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OBJECTIVES: Four in ten women with breast cancer experience high levels of anxiety or depression, despite advances in oncology treatments. The study investigates the role of psychosocial, disease and treatment characteristics, and appraisal processes to better understand factors contributing to this high psychological morbidity. DESIGN: A postal survey was employed to observe psychological morbidity in women 2 and 6 months after initial diagnosis and treatment of breast cancer. The study was conducted as an adjunct to an Australian multi-centre feasibility study of an evidence-based specialist breast nurse (SBN) model of care. METHODS: In total, 195 women with a new diagnosis of early or locally advanced breast cancer completed the data collection relating to this study. Psychosocial, disease and treatment information for each woman at diagnosis was recorded in research logs. Women completed the GHQ-12 questionnaire 2 months after diagnosis, and at 6 months they completed the GHQ-12 and an appraisal process questionnaire designed by the National Breast Cancer Centre (NBCC). Bivariate and multiple regression analyses were undertaken to build a statistical model to account for GHQ-12 scores at 6 months. RESULTS: According to the GHQ-12, 43% of women had a likely affective disorder at either 2 or 6 months after diagnosis. Point prevalence decreased from 2 to 6 months yet remained substantial compared with general population statistics. Psychological functioning in women with breast cancer is related to a woman's psychiatric history, grade of tumour, and her appraisal processes. Most importantly, improved psychological functioning from 2 to 6 months after diagnosis is related to a woman having a lower primary appraisal of threat and a greater secondary appraisal of self-efficacy in terms of having confidence in her own ability to cope with concerns associated with the illness. CONCLUSION: Appraisal processes play a significant role in psychological adjustment to breast cancer. Adjustment may be facilitated by ensuring that the treatment team responds to shortfalls in a woman's appraisal of her illness and her perceived ability to cope, especially where a difficult prognosis is evident.

SynopsisCoping has attracted much attention in research as a possible mediator of the psychological impact of cancer. Yet, conceptual ambiguity and methodological limitations have resulted in weak and contradictory findings. A major shortcoming has been the use of designs which do not represent adequately the complexity or the diversity of demands which arise from the diagnosis and treatment of cancer. The neglect of appraisal in the assessment of the relationship between coping and mental health is of particular concern, given the role it has been found to play in the onset and maintenance of affective disorders.In a prospective study 673 newly diagnosed cancer patients were interviewed 4 to 8 weeks and 1 year later to assess the effects of their appraisals, coping responses and resolution of any concerns on subsequent mental health. Logistic regression analyses, adjusted for possible confounding variables, were used to investigate the relationships between coping variables and affective disorders. When examined separately the degree of threat appraised, the reporting of a helpless response and perceived success of primary responses in resolving concerns all predicted subsequent affective disorder. However, in a multivariate model only appraisal and success of the response in resolving the concern were significant. No response was found to prevent affective disorders, however certain types of responses were associated with the resolution of specific concerns. The results highlight the importance of assessing the whole coping process and the need to address the complex and multifaceted characteristics of cancer demands. On the basis of our findings we describe a maladaptive cycle of coping, which we believe contributes to the later onset of affective disorders in cancer patients.

The study gives some support to the theory that appraisal processes underlie how relatives react to having a family member with schizophrenia, and may have implications both for identifying those at risk of poor adaptation, and for understanding strategies that improve well-being.

A brief intervention, delivered by nonspecialists, promoted adjustment among newly diagnosed cancer patients at high risk of developing anxiety or depressive disorders.