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Asian, Black and Young Women Have Most Post-traumatic Stress Disorder After Breast Cancer Diagnosis

April 30, 2013

Written By Robin Warshaw
Reviewed By Hester Hill Schnipper, LICSW, BCD, OSW-C

Almost one-fourth of women diagnosed with early-stage breast cancer had symptoms of post-traumatic stress disorder (PTSD) within two to three months of diagnosis, according to research conducted in the U.S.

Women with the greatest PTSD risk included black and Asian women as well as those younger than age 50 at diagnosis. The study was published in the Journal of the National Cancer Institute.

Background

PTSD can occur after exposure to a traumatic event that threatens life or physical integrity, including a cancer diagnosis. Symptoms include:

  • Recurrent, intrusive and distressing thoughts
  • Physiological reactions
  • Avoiding activities or feelings related to the traumatic event
  • Trouble sleeping or concentrating  

Some small studies have looked at PTSD in women diagnosed with breast cancer. Those studies had varied findings about how many women experience PTSD after diagnosis and possible differences across racial and ethnic groups. 

Reason for the Study

The researchers wanted to determine if PTSD develops over time in women diagnosed with breast cancer.

They also looked at the relationship between PTSD and demographic characteristics, such as race or education, and clinical factors, such as cancer stage or breast surgery history.

Study Structure

Participants came from New York City, Detroit and northern California. The group was large, racially diverse and newly diagnosed with stage I, II or III breast cancer.  

Information was taken over time, in three phone interviews.The first (baseline) interview happened about two to three months after each woman was diagnosed. Follow-up interviews occurred at four months and six months after diagnosis.

To identify symptoms, the interviewers asked questions based upon a standard, scientific PTSD screening tool. The researchers then measured the data collected.

Findings

Results were drawn from interviews with 1,139 women. The study showed:

  • 23 percent of participants had PTSD at the baseline interview
    • 16.5 percent had PTSD at the second interview
    • 12.6 percent had it at the third time point
    • Women diagnosed younger than age 50 had a higher likelihood of PTSD than did women diagnosed older than 50
    • Black and Asian women had PTSD more often than did other racial/ethnic groups (women self-reported race/ethnicity)
      • At baseline, 29.3 percent of Asian women and 28.2 percent of black women had PTSD, compared to 24.1 percent of Hispanics and 20.5 percent of whites
      • By the third time point, 20 percent of Asian women and 23.6 percent of black women had PTSD, compared to 13.2 percent of Hispanics and 9.4 percent of whites 
      • Overall, 12.1 percent of participants had persistent PTSD, defined as occurring at two consecutive time points
      • The researchers found no association between PTSD and clinical factors such as breast cancer stage, grade or hormone receptor status

Study Limitations

The study did not ask about prior traumatic life events or emotional problems, and both are known to predict for cancer-related PTSD. Also, most participants had health insurance, so results could differ in uninsured women.

What This Means for You

It’s common to feel emotional distress after a breast cancer diagnosis. Sometimes that distress can be severe or frequent, causing you to feel helpless, fearful, angry or numb.

If you were recently diagnosed, you may have developed these symptoms soon after your diagnosis. Problems also can begin months later. Some women have PTSD, while others may become depressed or anxious. Although these feelings often resolve on their own, it can be very helpful to seek help from a professional. You might not have PTSD, but it’s important to talk with someone who understands the emotional effects of a breast cancer diagnosis.Your providers should be able to recommend a social worker or other counselor who can help you.

This study shows that the chances of developing PTSD symptoms increase after a breast cancer diagnosis, especially if you are young or Asian- or African-American. In addition, as the researchers note, PTSD may alter immune activity, make it harder to follow treatment and cause other problems.That emphasizes the importance of talking with someone about your distress.

PTSD declines over time, but getting help early can reduce symptoms and improve your life.  

N Vin-Raviv, GC Hillyer, DL Hershman et al. Racial Disparities in Posttraumatic Stress After Diagnosis of Localized Breast Cancer:The BQUAL StudyJournal of the National Cancer Institute, 2013; 105(8): 563-572.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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