Suicidal Ideation Versus Hopelessness/Helplessness in Healthy Individuals and in Patients with Benign Breast Disease and Breast Cancer: A Prospective Case-control Study in Finland.

BACKGROUND/AIM: The relation between suicidal ideation versus hopelessness/helplessness in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared to date in a prospective study. We, therefore, investigated suicidal ideation versus hopelessness/helplessness in 115 patients. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness versus suicidal/pessimistic thoughts before any diagnostic procedures were carried-out. RESULTS: In the self-rating score (SRS), hopelessness and the helplessness versus pessimistic thoughts were significantly correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa-values for hopelessness versus pessimistic thoughts in the BBD group were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) in the hopelessness versus pessimistic thoughts in the HSS, BBD and BC groups, as well as in the ERS, in the helplessness versus pessimistic thoughts in the HSS and BBD groups. In SRS, the hopelessness and the helplessness versus suicidal thoughts were significantly correlated in the HSS, BBD and BC groups. There was also a significant positive correlation in the ERS in the hopelessness versus suicidal thoughts in the HSS, BBD and BC groups, as well as in the ERS, in the helplessness versus suicidal thoughts in the BBD group. CONCLUSION: A new finding with clinical relevance in the present work is the agreement between hopelessness/helplessness versus suicidal/pessimistic thoughts in the self-rating and examiner-rating. In the breast cancer diagnostic Unit, the identification of suicidal ideation is essential in suicide prevention and it is important to assess and treat depression even though a subject reports little suicidal ideation.

Work and family stress is associated with menstrual disorders but not with fibrocystic changes: cross-sectional findings in Chinese working women.

OBJECTIVES: To explore the separate and combined effects of work and family stress on menstrual disorders and fibrocystic changes in Chinese working women. METHODS: Data were obtained from a cross-sectional study of 1,642 female railway workers. The Effort-Reward Imbalance Questionnaire and Family Stress Scale were used to measure work stress and family stress, respectively; the menstrual and breast conditions were evaluated by gynecologic interview and a medical examination. Multivariate log-binomial regression was performed to analyze the associations. RESULTS: Menstrual disorders were found in 59.3% of female workers, and 54.8% had fibrocystic changes. The risk of menstrual disorders was significantly elevated with respect to work and family stress. The highest risk was found in the group with combined exposure to both work and family stress (RR with 95% CI 1.33 (1.18-1.49)). No significant association between stress and fibrocystic changes was observed. CONCLUSIONS: Menstrual disorders were associated with stress from work and family life, but not fibrocystic changes, in working women. Tailored intervention measures reducing the burden of stressful psychosocial work and family environment are needed to improve women's reproductive well-being.

Psychological impact of benign breast biopsy: a longitudinal, comparative study.

The impact of benign breast biopsy (BBB) on distress and perceptions of risk for breast cancer (BC) was examined. Interviews were conducted with 100 women shortly after notification of biopsy results and 4 and 8 months post-BBB. Compared with matched healthy comparison (HC) women without BBB, the BBB group evidenced greater BC-specific distress at baseline. BC-specific distress declined after BBB, remaining elevated relative to the HC group at the 8-month follow-up. Dispositional (optimism, informational coping style), demographic (education), clinical (family history of BC), and cognitive (BC risk perception) variables were associated with baseline levels of BC-specific distress or persistence of distress. Results support the monitoring process model (S. M. Miller, 1995) and the cognitive social health information processing model (S. M. Miller, Y. Shoda, & K. Hurley, 1996).

Physical symptoms, distress, and breast cancer risk perceptions in women with benign breast problems.

Physical symptoms, general and breast cancer-specific distress, and perceived breast cancer risk were assessed in 66 women with benign breast problems (BBP) and 66 age-matched healthy comparison (HC) women. BBP women reported significantly greater worry about breast cancer than HC women. Breast symptom incidence and breast cancer risk perceptions were found to mediate group differences in breast cancer worry. Hierarchical regression analyses indicated that perceptions of control over a potential breast cancer prognosis moderate the impact of breast symptoms on reports of breast cancer worry. Implications for risk counseling with BBP women are discussed.

Family goals as indicants of adaptation during chronic illness.

