Depression, anxiety, and stress in breast cancer patients: prevalence, associated risk factors, and clinical correlates

Abstract

Abstract Overall, the prevalence and determinants of various forms of psychological distress such as depression and anxiety in breast cancer (BC) patients exhibit conflicting results, with some factors underexplored. The present study aimed to assess the prevalence and determinants of depression, anxiety, and stress among BC patients. This cross-sectional study assessed depression, anxiety, and stress in BC patients in Mazandaran, Iran, using the DASS-21 questionnaire, which showed high reliability (Cronbach’s alpha: 0.83–0.90). Data were collected via phone interviews and web-based surveys, and analyzed using SPSS software version 27. Demographic, clinical, and socioeconomic determinants were evaluated via logistic regression. This study included 283 BC patients, predominantly aged 40–44 (34.3%), married (95.4%), unemployed (73.9%), and urban residents (76.7%). Most patients received chemotherapy (94.3%), with 30.4% at Stage 1 and 43.1% Grade 2 tumors. Depression, anxiety, and stress prevalence were high (46.6%, 56.9%, and 51.9%, respectively). Key determinants included the absence of second-degree BC family history (linked to higher depression and stress, ORs: 1.86 and 2.15), urban living (higher depression and stress, ORs: 3.06 and 2.19), inadequate income (higher depression and stress, ORs: 2.62 and 1.94), and mastectomy (higher depression and stress, ORs: 3.28 and 1.90) versus breast-conserving surgery. The high prevalence of psychological distress in BC patients, particularly among those without second-degree family history, urban residents, individuals with inadequate income, and mastectomy recipients, underscores the critical need for routine psychological screening and early intervention in these high-risk groups.