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To examine whether depression, anxiety disorder, and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same. Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study. Depression and anxiety disorder were associated with an increased risk of mortality [Hazard Ratio (HR) 1.26, 95% CI 1.18–1.36; HR 1.14, 95% CI 1.08–1.22, respectively] and their co-occurrence further increased the risk (HR = 1.38, 95% CI 1.24–1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients without any psychiatric comorbidity with no antidepressant treatment, the mortality risk increased in patients with either psychiatric comorbidity or both, but the risk seemed to attenuate with antidepressant treatments. The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer, and antidepressant treatment may attenuate the risk. This underscores the need for screening and treating depression and anxiety disorders to improve survival in patients with breast cancer.

The aim of this study was to examine profiles of depressive symptoms and the association with anxiety and quality of life (QOL) in breast cancer survivors. A cross-sectional multicenter survey involving 5 hospitals in Korea was implemented between February 2015 and January 2017. A self-report survey included the Patient Health Questionnaire-9, Short Form 36, and State and Trait Anxiety Scale. Data from 347 patients were analyzed. Latent profile analysis identified five profiles of depressive symptoms: (1) “no depression” (63.98%); (2) “mild depression with sleep problems” (16.43%); (3) “mild depression” (8.65%); (4) “moderate depression with anhedonia” (7.78%); and (5) “moderately severe depression” (3.17%). Results from Fisher’s exact test and analysis of variance (ANOVA) to examine whether sociodemographic and clinical characteristics distinguish the classes indicated that marital status, income and education as well as C-reactive protein distinguished a few classes. Multivariate analysis of covariance and analysis of covariance results indicated that both types of anxiety as well as several dimensions of QOL differed between the identified classes. The current results suggest that although identified classes were characterized overall by severity of depression, a few classes also reflected pronounced individual symptom patterns, warranting tailored interventions for these symptom patterns, along with overall severity of depression.

Delirium is a common neurocognitive complication in cancer. Despite this, the studies examining the trajectory of the severity of delirium symptoms and its impact on health outcome in gastric cancer is rather limited. This study examined the trajectory of delirium symptom severity (DSS) following resection surgery for gastric cancer and its prospective association with cognitive function. A three-wave prospective observational study was conducted with 242 gastric cancer patients admitted for resection surgery at a teaching hospital in South Korea from May 2016 to November 2017. DSS was assessed by the clinical staff before and 1, 2, 3, and 7 days after surgery using the Delirium Rating Scale-Revised-98. A survey including the Functional Assessment of Cancer Therapy-Cognitive Scale (FACT-Cog) and Mini-Mental State Examination (MMSE) was administered before surgery (T0), 7 days after (T1), and 3 to 6 months after surgery (T2). Out of 242 participants, 48.8% (118) completed the survey at all three time points, 43.4% (105) did so for two time points, and 7.9% (19) for one time point. No cases of full delirium were observed over four postoperative time points. Latent growth curve modeling analyses indicated that DSS declined over 3 days after surgery. Age and anesthesia time were positively associated with the initial level of DSS. A medication history for memory complaints was related to a slower recovery from delirium symptoms. While the use of propofol as an anesthetic agent was associated with lower initial DSS, it predicted a slower recovery from DSS. A higher initial DSS predicted a lower T1 MMSE score. Severity of postoperative delirium symptoms predicts a short-term and objective cognitive function post-surgery. Monitoring and timely treatment of postoperative delirium symptoms is needed to diminish cognitive consequences in gastric cancer patients.

The present study compared psychological factors (i.e., alexithymia, somatization, pain catastrophizing (PC), anxiety, and depression) and QOL for headache patients and headache-free individuals, and examined whether somatization and PC mediate the relationship between alexithymia and headache impact in headache patients. Study participants consisted of 123 headache patients from an outpatient clinic at a university hospital and 124 headache-free individuals in Daegu, Korea. The survey employed the somatization and anxiety subscales of the Symptom Checklist-90-revised, the Patient Health Questionnaire-9, Pain Catastrophizing Scale, Toronto Alexithymia Scale, Short-Form Health survey-8 (SF-8), and the Headache Impact Test-6. Headache patients showed a higher level of all psychological factors and lower level of two summary scores (physical and mental health) as well as the seven dimensions of the SF-8 compared with headache-free individuals. Examination employing the SPSS Process macro found that the direct effect of alexithymia on headache impact was not significant after controlling for somatization and PC. The total indirect effects of alexithymia on headache impact were significant without anxiety and depression as covariates with the significant indirect effects of alexithymia on headache impact via somatization or via PC as well as via somatization and PC. However, after controlling for anxiety and depression, PC was the only significant pathway through which alexithymia was related to headache impact. Headache patients may benefit from interventions aiming at improving psychological factors in order to improve the functioning and QOL of headache patients.

