Bianca Hund1,2, Katrin Reuter2, Martin Härter3, Elmar Brähler4,5, Hermann Faller6, Monika Keller7, Holger Schulz3, Karl Wegscheider8, Joachim Weis9, Hans-Ulrich Wittchen10, Uwe Koch3, Michael Friedrich4, Anja Mehnert4. 1. Rhein-Jura-Klinik, Bad Säckingen, Germany. 2. Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany. 3. Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany. 5. Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Germany. 6. Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany. 7. Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine, University Hospital Heidelberg, Heidelberg, Germany. 8. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 9. Department of Psychooncology, Tumor Biology Center, University of Freiburg, Freiburg, Germany. 10. Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technical University Dresden, Dresden, Germany.
Abstract
BACKGROUND: We aimed to investigate type and frequency of stressors, predominant symptom profiles, and predictors of adjustment disorders (AD) in cancer patients across major tumor entities. METHODS: In this epidemiological study, we examined 2,141 cancer patients out of 4,020 screened with the Composite International Diagnostic Interview, adaptation for oncology (CIDI-O). AD were operationalized as subthreshold disorders according to DSM-IV criteria. RESULTS: In our sample, 265 out of 2,141 patients (12.4%) met all criteria for AD (unweighted 4-week prevalence). The disclosure of the cancer diagnosis, relapse or metastases, and cancer treatments were most frequently described as stressors associated with depressive or anxious symptoms. With regard to AD symptom profiles, patients showed high prevalence rates of affective symptoms according to the DSM-IV criteria of Major Depression: The highest prevalence rates were found for cognitive disturbances (concentration and memory problems) (88%), sleeping disturbances (86%), and depressive mood (83%). We found sex, education, and metastasis as significant predictors for AD. Higher education was the most influential predictor. Men were half as likely to report symptoms fulfilling the AD criteria as women. Patients with metastasized tumors had a more than 80% higher risk of AD than those without metastasis. However, the explained variance of our model is very small (Nagelkerke's R² = 0.08). CONCLUSIONS: Patients with AD can be identified using a standardized instrument and deserve clinical attention, as they often show severe clinical symptoms and impairments. Improving the clinical conceptualization of AD by the adding-on of potential stress-response-symptoms is necessary to identify severe psychological strain.
BACKGROUND: We aimed to investigate type and frequency of stressors, predominant symptom profiles, and predictors of adjustment disorders (AD) in cancerpatients across major tumor entities. METHODS: In this epidemiological study, we examined 2,141 cancerpatients out of 4,020 screened with the Composite International Diagnostic Interview, adaptation for oncology (CIDI-O). AD were operationalized as subthreshold disorders according to DSM-IV criteria. RESULTS: In our sample, 265 out of 2,141 patients (12.4%) met all criteria for AD (unweighted 4-week prevalence). The disclosure of the cancer diagnosis, relapse or metastases, and cancer treatments were most frequently described as stressors associated with depressive or anxious symptoms. With regard to AD symptom profiles, patients showed high prevalence rates of affective symptoms according to the DSM-IV criteria of Major Depression: The highest prevalence rates were found for cognitive disturbances (concentration and memory problems) (88%), sleeping disturbances (86%), and depressive mood (83%). We found sex, education, and metastasis as significant predictors for AD. Higher education was the most influential predictor. Men were half as likely to report symptoms fulfilling the AD criteria as women. Patients with metastasized tumors had a more than 80% higher risk of AD than those without metastasis. However, the explained variance of our model is very small (Nagelkerke's R² = 0.08). CONCLUSIONS:Patients with AD can be identified using a standardized instrument and deserve clinical attention, as they often show severe clinical symptoms and impairments. Improving the clinical conceptualization of AD by the adding-on of potential stress-response-symptoms is necessary to identify severe psychological strain.
Authors: F E Van Beek; L M A Wijnhoven; J A E Custers; K Holtmaat; B H De Rooij; N J E Horevoorts; E J Aukema; S Verheul; S E J Eerenstein; L Strobbe; I M Van Oort; M R Vergeer; J B Prins; I M Verdonck-de Leeuw; F Jansen Journal: Support Care Cancer Date: 2021-10-02 Impact factor: 3.603