Probable Cases Of Anxiety Research Articles

Quality of life among caregivers of patients with severe mental illness in northwest Ethiopia, 2022: an institutional-based cross-sectional study.

Severe mental illness has negative consequences not only for the person suffering from it but also for their caregiver's quality of life and the community in which they reside. These impacts could be particularly visible in low- and middle-income countries, where the treatment gap for mental illnesses is particularly high. There is a dearth of evidence in Ethiopia. This study aims to assess the quality of life and its associated factors among caregivers of patients with severe mental illness at Felege Hiwot and Tibebe Ghion Compressive Specialized Hospital, Bahir Dar, Northwest Ethiopia, in 2022. An institution-based cross-sectional study design was conducted at Felege Hiwot and Tibebe Ghion Compressive Specialized Hospitals from 13 June to 13 July 2022. A systematic random sample technique was utilized to select 469 study participants. The World Health Organization quality of life-BREF questionnaire was utilized to assess quality of life, and perceived stigma was measured through a family interview schedule questionnaire. The data were gathered using the epicollect5 software with a face-to-face interview method and then exported to SPSS-25. Simple and multiple linear regression analyses were conducted to identify associated factors of quality of life for variables that are statistically significant (p-value< 0.05) with B-coefficients and a 95% CI. Descriptive statistics were used to describe the outcome and predictor variables. A total of 456 respondents participated, with a response rate of 97.2%. The result showed that the mean quality-of-life score of caregivers of patients with severe mental illness for each domain (mean ± standard deviations) was between 46.5 ± 18.7 and 51.2 ± 19.9, with the worst score of zero in the environmental domain and 94 in the social domain. In multiple regression, living in a rural area (B = -5.2; 95% CI, -8.9, -1.8), being illiterate (B = -7.2; 95% CI, -10.6, -3.7), having chronic medical illness (B = -5.2; 95% CI, -8.6, -1.7), having probable cases of anxiety (B = -6.9, 95% CI, -10.5, -13.3), having probable cases of depression (B = -4.9; 95% CI, -8.2, -1.7), and the presence of perceived stigma (B = -7.9; 95% CI, -11.2, -4.77) were significantly associated with the overall quality of life. This analysis suggests that the identified factors can predict over 40% of the variability in overall quality of life scores for caregivers. The quality of life of caregivers of patients with severe mental illness was found to be low. Living in a rural area, being illiterate, having chronic medical illnesses, having probable cases of anxiety and depression, and being stigmatized were negatively associated with the overall quality of life. The findings indicate the necessity for health professionals, the government, and other concerned bodies to pay more attention to caregivers' quality of life.

Impact of Early-stage Relapsing Remitting Multiple Sclerosis on Quality of Life (P13-3.006)

Impact of Early-stage Relapsing Remitting Multiple Sclerosis on Quality of Life (P13-3.006)

Association between screen time exposure, anxiety, and sleep quality in adolescents

Introduction. The increase in sedentary screen time can negatively affect the quality of sleep, impacting the performance of daily activities. Objective. To analyze the association between sedentary screen time and sleep quality, regardless of the symptoms of anxiety in adolescents of both genders. Method. Cross-sectional study integrating school-based epidemiological research with a representative sample (n = 666) of high school students (14 to 19 years old) in public schools in the municipality of Caruaru-PE. The translated versions into Portuguese of the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HAD) were applied to analyze sleep quality and anxiety, respectively. Binary logistic regression was used to analyze the association, considering sleep quality as an outcome. Results. There was a positive, statistically significant (p #abr# .001) correlation between sleep quality and symptoms of anxiety (r = .393). A significant association regarding the association between screen time and sleep quality was noted only in those adolescents classified as being possible or probable anxiety cases and only in exposure to the computer (OR = 2.337; 95% CI [1.01, 5.43]) and video games (OR = 8.083; 95% CI [2.0, 32.8]) after adjusting for gender, age, and school shift. Discussion and conclusion. Increased interaction with the screen and higher levels of anxiety can be more harmful to sleep in adolescents. Exposure to screen time, specifically those which have a greater interaction such as video games and computers, can have a negative impact on sleep quality, but only in adolescents with a higher risk of anxiety.

Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study.