University students are vulnerable to fatigue. If not adequately dealt with, fatigue might develop into various health problems and negatively affect quality of life (QOL). The present study examined psychometric properties of the Korean version of the Chalder Fatigue Scale (K-CFQ) in university students. Data were obtained from two samples of undergraduate students in Korea. The first dataset (N = 557) was collected in a cross-sectional survey in 2015 and the second dataset (N = 338) from a longitudinal survey with three time points over a semester period in 2016. Participants completed measures of fatigue, QOL, depression, anxiety, and sleep quality. Three-factor model (physical fatigue, low energy, and mental fatigue) rather than the original two-factor model (physical and mental fatigue) provided a better goodness of fit indices to the data. Internal consistency of the K-CFQ was satisfactory, with Cronbach’s α value of 0.88 for the total scale and those of subscales ranging from 0.73 to 0.87. Its convergent validity was supported by its significant association with anxiety, depression, sleep quality, and QOL. Significant association between T1 K-CFQ with physical QOL at T2 and T3 supported its predictive validity. Its known-group validity was proven with higher K-CFQ scores observed in the participants with depression and those with poor sleep quality. Current results suggest that K-CFQ is a valid and reliable measure of fatigue, and a better model fit of the three-factor structure of the K-CFQ implies potential cross-cultural differences in the dimensionality of fatigue.

Little research has examined the role of pain catastrophizing (PC) in predicting suicide among patients with rheumatic disease or the mechanisms through which it works. This study examines whether depression, perceived social support (PSS), and perceived burdensomeness (PB) mediate the relationship between PC and suicide risk. It also examines the relative importance of sociodemographic, clinical, and psychological factors in predicting suicide risk. Three hundred sixty patients from a rheumatology clinic in Korea completed measures of pain catastrophizing, social support, depression, and perceived burdensomeness. In hierarchical multiple regression analysis, the PC magnification, PB, physical disability, and PSS were significantly related to suicide risk. Results of the serial multiple mediation analysis indicated that the total indirect effect of PC magnification on suicide risk was significant while the direct effect was not. Four specific indirect effects of PC magnification were found to be statistically significant. First of all, PC magnification was associated with suicide risk through PB and through depression and PB. PC magnification was also associated with suicide risk through depression and PSS. Lastly, PC magnification was associated with suicide risk through depression, PSS, and PB. The identified pathways through which PC affects suicide risk suggest the importance of depression, PSS, and PB. Evaluation and intervention targeted at physical disability and the psychological factors of PC magnification, depression, PSS, and PB may be integrated into the management of suicide risk in patients with rheumatic disease.

Shared decision making and an integrative approach is expected to result in better outcomes, but might require more time. While ensuring that sufficient consultation time is essential to quality cancer care, it is not clear whether cancer patients feel that the amount of consultation time with their oncologists is sufficient. Data were collected from 2,556 cancer patients on their perceived and preferred consultation time, and included potential predictors, such as socio-demographics, clinical, behavioral, and quality-of-life factors, as well as potential outcomes, including unmet patient needs, trust in doctor, and satisfaction. The feeling of insufficient consultation time was defined as the perception that consultation time is less than the preferred consultation time; multivariate analyses were used for identification of predictors and comparison of outcomes. Overall, 37.1% felt that consultation time was less than preferred. Younger age, female sex, higher education level, having national health insurance, having been diagnosed with less common cancers, and having anxiety/depression were significantly associated with feelings of insufficient consultation time. Subjects with a feeling of insufficient consultation time reported higher current needs for information, physical symptoms, and psychological problems. They also reported less trust in their physician, lower overall satisfaction, and lower intention to continue treatment at the current cancer center. This study illustrated that high-quality cancer care, characterized by shared decision making and an integrative approach, seems to be related to sufficient consultation time that meets the individual’s subjective needs, and measures should be taken to ensure sufficient consultation time.

Needs assessment is an important step toward quality and patient-centered cancer care, as it identifies patient need, guiding evidence-based cancer care policy, and maximizing care outcome. This study reports on the development and validation of comprehensive needs assessment tool in cancer (CNAT).The CNAT, 59-item needs assessment tool for cancer was developed and validated in a large scale multi-center survey involving 2,661 cancer patients in ten fairly distributed cancer centers throughout Korea.To ensure content validity of the CNAT, items were derived from major needs assessment tools and input from experts and patients. Exploratory factor analysis confirmed its construct validity and identified seven factors: health care staff, psychological problems, physical symptoms, information, social and religious/spiritual support, practical support, and hospital facilities/services. Cronbach's alpha for the scale was 0.97, and for subscales, it varied from 0.80 to 0.97. Convergent validity was demonstrated by its significant association with the EQ5D. Patients with elevated stress, depressive episodes, or suicidal ideation reported a significantly higher level of psychological and overall need. Known-group validity was also supported by its ability to detect significant differences according to age, gender, education, insurance status, months since diagnosis, and non-surgical anticancer treatment. Needs differed according to SEER stage and cancer type: advanced stage and breast and lung cancer were associated with a greater level of need.The CNAT constitutes a meaningful and valid response to the challenges of cancer care, enabling assessment of need in cancer with a comprehensive yet concise and psychometrically sound tool.

A rapidly aging population with its mental health care needs presents an enormous challenge in the current mental health field. In light of this, pastoral counselors will have an increasingly important role to play in the care of older adults because of their strategic position in the community and their competence in dealing with religious/spiritual issues particularly salient in old age. This article proposes a short-term integrative approach to enable pastoral counselors to effectively and efficiently meet the mental health care needs of the elderly.