Predicting psychological morbidity in Chinese women after surgery for breast carcinoma

BACKGROUND. Between 30% and 70% of western women experience psychological morbidity after undergoing surgery for breast carcinoma; however, the rates and risk factors among Chinese women are unknown. Identifying at-risk women enables preventive intervention. METHODS. Among 430 Chinese women who were approached within 1 week after undergoing surgery for early-stage breast carcinoma (baseline), 405 women (94%) completed measures of self-efficacy and psychological morbidity (the Chinese Health Questionnaire 12-item instrument [CHQ12]) and completed retrospective measures of treatment decision-making (TDM) difficulties, satisfaction with TDM involvement, and satisfaction with consultation and treatment outcome expectations. One-month postsurgery follow-up (follow-up), CHQ12 scores for 367 of 405 women (91%) were adjusted for concurrent physical symptom distress and trait optimism (the revised Chinese Life Orientation Test) and baseline predictors using stepwise multivariate regression. RESULTS. At baseline 28% of women evidenced mild psychological morbidity, and 42% of women evidenced moderate-to-severe psychological morbidity: At follow-up, the respective rates were 32% and 36%. Preferred TDM involvement was associated with lower psychological morbidity (F = 6.702; P < 0.001). Baseline CHQ12 scores were predicted by outcome expectancies and TDM difficulties (adjusted regression coefficient [R-2] = 0.192). Baseline CHQ12 scores and follow-up chemotherapy, in turn, predicted physical symptom distress at follow-up. After adjustment, high physical symptom distress, baseline psychological morbidity, low optimism, and no chemotherapy independently predicted follow-up CHQ12 scores (adjusted R2 = 0.585). CONCLUSIONS. Psychological morbidity was linked to women's TDM difficulties, their inability to anticipate treatment effects accurately, and physical symptom distress, possibly exacerbated by symptom misattribution. Optimizing TDM support and helping women accurately determine outcomes in terms of symptom experience and meaning and physical appearance may help to reduce psychological morbidity. Women who have TDM difficulties should be considered to be at high risk for psychological distress. (C) 2004 American Cancer Society.