Background: The COVID-19 pandemic has induced demanding work situations in intensive care units (ICU). The objective of our study was to survey psychological reactions, the disturbance of social life, work effort, and support in ICU nurses, physicians, and leaders. Methods: From May to July 2020, this cross-sectional study included 484 ICU professionals from 27 hospitals throughout Norway. Symptoms of anxiety and depression were measured on Hopkins Symptom Checklist-10 (HSCL-10). Symptoms of post-traumatic stress disorder (PTSD) were measured on the PCL-5. Results: The study population were highly educated and experienced professionals, well prepared for working with COVID-ICU patients. However, 53% felt socially isolated and 67% reported a fear of infecting others. Probable cases of anxiety and depression were found in 12.5% of the registered nurses, 11.6% of the physicians, and 4.1% of the leaders. Younger age and <5 years previous work experiences were predictors for high HSCL-10 scores. Reported symptom-defined PTSD for nurses 7.1%; the leaders, 4.1%; and 2.3% of physicians. Conclusions: ICU health care professionals experienced talking with colleagues as the most helpful source of support. The COVID-ICU leaders reported a significantly higher mean score than physicians and nurses in terms of pushing themselves toward producing high work effort.

Risk factors for mental health symptoms during the COVID-19 pandemic in ophthalmic personnel and students in USA (& Canada): a cross-sectional survey study

BackgroundThe COVID-19 pandemic poses mental health challenges to frontline healthcare workers. Eye care professionals may be especially susceptible to mental health problems due to high-risk exposures to patients. Yet, no prior research has studied mental health issues among eye care professionals during the COVID-19 pandemic.ObjectiveThe purpose of this study was to identify risk factors for mental health problems during the COVID-19 pandemic among eye care professionals.MethodsWe conducted a cross-sectional survey study among eye care professionals and students in the United States and Canada from June 23 to July 8, 2020 during the COVID-19 pandemic. A total of 8505 eye care professionals and students received email invitations to the survey and 2134 participated. We measured mental health outcomes including symptoms of depression, anxiety, and stress using validated scales, as well as potential risk factors including demographic characteristics, state-level COVID-19 case counts, participants’ patient interactions, childcare responsibilities, and pre-pandemic stress levels. Linear multiple regression and logistic regression analyses were used to determine relationships between risk factors and mental health outcomes.ResultsWe found that 38.4% of eyecare professional participants in the survey met screening threshold as probable cases of anxiety, depression, or both during the COVID-19 pandemic. Controlling for self-reported pre-pandemic stress level and state COVID-19 case daily cases, significant risk factors for depression, anxiety, and psychological stress during the COVID-19 pandemic included: being female, younger age, and being Black or Asian. Interestingly, we found two somewhat surprising protective factors against depression symptoms: more frequent interactions with patients and having a greater proportion of childcare responsibilities at home.ConclusionsThis study showed a high prevalence of mental health problems and revealed disparities in mental health among eye care personnel and students: Female, younger, Black, and Asian populations are particularly vulnerable to mental health issues. These results indicate that it is critical to identify mental health issues more effectively and develop interventions among this population to address this significant and growing public health issue. The strategies and policies should be reflective of the demographic disparities in this vulnerable population.

Pandemic anxiety stress scale for pregnant women(PASSP): Development and validation

Introduction Coronavirus disease (COVID-19) is a new pandemic caused by a newly discovered coronavirus. This pandemic has caused increase in anxiety among people globally and more the pregnant women. Elevated levels of anxiety and stress may adversely affect the outcome. Aim & Objective: This study aimed at developing and validating a tool to assess the stress and anxiety due to pandemic which helps the health care professionals to identify the probable cases of anxiety associated with the coronavirus and can take adequate measures to improve the emotional well-being of the antenatal women. Methods & Material: A cross-sectional survey was carried out among the pregnant women in Kerala using a 29-itemtool through google forms during the month of June. Statistical Analysis: Item analysis, Exploratory factor analysis and confirmatory factor analysis were done to evaluate scale dimensionality, factor loadings, and factor structure using the R Software version 4.0.2. Results: Factor analysis resulted in a 15-item short tool, Pandemic anxiety stress scale for pregnant women (PASSP) with the reliably index of Cronbach’s alpha of 0.93. Exploratory factor analysis extracted two factors. Confirmatory factor analysis confirmed the factor structure of the PASSP with Goodness of fit indices. Two factor model structure has good fit indices with GFI>0.90, DFI and TLI>0.95 and SRMR =0.04. Discussion: This study developed a new validated instrument PASSP for assessing the anxiety and stress due to a pandemic among pregnant women in Kerala. Keywords: COVID19, anxiety, pandemic, pregnancy, tool validation, factor analysis.

