Investigation and Analysis on Mental Health State of Breast Cancer Patients in China

Purpose: There are nearly 170,000 new cases of breast cancer in China every year, and this number is showing an increasing trend. Mental health plays an important role in promoting the physical rehabilitation of patients. Therefore, attention paid to their psychological problems needs to be reinforced. The current study aims to investigate the mental health states of the breast cancer patients and provides the references for their psychosomatic rehabilitation in the future work. Methods: A total of 643 breast cancer patients completed the whole study. A questionnaire survey on anxiety, depression, posttraumatic stress disorder (PTSD), and posttraumatic growth (PTG) was conducted in Jiangsu Women and Children Health Hospital. Results: 13.53% breast cancer patients had anxiety; 21.5% had depression; the prevalence of PTSD was 7.15%, while the prevalence of PTG was 26.12%; Anxiety levels in older patients were significantly lower than those in the other two groups; PTG levels in older patients were significantly lower than those in the other two groups. Conclusion: Breast cancer patients have certain emotional distress and stress symptoms, but they also experience psychologically positive changes. And age shows various differences on anxiety and PTG. Clinical medical personnel should pay attention to the patient's psychological rehabilitation when concerning about the physical rehabilitation of patients. Patients in different ages have different mental health problems, thus the medical staff shall provide differential nursing plans for them. DOI : 10.14302/issn.2574-612X.ijpr-18-2110 Corresponding author: Wei Xu , School of Psychology, Nanjing Normal University , No.122 Ninghai Road, Gulou District, P. R. China, Phone number: +8615905141926,Email address: livingxw@163.com


Introduction
According to statistics, there are about 1.4 million new cases of breast cancer every year all over the world [1]. The incidence of breast cancer in China has surpassed the world and there are 170,000 newly diagnosed Chinese breast cancer patients each year [2].
Furthermore, this number is showing an increasing trend [2]. Of all cancers, breast cancer has become the most lethal disease with the exception of lung cancer among female [3].
Being diagnosed with breast cancer not only damages the physical function of the patients, but also has a negative impact on their mental health. They may experience a threat of physical integrity due to mastectomy and hair loss caused by chemotherapy.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), threats of physical integrity and life-threatening illnesses are events that may traumatize individuals [4]. More than 75% patients with breast cancer were suffering from subclinical symptoms of posttraumatic stress disorder (PTSD) [5][6]. Patients with breast cancer may have persistent memory of surgical scars, avoid underwear advertisements, nightmares and other posttraumatic stress symptoms [7].
In addition, breast cancer patients are also suffering from different levels of negative emotions such as anxiety and depression. Fann et al. (2008) reviewed the evidence for the prevalence of depression in women with breast cancer from the last 20 years, and suggested that the incidence of depression is about 10% to 25% [8]. Literature had indicated that anxiety, which varied from 10% to 30%, is more common than depression among breast cancer patients [9-10]. Burgess et al. (2005) pointed out that the number of patients with depression and anxiety reached the maximum value in the first year after breast cancer diagnosis [11].
However, despite the initial negative posttraumatic response, research had also reported that breast cancer patients will experience positive changes [12]. One of the most typical positive changes is posttraumatic growth (PTG). Posttraumatic growth refers to a positive psychological change that occurs after individuals have fought against a disaster. It mainly includes changes in self-awareness, changes in interpersonal experience, and changes in life philosophy [13]. In addition, the study by Manne et al.
(2004) also found that breast cancer patients' posttraumatic growth scores increased with postoperative time [14].
With the increase in medical conditions and living standards, the survival rate of breast cancer has risen [3].

Experimental Procedure
Questionnaires and informed consent forms were sent to the hospital for investigation by the research personnels, mainly graduate students.
Researchers conducted a short interview with the patients and then the patients began to fill out the questionnaires. If the patient (infusion or bedridden) couldn't complete it by himself, the questionnaires will be read by the investigator and the patient gave the answers in oral. Most patients completed the questionnaires independently.  show that 8 factors can be obtained, while no single factor accounts for a majority of the covariance among the variables. Therefore, no significant common method bias existed in the current study.

Descriptive Statistics
The demographic and clinical information of the current sample were listed in Table 1