Network connectivity between psychological resilience and depression in prostate cancer patients.

OBJECTIVES: Prostate cancer (PCa) patients often experience depression. One possible buffer against stress-related depression is psychological resilience (PR), which has been described as heterogeneous in structure, like major depressive disorder (MDD). Although both of these constructs are central to understanding and assisting distressed PCa patients, no data have been reported on how they connect via network arrays at a component and symptom level. Such information has the potential to inform clinical practice with depressed PCa patients. METHODS: Using a cross-sectional design, 555 PCa patients completed the Patient Health Questionnaire-9 (PHQ-9) and the Connor-Davison Resilience Scale (CDRISC). Data were analysed via network analysis. RESULTS: Network analysis indicated that various CDRISC factors interacted with different PHQ-9 symptoms. For example, trust in one's instincts, tolerance of negative affect, and strengthening effects of stress (CDRISC) was associated with concentration problems and suicidal ideation (PHQ-9); positive acceptance of change, and secure relationships (CDRISC) was linked to low self-worth, anhedonia, fatigue/lethargy, motor problems, depressed mood, and concentration and appetite problems (PHQ-9). Similarly heterogeneous associations were found between individual CDRISC items and PHQ-9 symptoms. Network analytic figures depict both these sets of associations. CONCLUSIONS: As well as confirming the heterogeneous nature of PR and MDD in PCa patients, these findings argue for the further development of 'individualised' medicine approaches when working with PCa patients and their experiences of depression.

Network analysis of depression in prostate cancer patients: Implications for assessment and treatment.

OBJECTIVES: Many prostate cancer patients also suffer from depression, which can decrease their life satisfaction and also impede recovery from their cancer. This study described the network structure of depressive symptomatology in prostate cancer patients, with a view to providing suggestions for clinical interventions for depressed patients. METHODS: Using a cross-sectional design, 555 prostate cancer patients completed the Patient Health Questionnaire-9 (PHQ-9). RESULTS: Network analysis and multidimensional scaling indicated that anhedonia was the most central symptom for these men, and that several sets of depression symptoms were closely associated with each other. These included anhedonia-depressed mood; sleeping problems-fatigue/lethargy; and suicidal ideation-low self-worth-depressed mood. Other depression symptoms such as appetite problems, concentration problems, and motor problems, were less well-related with the remainder of the network. Patients receiving treatment for reocurring prostate cancer (PCa) had significantly higher PHQ9 scores than patients undergoing their initial treatment, but no major differences in their network structures. Implications for clinical practice were derived from the relationships between individual depression symptoms and the overall depression network by examining node predictability. CONCLUSIONS: The use of total depression scores on an inventory does not reflect the underlying network structure of depression in PCa patients. Identification and treatment of the central symptom of anhedonia in PCa patients suggests the need to adopt specific therapies that are focussed upon this symptom.

'Steeling' effects in the association between psychological resilience and cancer treatment in prostate cancer patients.

OBJECTIVE: To test the 'buffering' effect of psychological resilience (PR) upon depression in prostate cancer patients and to also investigate any effects that past or current treatment may have had upon patients' PR as a test of the 'steeling' hypothesis of past adversity upon future resilience. METHODS: A total of 576 volunteer prostate cancer patients completed questionnaires about their demographic and treatment variables, and their psychological resilience and depression. Factor analysis was used to identify the underlying components of the resilience measure. RESULTS: PR was confirmed as an inverse correlate of depression in these men. Additionally, some past and current treatments were found to be significantly associated with patients' psychological resilience in a way suggestive of 'steeling' effects. CONCLUSION: These data provide support for the model of PR as being influenced by past experiences of adversity and demonstrate that association for prostate cancer patients.

Assessment and management of newly diagnosed classical Hodgkin lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance.

The management of Hodgkin lymphoma (HL) has undergone significant changes in recent years. Due to the predilection of HL to affect younger patients, balancing cure and treatment-related morbidity is a constant source of concern for physicians and patients alike. Positron emission tomography adapted therapy has been developed for both early and advanced stage HL to try and improve the outcome of treatment, while minimising toxicities. The aim of this review is to digest the plethora of studies recently conducted and provide some clear, evidence-based practice statements to simplify the management of HL.

Limitations in the inverse association between psychological resilience and depression in prostate cancer patients experiencing chronic physiological stress.

