Research report Combined anxiety and depressive symptoms before diagnosis of breast cancer Lotje Van Esch a , Jan A. Roukema a, b , Miranda F. Ernst c , Grard A.P. Nieuwenhuijzen d , Jolanda De Vries a, e, ⁎ a CoRPS — Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands b Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands c Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands d Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands e Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands article info abstract Article history: Received 28 June 2011 Received in revised form 12 September 2011 Accepted 12 September 2011 Available online xxxx Purpose: To determine the relationship between pre-diagnosis state anxiety, depressive symp- toms, and combined state anxiety and depressive symptoms (CADS) with quality of life (QOL), fatigue, state anxiety and depressive symptoms one and two years after surgery in women with breast cancer. Methods: Women with breast problems referred to a Dutch outpatient clinic were recruited for the study. Participants (N = 428) completed a set of questionnaires before diagnosis (Time0) and the women with breast cancer subsequently received questionnaires at 12 (Time1) and 24 months (Time2) after surgical treatment. The questionnaire set consisted of questionnaires on demographics, state anxiety, depressive symptoms, fatigue, QOL, neuroticism, and trait anxiety. Chi-square tests, independent samples T-tests, and multivariate linear regression an- alyses were used to do the analyses. Results: Before their diagnosis of breast cancer, 111 women (28%) had CADS. Of the CADS- group, a higher percentage had elevated levels of anxiety, depressive symptoms, and CADS at all follow-up moments than of the non-CADS-group. CADS-score at before diagnosis and neuroticism were the most important predictors of outcome measures at Time1 and Time2. Conclusions: More than one in four women, who later received the diagnosis breast cancer, had elevated levels of both state anxiety and depressive symptoms (CADS) just before diagnosis. This factor was also a major predictor of QOL, state anxiety, depressive symptoms, and fatigue 12 and 24 months after surgery. This implies that women with a higher score on both state anxiety and depressive symptoms should be identified as soon as possible in the process of di- agnosis and treatment of breast cancer using validated questionnaires or screening instru- ments. Only by identifying this group of patients, tailored psychological care can be accomplished. © 2011 Published by Elsevier B.V. Keywords: Breast cancer Anxiety Depressive symptoms Personality Quality of life 1. Introduction In Europe, breast cancer incidence has increased from 76 per 100,000 inhabitants in 1995 to 88 per 100,000 inhabitants in 2008. Mortality, however, decreased from 27.3 per 100,000 inhabitants in 1995 to 24.3 per 100,000 inhabitants in 2008 (Bray et al., 2002; Ferlay et al., 2010), resulting in a growing group of breast cancer survivors every year. Journal of Affective Disorders xxx (2011) xxx–xxx ⁎ Corresponding author at: Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands. Tel.: + 31 134662705; fax: + 31 134662067. E-mail addresses: J.devries@uvt.nl, jvries@elisabeth.nl (J. De Vries). JAD-05231; No of Pages 7 0165-0327/$ – see front matter © 2011 Published by Elsevier B.V. doi:10.1016/j.jad.2011.09.012 Contents lists available at SciVerse ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Please cite this article as: Van Esch, L., et al., Combined anxiety and depressive symptoms before diagnosis of breast cancer, J. Affect. Disord. (2011), doi:10.1016/j.jad.2011.09.012