Quality of life and psychological distress during cancer: a prospective observational study involving young breast cancer female patients

BackgroundDespite the possible traumatic significance of cancer and of the incidence, prevalence, and survival of young women with breast cancer, these patients are underrepresented in multidimensional research. In the present survey, QoL and psychological distress were studied in a sample of young female breast cancer patients during the first year of their disease. More in detail, the study was firstly aimed to assess if QoL of 18–45 years old female breast cancer patients was different from QoL of women from the general population and if it changed over time. Secondly, it described the psychological distress and its change over time. Finally, it assessed if QoL registered 1 year post-surgery may be explained by QoL and/or psychological distress registered during the hospitalization.MethodsOne hundred six, consecutive 18–45 years old, female primary breast cancer patients undergoing anticancer surgery filled out the Short Form 36 Health Survey Questionnaire, the Hospital Anxiety and Depression Scale and a socio-demographic and clinical form during hospitalization to receive surgery (T0), and again at 12 months post-surgery (T1).ResultsAt T0, participants showed a better physical functioning (p = 0.001) than the female normative sample, whereas their mental functioning was worse (p < 0.001). In this time, mental functioning within our sample was weaker than physical functioning (p < 0.001). Over time, physical functioning decreased (p < 0.001), whereas mental functioning increased (p < 0.001). Both at T0 and T1, anxiety was higher than depression (p < 0.05). Both distress dimensions decreased over time (p < 0.001). Nevertheless, at T0 the 25.5 and 26.4% of the sample were respectively possible and probable cases of anxiety, whereas the 17.9 and 9.4% were possible and probable cases of depression. At T1, the percentages were 17.9 and 18.9% for anxiety, and 8.5 and 6.6% for depression. In both considered times, a better QoL corresponded to less psychological distress. However, QoL and psychological distress assessed at T0 did not predict the QoL at T1.ConclusionsThis study documented as QoL and psychological distress may change during the first year after surgery for a primary breast cancer in young women; therefore, they should be monitored over time to detect and treat women with alarming levels on them.

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.

ASSOCIATION OF PSYCHOSOCIAL FACTORS WITH ANXIETY AND DEPRESSION IN PATIENTS FOLLOWING ACUTE MYOCARDIAL INFARCTION

Background: Anxiety and depression are proven independent predictors of mortality, disability, and reduced health related quality of life (HRQoL). Hence, this study was undertaken with aim to find the prevalence of anxiety and depression in patients following acute myocardial infarction (AMI) and to find out its association with various psychosocial factors.Methods: Stable patients admitted during 3 month period in Cardiology Intensive care unit of tertiary care Hospital with the diagnosis of acute myocardial infarction were included in this cross sectional study. Data was collected using a Semi- structured questionnaire. Anxiety and depression were assessed using Hospital Anxiety and Depression Scale (HADS) .Scores were analyzed using SPSS version 16.Results: A total of 75 patients (73.3% men and 26.7% women) with mean age 54.86 ± 9.91 years were included. Mean scores of anxiety and depression were 4.49 and 4.0 out of 21, respectively. Probable cases of anxiety and depression as per HADS were 29.33% and 21.33% respectively. There was a statistically significant association of Anxiety and depression with gender (P= 0.004(A), P= 0.002(D); education [P=0.018(A), P= 0.002 (D)]; and pre-existing known stressor [P=<0.001 (A) and P=0.002(D)]. The association of anxiety and depression with age, addiction, presence of co-morbidies and previous history of AMI / stroke was not statistically significant.Conclusion: Anxiety and depression are common after AMI. It was seen more in females, low literacy and those with pre-existing known cause of stress (stressor). Hence, psychological screening should be incorporated in routine assessment in patients with AMI during hospitalization to plan early intervention that could potentially improve recovery pattern.

The prevalence of anxiety and depression among end-stage renal disease patients on hemodialysis in Saudi Arabia

Depression commonly overlaps with uremic symptoms, but anxiety is less commonly studied among renal patients. The symptoms of medical illness, along with the psychological and social stresses that often accompany a debilitating chronic disease, are thought to produce deleterious psychological consequences. We sought to determine the prevalence and predictors of anxiety and depression among Saudi dialysis patients in Makkah. A cross-sectional study of anxiety and depression among end-stage renal disease (ESRD) patients in Makkah was conducted in November 2011. The Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. Participants’ demographic data, possible stressors and past psychiatric history were obtained. All participants were Saudi ESRD patients on maintenance hemodialysis. According to HADS, 57 (21.1%) patients were probable cases of anxiety and 63 (23.3%) were probable cases of depression. Only 32 (11.3%) were diagnosed with depression or anxiety before ESRD onset. Age was a significant predictor of anxiety and depression diagnoses. Major family problems (p = 0.001) were also a significant predictor of anxiety. Anxiety and depressive symptoms are prevalent among ESRD patients in Makkah, and anxiety can be predicted by family factors. Early detection, management and family support might improve clinical outcomes.

