Prevalence and psychosocial factors of anxiety and depression in breast cancer patients.

BACKGROUND: Breast cancer is the most common cancer in women. It is seen as a terrifying disease due to a high mortality rate, its impacts on self-image, and the sexual relationship. Many patients experience psychological reactions, and may have psychiatric morbidities, especially anxiety and depressive disorders. Although anxiety and depressive disorders are common in breast cancer and worsen the disease course and treatment outcomes, these psychiatric disorders are ignored and left untreated. Understanding these common psychiatric disorders and associated psychosocial factors can help to plan for treatment and may result in more treatment success. OBJECTIVES: The present study was aimed to identify the prevalence and associated psychosocial factors of anxiety and depressive disorders in breast cancer patients. The psychosocial factors in the present study focused on social support, family relationship and functioning, and problem and conflict solving. MATERIAL AND METHOD: Three hundred female breast cancer patients, aged above 18 years old from the Surgical Outpatient Department, King Chulalongkorn Memorial Hospital, were recruited into the study from December 2006 to May 2007. All samples completed five questionnaires; 1) Demographic data and history form, 2) Thai Hospital Anxiety and Depression Scale (Thai HADS), 3) Social Support Questionnaire, 4) Family Relationship and Functioning Questionnaire, 5) Problem and Conflict Solving Questionnaire. The prevalence of anxiety and depressive disorders was reported in percentage. The association between psychosocial, demographic, and clinical factors and anxiety and depression was analyzed by ANOVA test (for continuous data) and chi-square test (for categorical data). Logistic regression was performed to identify the potential predictors of anxiety and depression. A p-value of less than 0.05 was considered statistically significant. RESULTS: The prevalence of anxiety disorder was 16.0%, and that of anxiety symptoms was 19.0%. The prevalence of depressive disorder was 9.0%, and that of depressive symptoms was 16.7%. Factors associated to anxiety and depression were psychosocial factors (social support, family relationship and functioning, and problem and conflict solving) (p < 0.01), number of hospital admissions, and presence of disturbing symptoms: pain, respiratory symptoms, and fatigue (p < 0.01). By regression analysis, the significant predictors of anxiety and depression were poor family relationship and functioning (p < 0.05), maladaptive problem and conflict solving (p < 0.05), and symptoms of pain (p < 0.01) and fatigue (p < 0.05). CONCLUSION: Anxiety and depressive disorders are two common psychiatric disorders in breast cancer. Strong predictors of anxiety and depression in breast cancer patients were poor family relationship and functioning, maladaptive problem and conflict solving, and presence of pain and fatigue. Promoting patients' social support, especially emotional support from family, and enhancing patient's coping skills may reduce the patients' psychological stress and psychiatric morbidities. Treatment of breast cancer patients should focus on reduction of patients' disturbing symptoms such as adequate pain control, and lessening the treatment complications. Moreover being alert on patients' emotional reactions and potential psychiatric disorders is essential.

Effects of psycho-educational program on knowledge and attitude upon schizophrenia of schizophrenic patients' caregivers.

BACKGROUND: Schizophrenia is mainly characterized by chronic psychotic symptoms such as delusions, hallucinations, and negative symptoms such as social withdrawal. These symptoms cause behavior problems, i.e. aggressive behavior violence, or social isolation that affect the patients' lives, and the health status and daily routine of caregivers or family members. Psychological distress or burden of caregivers often results in poor care provided to these patients. Most studies showed that high expressed emotion in the family leads to high a relapse rate of schizophrenia. The psycho-educational program is aimed to provide education about this disorder help the caregivers to deal with the patients' problems more effectively, reduce psychological distress of caregivers, and provide social support for caregivers. OBJECTIVE: Study the effects of psycho-educational program on knowledge and attitude of schizophrenia on caregivers of schizophrenic patients. MATERIAL AND METHOD: The participants completed the one-day psycho-educational program run by a team of psychiatrists in the Department of Psychiatry, Chulalongkorn Memorial Hospital. The psycho-educational program was composed of didactic session on schizophrenia, group discussion, and communication skill building. The participants were evaluated for the knowledge and attitude, before and after the program. The mean scores of knowledge, attitude before and after the program were compared by using paired t-test. RESULTS: Ninety-one caregivers of schizophrenic patients participated into the present study. The results showed that the mean scores of knowledge and attitude before the program were 6.06 (SD = 1.86) and 37.57 (SD = 6.46) and after the program were 6.91 (SD = 3.35), and 29.37 (SD = 15.79), respectively. The scores of knowledge and attitude of caregivers, before and after the program were statistically different. The participants evaluated the program as an interesting and very useful program. CONCLUSION: Psycho-educational program on schizophrenia increase the knowledge and shape the attitude of caregivers. Therefore, interventions targeting caregivers of schizophrenic patients should result in the successful treatment and rehabilitation of schizophrenic patients.

Quality of life and correlated health status and social support of schizophrenic patients' caregivers.

BACKGROUND: Quality of life (QOL) of caregivers is the new concept used for evaluating the caregivers' burden and well-being, and improving the caregiver interventions. Schizophrenia is considered as a chronic and severe mental disorder. It affects the lives of patients and the family members of caregivers who take care of them. The caregivers have to deal with patients' symptoms, and help patients in activities of daily living. Most studies showed low scores of QOL of schizophrenic patients' caregivers. OBJECTIVES: To study the QOL of schizophrenic patients' caregivers in Bangkok Metropolis community and the correlation between QOL, and health status and social support of schizophrenic patients' caregivers MATERIAL AND METHOD: One hundred and twenty schizophrenic patients' caregivers were recruited from three Public Health Centers of Health Department of the Bangkok Metropolitan Administration, in November-December 2005. They completed three self-rated questionnaires; 1) Quality of Life Index Generic Version - III (QLI Generic Version - III), 2) Short Form 36 Health Survey (SF-36 Health Survey), and 3) Questionnaire for Assessment of Social Support. QOL of caregivers was analyzed by using mean, percentage, and standard deviation. The correlation between QOL, and health status and social support was analyzed by using Pearson's correlation. RESULTS: Eighty-eight people (73.33%) were female and thirty-two people (26.67%) were male. The mean age of the caregivers was 49.91 years, and the age range of the caregivers was 23-81 years. Most of them had primary school education (62 people, 51.67%), and had a marital status of couples (73 people, 60.83%). The results showed most of the schizophrenic patients' caregivers (80 people, 66.67%) had low moderate level of QOL. The caregivers' health status and social support were positively correlated to their QOL. CONCLUSION: The present study showed schizophrenic patients' caregivers in the community had low moderate level of QOL. The health status and social support of caregivers were positively correlated to their QOL. Health promotion and increasing social support ofcaregivers may help to increase caregivers' QOL. Improving caregivers' QOL will increase the quality of care given and improve the success of treatment and rehabilitation of schizophrenic patients.