Summary
The aim of this study was to examine the possibility of predicting anxiety and depression 6 months after a cancer diagnosis on the basis of measures of anxiety, depression, coping and subjective distress associated with the diagnosis and to explore the possibility of identifying individual patients with high levels of delayed anxiety and depression associated with the diagnosis. A consecutive series of 159 patients with gastrointestinal cancer were interviewed in connection with the diagnosis, 3 months (non-cured patients only) and 6 months later. The interviews utilized structured questionnaires assessing anxiety and depression [Hospital Anxiety and Depression (HAD) scale], coping [Mental Adjustment to Cancer (MAC) scale] and subjective distress [Impact of Event (IES) scale]. Patient anxiety and depression close to the diagnosis were found to explain approximately 35% of the variance in anxiety and depression that was found 6 months later. The addition of coping and subjective distress measures did little to improve that prediction. A model using (standardized) cut-off scores of moderate to high anxiety, depression (HAD) and intrusive thoughts (IES subscale) close to the diagnosis to identify patients at risk for delayed anxiety and depression achieved a sensitivity of 75% and a specificity of 98%. Levels of anxiety and depression at diagnosis predicted a similar status 6 months later. The results also indicated that the HAD scale in combination with the IES intrusion subscale may be used as a tool for detecting patients at risk of delayed anxiety and depression.
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Andersen, B. (1992). Psychological interventions for cancer patients to enhance the quality of life. J Consult Clin Psychol 60: 552–568.
Burton, M., Parker, R., Farell, A., Bailey, D., Conneely, J., Booth, S. & Elcombe, S. (1995). A randomized controlled trial of preoperative psychological preparation for mastectomy. Psycho-Oncology 4: 1–19.
Derogatis, L., Marrow, G., Denmann, D., Piasetsky, S., Schmale, A., Heinrichs, M. & Carnicke, C. (1983). The prevalance of psychiatric disorders among cancer patients. JAMA 249: 751–757.
Fawzy, F., Fawzy, N., Hyun, C., Elashoff, K., Guthrie, D. & Fahey Morton, D. (1993). Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiat 50: 681–689.
Glanz, K. & Lerman, C. (1992). Psychosocial impact of breast cancer: a critical review. Ann Behav Med 14: 204–212.
Greer, S., Moorey, S., Baruch, J., Watson, M., Robertson, B., Mason, A., Rowden, L., Law, M. & Bliss, J. (1992). Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. BMJ 304: 675–680.
Greer, S., Moorey, S. & Watson, M. (1989). Patients adjustment to cancer (MAC) scale vs clinical ratings. J Psychosom Res 33: 373–377.
Harrison, J. & Maguire, P. (1994). Predictors of psychiatric morbidity in cancer patients. Br J Psychiat 165: 593–598.
Hellbom, M., Brandberg, Y. & Sjödén, P. (1998). Individual psychological support for cancer patients: utilization and patient satisfaction. Pat Ed Counsel 34: 247–256.
Horowitz, M. (1993). tress response syndromes and their treatment. In Handbook of Stress. Theoretical and Clinical Aspects, Goldberger L, Breznitz S (eds), pp. 757–773, The Free Press: New York
Horowitz, M., Wilner, N. & Alvarez, W. (1979). Impact of Event Scale: a measure of subjective stress. Psychosom Med 41: 209–213.
Leigh, S., Wilson, K., Burns, R. & Clark, R. (1995). Psychosocial morbidity in bone marrow transplant recipients: a prospective study. Bone Marrow Trans 16: 635–640.
Maguire, G. (1992). Improving recognition and treatment of affective disorders in cancer patients. In Recent Advances in Clinical Psychology, Granville-Grossman K (ed.). Churchill Livingstone: Edinburgh
Nordin, K. & Glimelius, B. (1997). Psychological reactions in newly diagnosed gastrointestinal cancer patients. Acta Oncol 36: 803–810.
Razavi, D., Delvaux, N., Farvacques, C. & Robaye, E. (1990). Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiat 156: 79–83.
Schwartz, C., Daltroy, L., Brandt, U., Friedman, R. & Stolbach, L. (1992). A psychometric analysis of the Mental Adjustment to cancer scale. Psychol Med 22: 203–210.
Spijker AVT Trijsburg, R. W. & Duivenvoorden, H. J. (1997). Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med 59: 280–293.
Trijsburg, R., Knippenberg van, F. & Rijpma, S. (1992). Effects of psychological treatment on cancer patients: a critical review 54: 489–517.
Watson, M. (1983). Psychosocial intervention with cancer patients: a review. Psychol Med 13: 839–846.
Watson, M., Fenlon, D., McVey, G. & Fernandez-Marcos, M. (1996). A support group for breast cancer patients: development of a cognitive-behavioural approach. Behav Cogn Psychoth 24: 73–81.
Watson, M., Greer, S., Young, J., Inayat, Q., Burgess, C. & Robertson, B. (1988). Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psychol Med 18: 203–209.
Zigmond, A. & Snaith, R. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiat Scand 67: 361–370.
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Nordin, K., Glimelius, B. Predicting delayed anxiety and depression in patients with gastrointestinal cancer. Br J Cancer 79, 525–529 (1999). https://doi.org/10.1038/sj.bjc.6690082
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bjc.6690082
Keywords
This article is cited by
-
Early rehabilitation of cancer patients – a randomized controlled intervention study
BMC Cancer (2013)
-
Design of the study: How can health care help female breast cancer patients reduce their stress symptoms? A randomized intervention study with stepped-care
BMC Cancer (2012)
-
Anxiety and depression in patients with gastrointestinal cancer: does knowledge of cancer diagnosis matter?
BMC Gastroenterology (2007)
-
The Influence of Cancer‐related Distress and Sense of Coherence on Anxiety and Depression in Patients with Hereditary Cancer
Journal of Genetic Counseling (2007)