Perceived stress, anxiety, and depression in treatment-naive women with breast cancer: a case-control study

Objective Women with breast cancer face elevated risk for psychological problems. We aimed to examine to what extent treatment-naive women with breast cancer are at higher risk for perceived stress and symptoms of anxiety and depression, compared with matched women with benign breast disease and healthy women, and explore the contribution of perceived stress in the association between breast cancer and symptoms of anxiety and depression. Methods The study included 360 women (120 per group). Perceived stress and symptoms of anxiety and depression were assessed using self-report questionnaires. We conducted linear and logistic regressions to assess increased risk and mediation analyses to test the role of perceived stress. Results After adjusting for potential confounders, perceived stress in women with breast cancer was 0.71 and 1.58 points higher than in patients with benign breast disease (p= 0.029) and healthy controls (p< 0.001), respectively; they were 1.85-2.44 times more likely to experience anxiety than either control group (p< 0.05) and 3.57 times more likely to experience depression than healthy controls (p< 0.001). The indirect effect of perceived stress between breast cancer and anxiety and depressive symptoms was 0.19-0.47 (p< 0.05). Conclusions This study demonstrates the high risk of perceived stress and symptoms of anxiety and depression in treatment-naive patients with breast cancer, and the association between breast cancer and increased anxiety and depressive symptoms through elevated perceived stress. It underscores the need to assess psychological status in pretreatment period and conduct stress-targeted prehabilitation interventions.

Automated summary

The study showed that treatment-naive patients with breast cancer were at higher risk for perceived stress and symptoms of anxiety and depression compared to patients with benign breast disease and healthy controls. The elevated perceived stress in breast cancer patients played a mediating role in the association between breast cancer and increased anxiety and depressive symptoms.