Original article Associated factors with psychological distress in Moroccan breast cancer patients: A cross-sectional study Soufiane Berhili a, *, 1 , Selma Kadiri a, 1 , Amal Bouziane b , Abdallah Aissa a , Elamin Marnouche a , Etienne Ogandaga a , Yassine Echchikhi a , Asmae Touil a , Hasna Loughlimi a , Ibtissam Lahdiri a , Sanae El Majjaoui a , Hanan El Kacemi a , Tayeb Kebdani a , Noureddine Benjaafar a a Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco b Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine, Department of Periodontology, Faculty of Dental Medicine, Mohammed V University, Rabat, Morocco article info Article history: Received 7 June 2016 Received in revised form 11 October 2016 Accepted 15 October 2016 Keywords: Breast cancer Psychological distress HADS Distress thermometer Depression Anxiety Associated factors abstract Objectives: To estimate the prevalence of psychological distress (PD) in Moroccan breast cancer patients, and to determine clinical and social demographic factors associated with PD. Methods: It was a cross-sectional study where we included all female breast cancer patients that did not have other malignancies. Judgment criteria were based on the Hospital Anxiety and Depression Scale (HADS), and the Distress Thermometer (DT). Threshold values of 15 and 3 were fixed to detect patients on PD by the HADS and the DT, respectively. We analyzed data by calculation of Cronbach's alpha co- efficient for the reliability of measurements, and by simple and multiple logistic regressions. Results: 446 women were enrolled. Cronbach's alpha coefficient was 0.801, 0.669 and 0.639 respectively for the HADS, HAD-A and HAD-D questionnaires. 120 patients (26.9%) had a HADS global score 15. HAD-A and HAD-D sub-scores were 11 in 25 (5.6%) and 30 (6.7%) patients respectively. In multivariate analysis, adjusted for the education level, marital status, taking analgesic and/or anxiolytic treatment, and current treatment type; we found that the occurrence of a distant metastasis [OR ¼ 14.427 p < 0.001], lack of social family support [OR ¼ 4.631 p < 0.001], living a difficult emotional [OR ¼ 2533 p ¼ 0.034] and/or financial [OR ¼ 2.09 p ¼ 0.037] situation, and younger (<50 years) age [OR ¼ 2.398 p ¼ 0.002], were independent associated factors with PD as assessed by the HADS. Conclusions: Social family support, emotional and financial difficulties should be investigated in all Moroccan breast cancer patients, especially among younger ones, in order to detect those at risk of PD and offer them appropriate support. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction Living with chronic medical conditions is largely associated with psychological disorders, and cancer is a typical example of increased need for psychological support [1,2]. The term “distress” was defined by the US National Cancer Center Network (NCCN) as a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treat- ment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis [3]. Cancer is percieved by the patient as a serious lifethreatening disease, and even as a deadly illness without a specific treatment, which has an effect on his psychological and physiological states [1]. Understanding how these consequences interfere with the daily life and well-being of cancer patients is becoming an issue of growing concern, not only for the patients themselves and their families, but also for caregivers and policy makers in the hope of promoting the management strategies and the quality of care in oncology. * Corresponding author. PO Box 3099, Bettana, Rabat-Sal e, 11000, Morocco. E-mail address: berhili.soufiane@gmail.com (S. Berhili). 1 SB and SK contributed equally to this work. Contents lists available at ScienceDirect The Breast journal homepage: www.elsevier.com/brst http://dx.doi.org/10.1016/j.breast.2016.10.015 0960-9776/© 2016 Elsevier Ltd. All rights reserved. The Breast 31 (2017) 26e33