FRI0463 Factors associated with anxiety and depression in spondyloarthritis patients: results from the swedish population based spa scania cohort

BackgroundAnxiety and depression are more common among patients with rheumatic diseases and can influence treatment options and outcome. However insight in factors associated with anxiety and depression in patients with...

Use and need for psychosocial support in cancer patients

Cancer patients and their minor children have been shown to experience psychological distress. The objectives of the current study were to 1) describe the need for and use of psychosocial support and 2) determine predictors of family-centered support use in patients with minor children. A population-based sample of 1809 patients was recruited via 2 cancer registries. The eligibility criteria were age 25 years to 55 years, an initial diagnosis received no longer than 6 years before this survey, and having at least 1 minor child. Medical characteristics and self-report measures were used. Overall, approximately 38% cases were identified as being borderline or probable anxiety cases and 16% were identified as being borderline or probable depression cases. Since diagnosis, 44% of the patients had used psychosocial support and 9% had received family-focused and child-focused support. These patients perceived a lower quality of life and poorer family functioning. Approximately 73% of patients with children wanted information concerning or psychosocial services to support their children or parenting. Use of family-centered support was not found to be predicted by disease-related factors (eg, cancer staging) but rather by subjective needs (eg, mental health and having a distressed child in the family). The results of the current study emphasize the importance of child and parenting concerns in psychosocial care in oncology. Screenings for children and appropriate training programs for health care may increase awareness of this issue.

Use of the Hospital Anxiety and Depression Scale (HADS) in a Cardiac Emergency Room – Chest Pain Unit

OBJECTIVETo determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance.INTRODUCTIONPatients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis.METHODOLOGYPatients were assessed by the “Hospital Anxiety and Depression Scale” as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered “probable case” of anxiety or depression.RESULTSAccording to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression.CONCLUSIONThe high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient’s quality of life.

Ansiedade e depressão em familiares de pacientes internados em unidade de cuidados intensivos

OBJETIVO: Identificar a ocorrência de sintomas de ansiedade e/ou depressão em familiares de pacientes internados em uma unidade de cuidados intensivos e correlacionar a presença desses sintomas com o sexo e idade de familiar e com o tempo de internação dos pacientes. MÉTODOS: Fizerem parte da amostra 39 familiares de pacientes em estado crítico de saúde. Para coleta de dados foi utilizada a Escala Hospitalar de Ansiedade e Depressão. RESULTADOS: Foram identificados 11 (28,2%) possíveis casos de ansiedade, 17 (43,6%) prováveis casos de ansiedade, 14 (35,9%) possíveis casos de depressão e 7 (17,9%) prováveis casos de depressão. CONSIDERAÇÕES FINAIS: O suporte emocional e a satisfação das necessidades dos familiares devem ser prioridades no plano de assistência de enfermagem, de forma a prevenir esses transtornos.

The effect of depression on survival in patients with newly diagnosed advanced non-small cell lung cancer (NSCLC)

8511 Background: The impact of emotional distress on cancer-related mortality is unclear. Divergent results in studies are due, in part, from heterogeneous populations in terms of type of cancer, stage of disease, and time of emotional assessment. This study examined the effect of depression and anxiety on a well-defined cohort of patients with newly diagnosed advanced NSCLC. Methods: 46 patients with advanced NSCLC were recruited within eight weeks of diagnosis to participate in a feasibility study of early palliative care. Participants completed the Hospital Anxiety and Depression Scale (HADS) at baseline and were followed for six months. The primary study endpoint was survival at six months. The effects of depression and anxiety were evaluated first by Kaplan-Meier survival analysis and then by Cox regression to control for other variables. Results: Three patients (6%) had stage IIIB with effusions and the remaining 43 (93%) had stage IV disease. The median age of patients was 65.5 years and 28 of the 46 (61%) were women. 34 patients had a PS 1 (74%), 11 (24%) had PS 0 and one (2%) had PS 2. 96% of the patients completed the baseline HADS. 23% met HADS criteria for probable cases of depression (8 or greater) at baseline and 34% met HADS criteria for probable cases of anxiety (8 or greater). Using Kaplan-Meier survival analysis, patients with depression were less likely to have survived at 6 months than non-depressed patients (50% versus 80%, log rank p=0.01). Baseline anxiety did not appear to impact survival. Using Cox proportional hazard regression analyses to control for stage, ECOG performance status, age, and gender, the effect of depression remained significant at p=0.03. Conclusion: Depression in newly diagnosed advanced NSCLC patients was associated with inferior survival in this well-defined patient population. Conversely, anxiety did not appear to be associated with mortality. These findings strengthen the argument that emotional distress influences survival. Larger prospective studies are needed to confirm this conclusion, explore possible mediators, and investigate the effects of treatment for depression. No significant financial relationships to disclose.

