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Prevalence of Depression in Breast Cancer Survivors: a Systematic Review of Observational Studies
Open accessAbstract
BACKGROUND: Depression is common in breast cancer patients. The aim of this paper was to make a systematic review of its prevalence and associated factors oin breast cancer survivors. MATERIALS AND METHODS: An extensive systematic electronic review (PUBMED, CINAHL, PsyINFO and Ovid) and handsearch were carried out to retrieve published articles up to November 2012, using Depression OR Dysthymia AND (Cancer OR Tumor OR Neoplasms as the keywords. Information about the design of the studies, measuring scale, characteristics of the participants, prevalence of depression and its associated factors from the included studies were extracted and summarized. RESULTS: We identified 32 eligible studies that recruited 10,826 breast cancer survivors. Most were cross-sectional or prospective designed. The most frequent instrument used to screen depression was the Center for Epidemiological Studies for Depression (CES-D, n=11 studies) followed by the Beck Depression Inventory (BDI, n=6 studies) and the Hospital Anxiety and Depression Scale (HADS, n=6 studies). CES-D returned about similar prevalence of depression (median=22%, range=13-56%) with BDI (median=22%, range=17-48%) but higher than HADS (median=10%, range=1-22%). Depression was associated with several socio-demographic variables, cancer-related factors, treatment-related factors, subject psychological factors, lifestyle factors, social support and quality of life. CONCLUSIONS: Breast cancer survivors are at risk for depression so that detection of associated factors is important in clinical practice.
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“Recent reviews by Zainal et al. (2013) and Maass et al. (2015) determined that the prevalence of depression and anxiety in breast cancer survivors varies from 6% to 56% and 17,9% to 33,3%, respectively.”
From A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol (2019) · cites this paper as Zainal et al., 2013
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“When compared to the general female population, the prevalence of depression was found to be higher and persistent over >5 years after diagnosis, while the prevalence of anxiety was considered equivalent to results exhibited by the general female population.”
From A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol (2019) · cites this paper as Zainal et al., 2013
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“These individuals, given treatment side effects and sequelae, are three times more likely to experience physical symptoms and psychological disorders than patients with other kinds of tumors [6, 7].”
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“…depression where the prevalence rate can range from 7.5% to 44.5% depending on the type of cancer, the stage of the illness and study type (Cullivan et al., 1998; Grabsch eal., 2006; Wilson et al., 2007; Miovic and Block, 2007; Dastan and Buzlu, 2011; Maneeton et al., 2012; Zainal et al., 2013).”
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“Breast cancer and its treatment have physical effects such as fatigue, insomnia, loss of appetite, nausea, vomiting, appearance changes, emotions such as anxiety and depression, and social pressures resulting in decreased body function, sexuality problems, self-image changes, decreased confidence, emotions, severity o…”
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Parambil, N. A., & Kannan, S. (2024) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2024.25.1.115 · Cited by 5
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After the Psychoeducational Intervention: Turkish Breast Cancer Survivors’ Experiences
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Prevalence of Anxiety and Depressive Symptoms in Female Breast Cancer Patients
Sahu, V. K., Dhillon, H. S., Divinakumar, K. J., Dhillon, G. K., & Sasidharan, S. (2021) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_179_20 · Cited by 5
Turdaliyeva, B., Karibayeva, I. K., Bagiyarova, F., Zainal, N. Z., & Kussainova, D. (2022) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2022.23.7.2483 · Cited by 5
“Furthermore, diagnosis of breast cancer is often associated with the presence of psychological disorders including depression (Zainal et al., 2013).”
Self-citationSánchez-Valdeón, L., Fernández, N., Calle, Á. P., Ladera, V., Verdejo, I. C., Darkistade, E. B., García-Rodríguez, I., & Sahagún, A. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159672 · Cited by 5
“However, other authors [33] described that the most stressful moment for breast cancer women was the period of time between diagnosis and the surgical intervention.”
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“In addition, high levels of anxiety and depression were observed among long-term breast cancer survivors (Maass et al., 2015; Breidenbach et al., 2022; Zainal et al., 2013).”
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Identification of health care needs of long-term breast cancer survivors among Israeli women
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“A systematic review of the prevalence of depression in breast cancer survivors reported a median prevalence of 22 % in two studies, with ranges of 13–56 and 17–48 %, respectively [26].”
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Breast Cancer Survivorship Experiences
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“In this respect, the declaration of breast cancer and its management cause real psychological trauma due to its impact on femininity, sexual relations, and self-image (Karako-yun-Celik et al., 2010; Zainal et al., 2013b).”
Sebro, E., Biranu, E., Nigussie, A., Gebremedhin, T., Sisay, M. M., & Shaweno, T. (2024) · SAGE Open Medicine · doi:10.1177/20503121241283727 · Cited by 5
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“21 Depression during the treatment phase may stem from fears of death and disease recurrence.”
Correlation of Clinicopathological Characteristics of Breast Carcinoma and Depression
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Factors that Influence the Incidence of Depression in Breast Cancer Patients
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“[3], the three studies with the highest prevalence of depression included patients in the 1 year after diagnosis [4], in addition, sociodemographic factors, such as age, marital status, occupation, education, socioeconomic status, lack of family support, stress, anxiety, and impaired self-concept, can also increase th…”
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“The other choice to pharmacological therapeutic intervention for managing these side effects is psychological therapeutic interventions [48, 49].”