OBJECTIVE: To investigate the effect of chronic stress as measured in cortisol concentrations upon the association between psychological resilience (PR) and depression in prostate cancer (PCa) patients. METHODS: A total of 104 men with PCa completed inventories on PR, depression, and background factors, plus gave a sample of their saliva for cortisol assay. RESULTS: The inverse correlation between PR and depression was present only for PCa patients with low or moderate concentrations of salivary cortisol (when classified as more than 1.0 SD below the mean vs within 1.0 SD of the group mean) but not for those men whose cortisol was >1.0 SD from the group mean. Specific PR factors and behaviours that made the greatest contribution to depression were identified for the low and moderate cortisol groups. CONCLUSIONS: These results suggest that there are particular aspects of PR that are most strongly related to depression, but that PR's inverse association with depression may be absent in participants with extreme chronic physiological stress.

Comparing a genetic and a psychological factor as correlates of anxiety, depression, and chronic stress in men with prostate cancer.

PURPOSE: Some prostate cancer (PCa) patients become clinically anxious or depressed after diagnosis and treatment. Some also show the physiological signs of chronic stress. However, there are currently no data describing how these particular patients might be identified at intake. This study tested the individual and combined predictive power of a psychological factor and a genetic factor as potential predictors of anxiety, depression, and chronic stress in a sample of PCa patients. METHODS: Ninety-five PCa patients completed psychological inventories for anxiety, depression, and psychological resilience (PR) and also gave a saliva sample for cortisol and a mouthwash sample for genetic testing for the presence of the BDNF Val66Met polymorphism. RESULTS: High PR patients had significantly lower anxiety and depression than low PR patients, but showed no significant differences in their salivary cortisol. Carriers of the Met allele of the BDNF Val66Met polymorphism had significantly higher salivary cortisol concentrations than patients who did not carry this allele. CONCLUSIONS: Each of these two factors may provide valuable information regarding the vulnerability of PCa patients to anxiety, depression, or chronic stress. Suggestions are made for their inclusion in clinical settings.

Using cluster analysis of anxiety-depression to identify subgroups of prostate cancer patients for targeted treatment planning.

BACKGROUND: To explore any possible subgroupings of prostate cancer (PCa) patients based upon their combined anxiety-depression symptoms for the purposes of informing targeted treatments. METHODS: A sample of 119 PCa patients completed the GAD7 (anxiety) and PHQ9 (depression), plus a background questionnaire, by mail survey. Data on the GAD7 and PHQ9 were used in a cluster analysis procedure to identify and define any cohesive subgroupings of patients within the sample. RESULTS: Three distinct clusters of patients were identified and were found to be significantly different in the severity of their GAD7 and PHQ9 responses, and also by the profile of symptoms that they exhibited. CONCLUSIONS: The presence of these 3 clusters of PCa patients indicates that there is a need to extend assessment of anxiety and depression in these men beyond simple total score results. By applying the clustering profiles to samples of PCa patients, more focussed treatment might be provided to them, hopefully improving outcome efficacy.

Trajectories of total depression and depressive symptoms in prostate cancer patients receiving six months of hormone therapy.

OBJECTIVE: The aim of this study was to investigate the effects of hormone therapy (HT) on depression and depressive symptoms in prostate cancer patients undergoing 6 months of HT. METHODS: One hundred two prostate cancer patients who had been prescribed HT completed the Zung Self-rating Depression Scale (SDS) and two questions about their sexual enjoyment and performance, plus a background questionnaire before HT, after 8 to 10 weeks of HT and again after 16 to 20 weeks of HT. RESULTS: There was a significant increase in SDS scores from before to during HT. High depression score before HT was a significant predictor of later increases in depression during HT. Increases in depressive symptoms were restricted to 8 of the 20 SDS symptoms, the most powerful change being in sexual anhedonia, which was a result of decreased ability to perform during sexual activity. CONCLUSIONS: The association between HT and elevated depression is confirmed, but the relative influence of sexual anhedonia over other depressive symptoms expands the understanding of this association. The effects of decreased ability to perform during sex appear to dominate the increase in depression during HT. Copyright © 2016 John Wiley & Sons, Ltd.

Psychological resilience aspects that mediate the depressive effects of urinary incontinence in prostate cancer survivors 10 years after treatment with radiation and hormone ablation.

Repeated surveys of prostate cancer (PCa) patients indicate that their prevalence of depression is well above that for their non-PCa peers. Although standard first-line treatments for depression are only about 35% effective, some recent comments have suggested that a focus upon the possible correlates (factors that aggravate or mediate depression) might help improve treatment efficacy. To investigate this issue, 144 10 year PCa survivors were asked about the frequency of urinary incontinence, a common side effect of some PCa treatments. The 53 patients who suffered urinary incontinence had significantly higher depression scores on the Zung Self-rating Depression Scale than those patients who did not report urinary incontinence. Using mediation analysis, patients' psychological resilience (PR) significantly mediated the depressive effects of urinary incontinence, but those effects were confined to just one of the five components of PR-a sense of control over the things that happen to oneself. Implications for treatment models of psychosocial oncology support for PCa survivors are discussed.

