Open Access Research article

The status and correlates of depression and anxiety among breast-cancer survivors in Eastern China: a population-based, cross-sectional case–control study

Feng Wang1, Jiajia Liu2, Liyuan Liu3, Fei Wang1, Zhongbing Ma1, Dezong Gao1, Qiang Zhang1 and Zhigang Yu1*

Author Affiliations

1 Breast Disease Department, the Second Hospital of Shandong University, 247#, Beiyuan St, Tianqiao District, Jinan, Shandong 250033, P. R. China

2 School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong 250012, P. R. China

3 School of Public Health, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong 250012, P. R. China

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BMC Public Health 2014, 14:326  doi:10.1186/1471-2458-14-326

Published: 8 April 2014



Breast cancer presents specific challenges both physiologically and psychologically to women, and consequently affect the patients’ mental health. Psychosocial factors may play important roles in the symptoms and development of mental disorders among breast-cancer survivors. This study assesses the depression and anxiety status of breast-cancer survivors and further identifies the risk factors.


A 1:1 matched, case–control study was conducted with a total sample of 222 individuals. Participants were selected from a national epidemiological survey. The Center for Epidemiological Studies—Depression Scale and State-Trait Anxiety Inventory were used to assess depression and anxiety. The Social Support Rating Scale and Perceived Social Support Scale were used as measures of social support and perceived social support, and the Rosenberg Self-Esteem Scale as a measure of self-esteem. Coping style was assessed using the Simplified Coping Style Questionnaire. The predictive effect of these psychosocial factors for depression and anxiety was investigated with hierarchical linear regressions.


Breast-cancer survivors experienced a high level of depressive and anxious symptoms. Multivariate analysis revealed that breast cancer functions as an independent but not a main risk factor of both depression and anxiety. Higher levels of depression and anxiety were positively associated with a higher level of passive coping style, and negatively with perceived social support, objective social support and an active coping style.


The mental health of breast-cancer survivors should be promoted through the transformation of coping styles and improvement of social support.

Breast cancer; Depression; Anxiety; Coping style; Social support; Predictor