and depression during the first year after diagnosis of breast cancer are often the recurrence of previous disorder. In predicting disorder following diagnosis, self-blame and shame are merely markers of previous disorder. Low social support is an independent predictor and therefore may have a causal role.


Corresponding author

*Address for correspondence: P. Salmon, D.Phil., Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK. (Email:


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Andrews, B (1995). Bodily shame as a mediator between abusive experiences and depression. Journal of Abnormal Psychology 104, 277285.
Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.
Bennett, KK, Compas, BE, Beckjord, E, Glinder, JG (2005). Self-blame and distress among women with newly diagnosed breast cancer. Journal of Behavioral Medicine 28, 313323.
Burgess, C, Cornelius, V, Love, S, Graham, J, Richards, M, Ramirez, A (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study. British Medical Journal 330, 702.
Dean, C (1987). Psychiatric morbidity following mastectomy: preoperative predictors and types of illness. Journal of Psychosomatic Research 31, 385392.
Gallagher, J, Parle, M, Cairns, D (2002). Appraisal and psychological distress six months after diagnosis of breast cancer. British Journal of Health Psychology 7, 365376.
Gandubert, C, Carriere, I, Escot, C, Soulier, M, Hermes, A, Boulet, P, Ritchie, K, Chaudieu, I (2009). Onset and relapse of psychiatric disorders following early breast cancer: a case–control study. Psychooncology 18, 10291037.
Ganz, PA, Desmond, KA, Leedham, B, Rowland, JH, Meyerowitz, BE, Belin, TR (2002). Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. Journal of the National Cancer Institute 94, 3949.
Glinder, JG, Compas, BE (1999). Self-blame attributions in women with newly diagnosed breast cancer: a prospective study of psychological adjustment. Health Psychology 18, 475481.
Gotlib, IH, Lewinsohn, PM, Seeley, JR (1998). Consequences of depression during adolescence: marital status and marital functioning in early adulthood. Journal of Abnormal Psychology 107, 686690.
Grassi, L, Malacarne, P, Maestri, A, Ramelli, E (1997). Depression, psychosocial variables and occurrence of life events among patients with cancer. Journal of Affective Disorders 44, 2130.
Harrington, R, Hill, J, Rutter, M, John, K, Fudge, H, Zoccolillo, M, Weissman, M (1988). The assessment of lifetime psychopathology: a comparison of two interviewing styles. Psychological Medicine 18, 487493.
Helgeson, VS, Snyder, P, Seltman, H (2004). Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change. Health Psychology 23, 3–15.
Hill, J, Davis, R, Byatt, M, Burnside, E, Rollinson, L, Fear, S (2000). Childhood sexual abuse and affective symptoms in women: a general population study. Psychological Medicine 30, 12831291.
Hill, J, Pickles, A, Burnside, E, Byatt, M, Rollinson, L, Davis, R, Harvey, K (2001). Child sexual abuse, poor parental care and adult depression: evidence for different mechanisms. British Journal of Psychiatry 179, 104109.
Hill, J, Pickles, A, Rollinson, L, Davies, R, Byatt, M (2004). Juvenile- versus adult-onset depression: multiple differences imply different pathways. Psychological Medicine 34, 14831493.
Jaffee, SR, Moffitt, TE, Caspi, A, Fombonne, E, Poulton, R, Martin, J (2002). Differences in early childhood risk factors for juvenile-onset and adult-onset depression. Archives of General Psychiatry 59, 215222.
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.
Lewinsohn, PM, Rohde, P, Seeley, JR, Klein, DN, Gotlib, IH (2003). Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence. Journal of Abnormal Psychology 112, 353363.
Margolis, G, Goodman, RL, Rubin, A (1990). Psychological effects of breast-conserving cancer treatment and mastectomy. Psychosomatics 31, 3339.
Maunsell, E, Brisson, J, Deschenes, L (1992). Psychological distress after initial treatment of breast cancer. Assessment of potential risk factors. Cancer 70, 120125.
Moorey, S, Greer, S (2002). Cognitive Behaviour Therapy for People with Cancer. Oxford University Press: Oxford.
Morasso, G, Costantini, M, Viterbori, P, Bonci, F, Del Mastro, L, Musso, M, Garrone, O, Venturini, M (2001). Predicting mood disorders in breast cancer patients. European Journal of Cancer 37, 216223.
Pinder, KL, Ramirez, AJ, Black, ME, Richards, MA, Gregory, WM, Rubens, RD (1993). Psychiatric disorder in patients with advanced breast cancer: prevalence and associated factors. European Journal of Cancer 29A, 524527.
Salmon, P, Hill, J, Krespi, R, Clark, L, Fisher, J, Holcombe, C (2006). The role of child abuse and age in vulnerability to emotional problems after surgery for breast cancer. European Journal of Cancer 42, 25172523.
Sherbourne, CD, Hays, RD, Wells, KB (1995). Personal and psychosocial risk factors for physical and mental health outcomes and course of depression among depressed patients. Journal of Consulting and Clinical Psychology 63, 345355.
Sherbourne, CD, Stewart, AL (1991). The MOS social support survey. Social Science and Medicine 32, 705714.
Spitzer, RL, Endicott, J (1975). Schedule for Affective Disorders and Schizophrenia – Lifetime Version. Biometrics Research: New York.
Teasdale, JD, Cox, SG (2001). Dysphoria: self-devaluative and affective components in recovered depressed patients and never depressed controls. Psychological Medicine 31, 13111316.
Trunzo, JJ, Pinto, BM (2003). Social support as a mediator of optimism and distress in breast cancer survivors. Journal of Consulting and Clinical Psychology 71, 805811.
Whiffen, VE, Macintosh, HB (2005). Mediators of the link between childhood sexual abuse and emotional distress: a critical review. Trauma, Violence and Abuse 6, 2439.


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Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer

  • J. Hill (a1), C. Holcombe (a2), L. Clark (a3), M. R. K. Boothby (a4), A. Hincks (a3), J. Fisher (a2), S. Tufail (a5) and P. Salmon (a3)...


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