Why do patients regret their prostate cancer treatment? A systematic review of regret after treatment for localized prostate cancer.

OBJECTIVE: The aim of this study was to review regret following treatment for localized prostate cancer, including factors associated with higher levels of regret, regret after specific treatments and the use of interventions to modify the likelihood of regret. METHODS: Online databases including Medline, CINAHL, EMBASE, EBSCO and PsycINFO were searched in June 2014, using the terms 'prostate' and 'regret' for publications written in English and appearing in print since the year 1997. RESULTS: Of 422 articles identified by the search criteria, 28 contained analyzable data regarding 8118 patients. The most commonly identified factors associated with regret after prostate cancer treatment were treatment toxicity factors, especially sexual and urinary function. Other factors included older age and longer time since treatment. The levels of regret were generally higher after radical prostatectomy than external beam radiotherapy or brachytherapy. Decision-making aids were the most commonly used method for reducing the likelihood of regret and were effective. CONCLUSIONS: This is the first systematic review of regret following treatment for localized prostate cancer. Suggestions for the future study of regret in this setting can be made. These include the use of a standardized scale; recognizing levels of regret as low, medium or high; and separately identifying the decision made when patients have combinations of treatments such as surgery followed by radiotherapy.

Measuring individual burden of illness for depression among prostate cancer patients.

OBJECTIVE: This study aims to develop and test three potential models of Individual Burden of Illness for Depression (IBI-D) in prostate cancer patients. METHODS: Responses to three sets of scales measuring depressive symptoms, functional impairment, and quality of life satisfaction were collected from 191 prostate cancer patients and analysed via principal components analysis to obtain weightings for each of the scales within the three sets of measures. These weightings were then used to form IBI-D Indices, and these were then compared with depressive symptoms alone for their overlap. RESULTS: Single-factor solutions were found for each of the three IBI-D models, demonstrating generalizability across the three models. Equations based on the loadings of each scale within each IBI-D model, divided by the standard deviation of total IBI-D scores, were used to form IBI-D Indices. Although the correlations between the Patient Health Questionnaire-9 (PHQ9) and each of these IBI-D Indices were statistically significant, between one-quarter and one-fifth of the variance in IBI-D Indices was not accounted for by PHQ9 score alone, demonstrating that the IBI-D Indices provided additional information above that obtainable from a measure of depression alone. CONCLUSIONS: The IBI-D Index can be used to more completely assess the overall effects of depression in prostate cancer patients, the associations between those effects and predictor variables, and the outcomes of intervention studies aimed at decreasing depression (and its effects) in these men.

Diagnosing 'male' depression in men diagnosed with prostate cancer: the next step in effective translational psycho-oncology interventions?

BACKGROUND: Depression in men diagnosed with prostate cancer is associated with several adverse outcomes. However, some data suggest that standard methods of assessing depression in males via the criteria for Major Depressive Disorder (MDD) may omit several extra key symptoms of male depression. Therefore, this study tested the comparative effects of standard MDD-based diagnostic criteria for depression and criteria for 'male depression' in a sample of men diagnosed with prostate cancer. METHOD: 191 men diagnosed with prostate cancer completed a postal survey questionnaire containing questions about background variables, the Patient Health Questionnaire-9 for depression (PHQ9) and the Gotland Male Depression Scale (GMDS). Comparisons were made of the relative prevalence of depression according to these scales, plus a scale that combined the PHQ9 and GMDS extra items for male depression RESULTS: Although there were significant correlations between total PHQ9 and GMDS scores, over one-third of variance in the GMDS was not accounted for by the PHQ9, and sensitivity of the PHQ9 against the GMDS showed that about 24% of those patients identified as depressed on the GMDS would not be similarly identified on the PHQ9. Different prevalence rates from the two scales suggested that they were assessing different sets of symptoms of depression. A combined PHQ9-GMDS scale of 15 items was used to produce a profile of male depression in these patients. CONCLUSION: Adequate and reliable assessment of depression in men diagnosed with prostate cancer may require use of additional symptoms to those listed for MDD, and treatment planning and delivery could be more precise and effective using this methodology.

Differences in major depressive disorder and generalised anxiety disorder symptomatology between prostate cancer patients receiving hormone therapy and those who are not.