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“In addition, our results show that BrCa survivors have a relatively increased Dep/Anx prevalence compared to their peers without a BrCa diagnosis, evidence that is also well established in the literature [25-27].”
BackgroundResultAdipogenesis of bioabsorbable implants under irradiation in a rodent model
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Self-citationProductivity and Income Effect of Breast Cancer among Women in Southwestern Nigeria
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“Other work in this area includes Zainal et al. (2013) and Dahlui et al. (2011), among many other works.”
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“5% to 31% in patients with BC in Asian countries, which is lower than the rates reported in Iran (49).”
ResultDepression and the Quality of Life among Filipino Chemotherapy Patients
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Williamson‐Butler, S., Creamer, S., Flahive, J., Keating, B., Crocker, C. R., Edmiston, K. L., Harralson, T. L., Boudreaux, E. D., & O’Hea, E. (2022) · Archives of Breast Cancer · doi:10.32768/abc.202291109-118 · Cited by 3
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BackgroundThe Relationship Between Social Support and Depression in Patients with Breast Cancer
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Breast cancer: definition, history, symptoms, causes, worldwide scenario, global statistics
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Spiritual Care Nurse To Patient With Breast Cancer At Last Stage : a Literature Review
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“Women with breast cancer experience mental disorders such as depression (Zainal et al., 2013), anxiety, as well as relationship challenges after being diagnosed with this disease (Kadmon et al., 2008).”
Guidelines unmet: Assessing gaps in breast cancer survivorship care
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Depression in the COVID-19 endemic era: Analysis of online self-disclosures by young South Koreans
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“5 up to 42% and has been associated with the progress of the disease itself, the amount of the experienced pain, the functional level and autonomy [4-6].”
BackgroundShi, R. (2023) · Highlights in Science Engineering and Technology · doi:10.54097/hset.v30i.4955 · Cited by 1
Ye, L., Ladbury, C. J., Tam, A. H., Eustace, N. J., Wakabayashi, L., Vermeersch, J., Salman, J., Sun, V. C.-Y., Li, R., Sampath, S., et al. (2024) · Palliative & Supportive Care · doi:10.1017/s1478951524000944 · Cited by 1
“Studies have reported overall depression prevalence rates in cancer patients between 13% and 30% with variability between different cancer categories as well as between certain risk factors (Erim et al. 2019; Inhestern et al. 2017; Zainal et al. 2013; Zhao et al. 2014).”
Prevalence of depression among breast cancer patients in Asia: a systematic review and meta-analysis
Mo, W., Ding, X., & Wu, X. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1665569 · Cited by 1
“This variability may stem from differences in study design, sample characteristics, and methodological approaches to diagnosing depression (15, 16).”
Síntomas depresivos en mujeres con cáncer de mama en intervalo libre de enfermedad
Castillo, V. E. M., Reyes, O. L. Á., Morales, V. M. G., Jiménez, L. F. H., & Castillo, E. F. (2016) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 1
Current Resources for Evidence‐Based Practice, March/April 2014
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Greater Post-Surgical Pain Predicts Long-Term Depressed Affect in Breast Cancer Patients
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Evaluation of Anxiety and Depression in Women Undergoing Mastectomy in Greece
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“The above studies focused on providing information about cancer stages and complications of treatment, assessing the needs of caregivers [29], and providing information based on the COPE model to reduce the burden of caregiving, stress, anxiety, and depression [29,30], and improving patients’ QOL.”
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“The CES-D has been used for evaluating distress in six other studies, in which the average proportion of patients with distress was 22% (range, 13%–59%) [15], which was relatively low compared with our study.”
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“The prevalence of depression in breast cancer survivors varies greatly from low to high depending on the tool of measurement used and how it has been defined.[3] Many factors may play a role in these results, such as the difference in socio-economic statuses.”
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Surveillance of Patients Following Primary Therapy
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Analysis of influencing factors and prognosis of depression in patients with ovarian cancerPreprint
Yan, R., Wang, H., Wang, L., Ke, X., Cheng, W., & Li, Z. (2025) · Research Square · doi:10.21203/rs.3.rs-8299744/v1
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The Lived experiences of Filipino women with breast cancer
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Metadata
- Authors
- Zainal, N. Z., Nik-Jaafar, N. R., Baharudin, A., Sabki, Z. A., & Ng, C. G.
- Affiliations
- University of Malaya (MY)
- University Kebangsaan Malaysia Medical Centre (MY)
- Venue
- Asian Pacific Journal of Cancer Prevention
- Published
- 2013-04-30
- Volume
- 14
- Issue
- 4
- Pages
- 2649-2656
- ISSN
- 1513-7368 (ISSN-L)
- OpenAlex
- W2107370237
- Cited by
- 204
- References
- 56
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 17 · 2023: 17 · 2022: 20 · 2021: 20 · 2020: 22 · 2019: 24 · 2018: 15 · 2017: 15 · 2016: 12 · 2015: 15 · 2014: 13 · 2013: 1
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Asian Pacific Journal of Cancer Prevention (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- depression, breast cancer survivors, prevalence, risk factors, depression screening, CES-D, Beck Depression Inventory, Hospital Anxiety and Depression Scale, social support, quality of life, lifestyle factors, cancer treatment effects
- MeSH terms
- Adult, Aged, Aged, 80 and over, Breast Neoplasms, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Obesity, Prognosis, Receptors, Estrogen, Receptors, Progesterone, Retrospective Studies, Body Mass Index, Survival Rate, Erb-b2 Receptor Tyrosine Kinases, Young Adult
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