Psychiatric morbidity and cognitive representations of illness in chronic daily headache

Objectives We studied patients with chronic daily headache (CDH) attending a headache clinic. Our hypothesis was that patients with anxiety or depression would have poorer functional status and differing cognitive representations of illness than would those without psychiatric morbidity. Methods The sample consisted of 144 consecutive new patients. Patients underwent a semistructured interview and completed a prospective headache diary, the Hospital Anxiety and Depression Scale (HADS) and other health-related questionnaires. Results Sixty patients (42%) were probable cases of anxiety or depression on the basis of their HADS score. These HADS-positive cases had longer, more severe headaches, were more worried about them, were more functionally impaired and believed that their illness would last longer. Principal components analysis revealed that the HADS-positive cases believed that psychological factors play a role in their headaches. Conclusions Psychological morbidity is high amongst CDH patients who attend specialist clinics. In addition to identifying those with high levels of psychological distress, the HADS can be used to predict those likely to have worse headaches and poorer functional ability.

Identifying the concerns of women undergoing chemotherapy

This cross-sectional study aimed to identify key concerns of cancer patients receiving in-patient chemotherapy, determine the prevalence of anxiety and depression, and assess whether ward nurses could identify patients’ concerns. Thirty-three women on a chemotherapy ward in the northwest of England who had breast, ovarian, cervical or uterine cancer were interviewed using a Concerns Checklist and the Hospital Anxiety and Depression Scale. Patients expressed an average of 10.3 concerns (range: 2–27). Eighty percent of these were not identified by the nurses, who showed a clear bias towards physical symptoms and treatment-related concerns. The nurses were unable to identify the three main concerns in 70% of patients. Twenty-four percent of patients were found to be probable cases of anxiety and/or depression; there was a moderate correlation between the number of concerns and levels of anxiety and depression. Given the body of evidence that lack of identification of concerns leads to unmet needs, increased psychological distress, dissatisfaction with care and possible complaints, this study has provided clear evidence for the need to address this key area of care, and has highlighted the potential of the Concerns Checklist in busy clinical environments.

Depression and anxiety as predictors of outcome after myocardial infarction.

The objective of this study was to investigate the significance of emotional distress immediately after a myocardial infarction as a predictor of physical, psychological, and social outcomes and resource use. In an epidemiological survey, demographic and cardiological data were obtained for all patients from a defined geographical area who had had a myocardial infarction (according to diagnostic criteria of the Monitoring Trends and Determinants in Cardiovascular Disease [MONICA] trial). Hospital survivors were interviewed and were asked to complete self-report assessments on mental state and quality of life. Full replies were available at baseline for 347 subjects. Self-report follow-up questionnaire information was collected 3 months and 1 year later. Fifteen percent of patients scored as probable cases of anxiety or depression. They were more likely than noncases to report preinfarct distress and poor adjustment (as indicated on the 36-item Medical Outcome Study short form). There was an improvement at 3 months, but there was little overall or individual change after that time. Anxiety and depression did not predict subsequent mortality but did significantly predict poor outcome at 1 year on all dimensions of the 36-item short form quality-of-life measure and on specific measures of everyday activity and reports of chest pain, use of primary care resources, and secondary prevention lifestyle changes. Subjects who are distressed in the hospital are at high risk of adverse psychological and quality-of-life outcomes during the ensuing year. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and anxiety after myocardial infarction.

Psychiatric disorder in patients with advanced breast cancer: Prevalence and associated factors

The prevalence of psychiatric disorder and associated factors has been examined in 139 women with advanced breast cancer. Patients completed a self-report assessment of mood, the Hospital Anxiety and Depression Scale (HAD). They were also interviewed to obtain sociodemographic details, UICC performance status and past psychiatric history. Overall, 35 (25%) scored 11 or above (out of a maximum of 21) on either the anxiety or the depression subscales, or both, of the HAD and were therefore probable cases of anxiety and/or depression. These patients are likely to benefit from psychosocial intervention. Clinical anxiety was unrelated to any sociodemographic or disease related factors. Clinical depression was significantly more prevalent amongst patients in the lower socioeconomic classes (P = 0.01) and those with poor performance status (P = 0.007). Depression can be difficult to detect in patients with advanced breast cancer and these factors may be useful indicators to clinicians of patients at high risk of this disorder.