Psycho-Oncology Psycho-Oncology 19: 839–846 (2010) Published online 23 September 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.1623 ‘Why I feel bad’: refinement of the Effects of Prostate Cancer Upon Lifestyle Questionnaire and an initial exploration of its links with anxiety and depression among prostate cancer patients Christopher F. Sharpley 1Ã , Vicki Bitsika 2 and David R. H. Christie 3 1 University of New England, New South Wales, Australia 2 Bond University, Queensland, Australia 3 Premion, Queensland, Australia Abstract Objective: To psychometrically refine a standardized scale for identifying those lifestyle changes that were most likely to contribute to anxiety and depression among prostate cancer (PCa) patients. Methods: Three hundred and eighty-one PCa patients who had received their initial diagnosis between one and 96 months completed a survey of background variables, anxiety and depression inventories and the 36-item Effects of Prostate Cancer upon Lifestyle Questionnaire (EPCLQ). Results: Levels of anxiety (24%) and depression (26%) were similar to those previously reported for PCa patients. The EPCLQ was shown to have satisfactory psychometric properties and significantly predicted anxiety and depression scores and the presence of psychological clinicity among this sample. Factor analysis of the EPCLQ showed that adverse emotions and social withdrawal, plus loss of cognitive ability, were the most powerful predictors of fear, physiological arousal, discomfort and pain factors underlying anxiety; these factors also predicted pessimism and fatigue factors underlying depression. Conclusions: The EPCLQ was shown to be a reliably sound and valid instrument for assessing important lifestyle changes that predict anxiety and depression among PCa patients. In addition, links between receiving a diagnosis and treatment for PCa and development of psychosocial disturbance via emotional negativity, decreased cognitive performance and withdrawal from others appear to warrant further investigation. Copyright r 2009 John Wiley & Sons, Ltd. Keywords: cancer; anxiety; depression; oncology; lifestyle Anxiety and depression among men suffering from prostate cancer (PCa) is elevated compared to age- relevant peers [1–9], with between 65 and 89% of PCa patients expressing a desire for psychosocial assistance [10,11]. Unfortunately, in most instances distress from cancer goes unrecognized [12], reducing the effectiveness of patients’ treatment decisions [13] and arguing for the early identification of psycholo- gically ‘at-risk’ PCa patients. While explorations of which PCa patients develop psychological distress have included measures of personality [14] and early identification of low levels of psychological distress [15], most PCa patients are older men [16] and it may be that the general personality measures are not always relevant. Similarly, measurement of low levels of psychological distress is done after the develop- ment of those symptoms. One model of anxiety and depression which has been shown to not only predict the development of the clinical symptomatology of anxiety and depres- sion but which also may be applied before the onset of those symptoms is that which conceptualizes anxiety and depression as stages in an adaptive response to threat [17–19]. That model posits that anxiety symptomatology [20] may be conceptualized as the individual’s sympathetic nervous system (SNS) arousal response [21] aimed at physically removing the organism from threat (in the case of PCa patients, the threat of death). Depression symptoms [20] represent similar cognitive, emotional, physiological and behavioral withdrawal responses designed to lessen the aversive effects of the PCa diagnosis, treatment and sequelae which cannot be reduced or avoided by SNS arousal. This withdrawal process * Correspondence to: University of New England, New South Wales, P.O. Box 378, Coolangatta, Qld, 4225, Australia. E-mail: csharpley@onthenet.com.au Received: 8 March 2009 Revised: 21 May 2009 Accepted: 13 July 2009 Copyright r 2009 John Wiley & Sons, Ltd.