PTSD diagnoses, subsyndromal symptoms, and comorbidities contribute to impairments for breast cancer survivors

Abstract

The clinical importance of posttraumatic stress disorder (PTSD) symptomatology for cancer patients is unclear. The association between the magnitude of cancer-related PTSD symptoms, comorbidity, and functioning is tested. Breast cancer patients (N = 74) were assessed at diagnosis/surgery, followed, and screened for cancer-related PTSD 18 months later. Participants then completed diagnostic interviews and PTSD (n = 12), subsyndromal PTSD (n = 5), and no symptom (n = 47) patient groups were identified. Posttraumatic stress disorder cases were distinguished by having experienced violent traumas and anxiety disorders predating cancer, whereas subsyndromal cases were not. Also, longitudinal data show that PTSD covarys with poorer functioning and lower quality of life among breast cancer survivors. Both PTSD and subsyndromal PTSD were associated with employment absenteeism and the seeking of mental health services.Studies of posttraumatic stress disorder (PTSD) in cancer patients find that diagnostic rates are low (3% to 14%), but symptomatology falling short of the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association [APA], 1994)-PTSD that is subsyndromal-may occur in upward of 50% of patients (Gurevich, Devins, & Rodin, 2002). How disabling subsyndromal PTSD may be for any individual is not fully known; however, the few data suggest that it is so. Stein, Walker, Hazen, and Forde (1997) using community survey data found that individuals with subsyndromal PTSD reported employment problems, social disruptions, and difficulties in the home. Similarly, Ciechanowski, Walker, Russo, Newman, and Katon (2004) found in a general survey of women in a health maintenance organization that quality of life was lower among those with subsyndromal PTSD compared to those with no symptoms. Finally, Marshall and colleagues (2001), using data from over 9,000 adults screened for anxiety disorders, reported that the presence of subsyndromal symptoms significantly raised the risk for suicidal ideation.It is not known if similar disruptions occur for cancer survivors. The majority of the available data come not from studies determining patients' syndromal or subsyndromal PTSD diagnoses, but from patient self-reports of traumatic symptoms found to be correlated with poor quality of life and/or impaired physical functioning (e.g., Diemling, Kahana, Bowman, & Schaefer, 2002;Jacobsen et al., 1998; for a review, see Kangas, Henry, & Bryant, 2002 (Gurevich et al., 2002;Kangas et al., 2002), only 8 studies used diagnostic interviews (e.g., SCID; First, Spitzer, Gibbon, & Williams, 1996). Across studies, 0 to 10 patients with PTSD were identified, for a total of 40 PTSD cases in the literature from over 700 patients assessed (Alter et al., 1996;Brewin, Watson, McCarthy, Hyman, & Dayson, 1998;Green et al., 1998;Kangas, Henry, & Bryant, 2005;Mehnert & Koch, 2007;Mundy et al., 2000;Palmer, Kagee, Coyne, & DeMichele, 2004;Pitman et al., 2001). Thus, a study ...

Post-traumatic Stress Disorder and Post-traumatic Growth in Breast Cancer Patients - a Systematic Review

“…The review team found five different types of subjects studied, including: i) PTSD in BC survivors (Andrykowski et al, 1998;Andrykowski et al, 2000;Amir and Ramati, 2002;Gurevich et al, 2002;Kangas et al, 2002;Levine et al, 2005;Kangas et al, 2007;Knobf, 2007;Mehnert and Koch, 2008;Shelby et al, 2008;Smith et al, 2008;Bellizzi et al, 2010;Nordin et al, 2012;Rustad et al, 2012;Arving et al, 2013;Perez et al, 2014).…”

“…(Andrykowski et al, 1998;Andrykowski et al, 2000;Levine et al, 2005;Mehnert and Koch, 2008;Shelby et al, 2008) Rustad and colleagues used PTSD Checklist-for Civilians (PCL-C) tool in the diagnosis of PTSD (Rustad et al, 2012). The author also discussed trauma-focused cognitive behavioural therapy for cancer patients, a technique which can also be implemented for women with BC (Rustad et al, 2012).…”

“…Previous studies noted that the majority of women with BC exhibited high levels of distress, appearance and body image concerns and psychological dysfunction in the first year after BC treatment (Tjemsland et al, 1998;Shelby et al, 2008;Ho et al, 2011;Abu-Helalah et al, 2014). BC survivors gradually appear to adapt to life with the ever present concerns of disease recurrence and the subsequent development of positive stress, known as PTG (Tedeschi and Calhoun, 2004).…”

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“…Prema istraživanju Shelby i suradnika iz 2008. na 74 pacijentice koje su imale tumor dojke, 12 je imalo PTSP, subsindromski oblik PTSP-a imalo je pet bolesnica, dok ostatak nije imao simptoma. Pokazalo se da su bolesnice s PTSP-om imale raniju povijest trauma nasilja i anksiozne poremećaje, dok to nisu imale pacijentice sa subsindromskim oblikom PTSP-a 20 . Osobe s PTSP-om imale su lošije funkcioniranje i lošiju kvalitetu života 20 .…”

Deconstructing the complexity of PTSD in cancer

“…As we previously noted, 1 many patients living with PTSD experience worse health outcomes than those without PTSD via multiple pathways that can lead to greater morbidity and shorter survival. 7,8 Thus, the costs of screening, evaluating and treating PTSD (when warranted) must be weighed against the allevi ation of the societal and personal burdens of untreated PTSD.…”