Families that successfully adapt to new situations have been found not only to appraise the situations as manageable but also to possess the necessary resources to meet the challenges. The purpose of this study was to determine the goals that families in which the mother had chronic illness identified for themselves and how these goals related to family functioning. A five-occasion, 15-month, descriptive longitudinal design was used to collect data. Data from occasions 2 and 3 were used to generate the coding scheme. This coding scheme was used to analyze the fourth-occasion data set, which is presented here. The sample at the fourth occasion consisted of 103 families in which the mother was diagnosed with breast cancer, diabetes, or fibrocystic breast disease. Content analysis of responses revealed 10 mutually exclusive categories of family goals: viability of children, cohesion, adaptation, boundary alterations, health maintenance, conflict management, individual achievements and pursuits, acquisition of possessions, financial stability, and family relocation. Types of goals identified did not significantly differ by disease type. The results suggest that family-system goals are relatively enduring and not readily discarded in response to health or illness disruption.

["Traditional" vs. "modified" approach to research within the scope of psycho-oncologic studies. Theoretical considerations and initial results]. / "Traditioneller" vs. "modifizierter" Forschungsansatz im Rahmen psychoonkologischer Studien. Theoretische Uberlegungen und erste Ergebnisse.

The paper points out two methods of research in the field of psychosomatic resp. psychooncologic research. The "traditional method" of an Inter-Group-Comparison is confronted with the "modificated method" of an Intra-Group-Comparison. The methodological advantage of taxonomic subgroups is demonstrated at a population of 60 breast cancer patients. Two homogeneous subgroups of the investigated population can be distinguished not only by contents criteria but also by means of a cluster-analysis. The prognostic importance of the psychodynamic profile within the different subgroups is discussed. In this context defense mechanisms are particularly relevant.

[Situational effects in reporting life change events? A comparison of two assessment techniques]. / Situationseffekte beim Berichten von Lebensereignissen? Ein Vergleich zweier Erhebungsmethoden.

Studies on the role of life events in the development of malignant diseases (particularly breast cancer) often rely on so-called limited prospective designs: Women with a suspicious breast lump are interviewed prior to surgery. After having learnt the final diagnosis, the sample is divided into a group having cancer and a control group. Research using this approach was criticised for producing artifacts: knowledge of diagnosis should cause reevaluations of past events and lead to overreporting of stressful experiences. Two limited prospective studies using different assessment methodologies are compared for possible artifacts due to knowledge of diagnosis. When considering less severe events, the application of a checklist technique leads to marked memory bias as assumed above. When leaving the respondents time to reconstruct their events at length, no artifacts are present. Reporting of the severest event categories remains unaffected under both methods.

Artifacts in "limited prospective" designs? Testing confounding effects on response behaviour of women prior to breast surgery.

Data from a 'limited prospective' study on life events and breast cancer were tested whether they were biased by knowledge of the prospective diagnosis or by related mood states. Data were gathered by semi-structured and tape-recorded interviews. Event classifications were made according to Brown and Harris' Life Events and Difficulties Scale, an interviewer-based rating method. Ratings were performed before the interviewer learned the final diagnosis. Among the women coming to hospital with a suspicious breast lump, 33 had a malignant and 59 had a benign diagnosis. For comparison for mood effects two more control groups (women prior to gall stone surgery and healthy women interviewed at home) were included. Although artifacts may in general play a role for reporting events in 'limited prospective' designs, the present study could not document a sizeable effect of presumed confounding variables on response behaviour.

Life events prior to manifestation of breast cancer: a limited prospective study covering eight years before diagnosis.

The role of life events in breast cancer was conceptualized within two models differing by vulnerability factors, 'social support' and 'early loss of mother'. The eight years prior to manifestation of the lump were covered by semi-structured interviews. Event ratings were performed according to Brown and Harris' Life Events and Difficulties Scale, an interviewer-based rating method. Data were collected within a so-called limited prospective design. This setting was subject to critical evaluation to control possible artifacts. Interviews were tape-recorded and rated before learning the final diagnosis. In the tumor groups, 97 women with a suspicious breast lump were interviewed immediately after hospital admission. In 33 cases, the diagnosis turned out to be malign, 59 had a benign result. Data analysis revealed that life events in the severest categories were reported most often in the cancer group. Path analyses showed that effects do not disappear when control variables are taken into account.

[Psychosocial factors of preserving health? Prospective studies of breast cancer, bronchial cancer and fibrocystic mastopathy]. / Psychosoziale Faktoren der Gesundheitserhaltung? Prospektive Untersuchungen bei Brustkrebs, Bronchialkrebs und Mastopathia fribrocystica.