OBJECTIVE: The aim of this study is to explore the associations between hormone treatment variables and depression, and the nature of depression in prostate cancer (PCa) patients by comparing the severity and symptom profile of anxiety and depression in men who were currently receiving hormone therapy (HT) versus those who were not. METHOD: Self-reports of anxiety and depression on standardized scales of GAD and major depressive disorder (MDD) were collected from 156 PCa patients across two recruitment sites in Australia. Patients who were currently receiving HT were compared with patients not receiving HT for their severity and symptom profiles on GAD and MDD. RESULTS: Participants receiving HT had significantly higher GAD and MDD total scores than patients who were not receiving HT. In addition, the symptom profiles of these two HT subgroups were differentiated by significantly higher scores on the key criteria for GAD and MDD plus fatigue and sleeping difficulties but not the remaining symptoms of GAD and MDD. However, there were no significant differences between HT subgroups for the degree of functional impairment experienced by these symptoms. CONCLUSION: Although these data confirm the association between HT and anxiety/depression, the range of GAD and MDD symptoms influenced is relatively restricted. Moreover, functional ability does not appear to be impaired by HT. These findings clarify the ways in which HT affects PCa patients and suggests that a simple total scale score for anxiety and depression may not be as helpful in designing treatment as consideration of the symptomatic profiles of PCa patients receiving HT.

Do hormone treatments for prostate cancer cause anxiety and depression?

BACKGROUND: To investigate the relationship between hormone therapy (HT) and incidence of anxiety and depression among prostate cancer patients (PCa). METHODS: 526 PCa patients completed a survey about their cancer status, treatment received, anxiety, and depression status. Total scores on anxiety and depression inventories, plus symptom profiles that discriminated between patients with current HT, past HT, and never having received HT, were compiled for analysis. RESULTS: Patients who were currently receiving HT had significantly higher total anxiety and depression scores than patients who had previously received HT or who had never received HT. Analysis of the symptoms of anxiety and depression which distinguished between these groups of patients suggested that patients who had never received HT had significantly lower scores than current or past HT patients. Although several symptoms could be directly allocated to PCa and/or HT, symptom profiles were indicative of clinically significant anxiety and/or depression in patients who were currently receiving, or who had previously received, HT. CONCLUSION: Current HT may lead to symptoms of anxiety and/or depression which require clinical attention. These effects seem to decrease after completion of HT.

Do patient-reported androgen-deprivation therapy side effects predict anxiety and depression among prostate cancer patients undergoing radiotherapy? Implications for psychosocial therapy interventions.

Antiandrogen therapy (AAT) is a common adjunct treatment for prostate cancer (PCa) patients and has shown significant benefits to long-term outcomes from radiation or surgery. Although AAT has some adverse side effects and data from breast cancer patients indicate that such side effects from hormonal therapies may contribute to anxiety and depression and may also hinder AAT treatment compliance, this issue has not been investigated within a sample of PCa patients. This study explores the incidence of AAT side effects in a sample of PCa patients, the links between those side effects and anxiety and depression, the possible ways in which these factors may contribute to AAT treatment noncompliance in PCa patients, and how psychosocial treatments might be developed to attend to this issue. 147 PCa patients completed questionnaires on demographic factors, treatment compliance, AAT side effects, anxiety and depression. About 18% of the sample reported AAT side effects, and there was a significant association between the presence of side effects and elevated anxiety and depression scores. Increased frequency of side effects was significantly associated with elevated anxiety, but not depression. The most powerful relationship between AAT side effects and anxiety-depression was for the subfactors of (1) Fatigue, Pain and Discomfort, and (2) Psychological Agitation and Pessimism. Although fatigue, pain, and discomfort may be outcomes of the hormonal treatment itself, psychological agitation and pessimism represent a discrete psychological pathway between AAT side effects and anxiety and depression and (potentially) treatment noncompliance. Methods of addressing patients' loss of optimism in their treatment outcomes are discussed.

Which Aspects of Psychological Resilience Moderate the Association between Deterioration in Sleep and Depression in Patients with Prostate Cancer?

This study aimed to investigate the moderating effect of psychological resilience on sleep-deterioration-related depression among patients with prostate cancer, in terms of the total score and individual symptoms. From a survey of 96 patients with prostate cancer, 55 who reported a deterioration in their sleep quality since diagnosis and treatment completed the Zung Self-Rating Depression Scale, Connor-Davidson Resilience Scale, and the Insomnia Severity Index. Moderation analysis was conducted for the scale total scores and for the 'core' symptoms of each scale within this sample, based on data analysis. Interaction analysis was used to identify key associations. The moderation analysis suggested that psychological resilience moderated the depressive effect of sleep deterioration that patients reported occurred after their diagnosis and treatment and did so at the total and 'core' symptom levels of being able to see the humorous side of things and to think clearly when under pressure, but there was an interaction between this moderating effect, the strength of psychological resilience, and severity of sleep deterioration. Although it appears to be a successful moderator of depression arising from sleep deterioration that was reported by patients with prostate cancer, the effectiveness of psychological resilience is conditional upon the severity of patients' sleep difficulties and the strength of their psychological resilience. Implications for the application of resilience training and concomitant therapies for patients with prostate cancer with sleep difficulties and depression are discussed.