Do psychosocial factors affect the development of health? 156 patients were interviewed and tested before a breast biopsy or before the initial medical treatment of lung cancer. Multiple regressions examined the influence of age, diagnosis (tumor stage) and different psychosocial parameters as dependent variables the development of health after 2 or 5 years as independent variables. The breastbiopsy-group (n = 52) shows five psychological variables being effective in a positive (health promoting) manner: autonomy, emotional outlet, expression of one's needs, family support, lack of life stress. In lung cancer (n = 104) the development of health 2 years after diagnosis is only influenced by the type of tumor (small cell versus non small cell) and by the initial tumor stage. A structuralequation model (LISREL) shows for the first 3 months of illness that almost exclusively biological variables have an influence on psychological variables. Despite this family dynamics had a moderate effect on the patient's general wellbeing (Karnoffsky-Index).

The relationship between psychosocial factors and breast cancer: some unexpected results.

A growing body of research suggests a link between psychosocial factors and breast cancer. Research in this area often contains methodological problems, however, such as small sample size, inadequate comparison groups, omission of important control variables, inclusion of only a few psychosocial variables, and failure to analyze moderating effects. To overcome these problems, the present study examined the link between breast cancer and multiple psychosocial variables (life events, coping, Type A behavior pattern, availability of social support) among 1,052 women with and without breast cancer. After controlling for history of breast cancer and age, we found very few significant relationships between psychosocial variables and breast cancer. Furthermore, the relationship between life events and breast cancer was not moderated by coping, Type A, or availability of social support. Methodological and substantive reasons for these findings are discussed.

Therapy of patients at risk.

PIP: This is an informal discussion of how the author manages fibrocystic breast disease. Cystic disease of the breast is common in premenopausal women, peaking at age 48. It usually follows a cyclic pattern, increasing premenstrually, and often developing during missed periods before menopause. Sometimes iatrogenic causes, such as premenopausal estrogen replacement or cimetidine, are responsible. 6% of women with cystic disease will progress to breast cancer by the age of 52. Patients are treated with excisional biopsy, and are followed up every 6 months. Disease can manifest on the range from benign fibroadenoma, to epitheliosis, to carcinoma in situ. It is advisable to discontinue birth control pills immediately in women with cyst disease. Estrogen replacement is especially contraindicated for these women because it will cause fibroadenosis in the upper outer quadrant, retard the process of fatty degeneration of breast tissue, and increase the woman's chances of more cysts, more biopsies, and more anxiety as future mammograms become increasingly difficult to interpret.^ieng

Factitial dermatosis of the breast: a possible dermatologic manifestation of Munchausen's syndrome.

We report on two cases of factitial dermatosis of the breast associated with benign fibrocystic disease. One of the patients could also be diagnosed as showing Munchausen's syndrome. The lesions were protracted and intractable, painful ulcers that recurred and eventually became bilateral, despite attempts at surgical correction. The management of factitial dermatosis of the breast is complex, and should include psychiatric referral as well as avoidance of further surgical treatment if possible.

Coping with breast cancer--a longitudinal prospective study.

In a prospective longitudinal study over several years, 58 patients with breast cancer are compared to 52 patients with fibrocystic disease and 24 patients with mastodynia. Results of coping (as assessed with the Bernese Coping Modes) are presented for the illness course of the first 6 months: (1) There is considerable variation of coping depending on illness situation and illness state. A core group of coping modes is predominant in most situations: 'attention & care', 'problem analysis', and 'Tackling'. In average 10 different coping modes were used by patients per given illness situation. (2) The different aspects of illness (in the same organ) ask for different coping. In the initial evaluation phase, however, the possibly fatal diagnosis overrides these differences. (3) Change over time (first 6 months) is net. Besides the core group of coping modes mentioned above, there is more variability in coping; in cancer a trend from a more fighting to a more accepting attitude is obvious; in fibrocystic disease more restricted coping is observed. Interdependence of coping with emotional stability and social adaptation will be studied as well.

A retrospective study of personality variables associated with fibrocystic disease and breast cancer.

Women with breast cancer were compared to women with fibrocystic disease and healthy women to determine differences in self-perceptions of personality characteristics. Four standardized personality instruments were analyzed using analysis of covariance. An Adjective Check List was analyzed using logistic regression. Women with breast cancer were found to be more depressed, less aggressive and less demonstrative than women in the other two groups. Women with fibrocystic disease and with breast cancer were found to have higher needs for neatness and order and were found to be less curious and analytical than women in the healthy group. Women in the healthy group described themselves as calm, relaxed, outgoing and able to express anger. Women in the fibrocystic group described themselves as tense, restless, outgoing and expressing anger. Women in the breast cancer group described themselves as timid, non-assertive, non-competitive, calm, easy going and as keeping anger inside.