Depression and Resilience in Breast Cancer Patients


  • Gordana Ristevska-Dimitrоvska University St. Kliment Ohridski Bitola, Higher Medical School Bitola, Bitola
  • Petar Stefanovski Clinical Hospital Dr. Trifun Panovski, Department of Oncology, Bitola
  • Snezhana Smichkoska University Clinic for Radiotherapy and Oncology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Marija Raleva University Clinic of Psychiatry, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
  • Beti Dejanova Department of Medical and Experimental Physiology with Anthropology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje



Connor Davidson Resilience Scale, Hospital Anxiety Depression Scale, depression, resilience, breast cancer


OBJECTIVE: A significant number of breast cancer patients, during their life with the diagnosis, experience emotional distress in the form of depression and anxiety. Psychological resilience is the ability of a person to protect his/her mental health when faced with adverse circumstances such as the cancer diagnosis. This study aims to assess the resilience in breast cancer patients and to explore whether depression affects the resilience.

MATERIAL AND METHODS: Two hundred eighteen (218) women, treated for early breast cancer responded to Connor - Davidson Resilience Scale and Hospital Depression and Anxiety Scale, in order to assess the level of psychological resilience and the level of depression.

RESULTS: There is a significant negative correlation between depression and resilience in our sample (r = - 0.562, p < 0.001). Individuals with higher levels of depression have lower levels of psychological resilience. There is no statistically significant correlation between the ages of the participants; time passed since diagnosis, cancer stage and resilience levels.

CONCLUSION: This study shows that patients who are less depressed have higher levels of resilience and that psychological resilience may independently contribute to lower levels of depression among breast cancer patients. The level of psychological resilience may be a protective factor for depression and psychological distress.


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Kroll J. Posttraumatic symptoms and the complexity of responses to trauma. JAMA. 2003;290:267270.


Brintzenhofe-Szoc KM, Levin TT, Li Y, et al. Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type. Psychosomatics. 2009;50:383-391.

Rodin G, Zimmermann C, Rydall A, et al. The desire for hastened death in patients with metastatic cancer. J Pain Symptom Manage. 2007;33:661-675.


Pirl WF. Evidence report on the occurrence, assessment, and treatment of depression in cancer patients. J Natl Cancer Inst Monogr. 2004;32:32-39.


Lo C, Zimmermann C, Rydall A, et al. Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. J Clin Oncol. 2010;28:3084-3089.


Benton T, Staab J, Evans DL. Medical comorbidity in depressive disorders. Ann Clin Psychiatry. 2007;19:289-303.


Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust. 2009;190:S54-S60.


Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095-3105.


Zainal NZ, Nik-Jaafar NR, Baharudin A, Sabki ZA, Ng CG.: Prevalence of depression in breast cancer survivors: a systematic review of observational studies. Asian Pac J Cancer Prev. 2013;14(4):2649-56.


Grassi L, Indelli M, Marzola M, et al. Depressive symptoms and quality of life in home-care-assisted cancer patients. J Pain Symptom Man-age. 1996;12:300-307.

Chochinov HM, Wilson KG, Enns M, et al. Depression, hopelessness, and suicidal ideation. Psychosomatics. 1998;39:366-370.

Colleoni M, Mandala M, Peruzzotti G, et al. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet. 2000;356:1326-1327.

Chen ML, Chang HK. Physical symptom profiles of depressed and nondepressed patients with cancer. Palliat Med. 2004;18:712-718.

Prieto JM, Blanch J, Atala J, et al. Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. J Clin Oncol. 2002;20:1907-1917.


Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40:1797-1810.

PMid:20085667 PMCid:PMC2935927

Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115:5349-5361


Lloyd-Williams M, Shiels C, Taylor F, et al. De-pression—an independent predictor of early death in patients with advanced cancer. J Affect Disord. 2009;113:127-132.


Iosifescu DV. Treating depression in the medically ill. Psychiatr Clin North Am. 2007;30:77-90.


Lo C, Li M, Rodin G. The assessment and treatment of distress in cancer patients: overview and future directions. Minerva Psichiatr. 2008;49:129-143.

Coleman MP, Forman D, Bryant H, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet. 2011;377:127-38.

Weinberger T, Forrester A, Markov D, et al. Women at a dangerous intersection: diagnosis and treatment of depression and related disorders in patients with breast cancer. Psychiatr Clin North America. 2010;33:409-22.


Allen JD, Savadatti S, Levy AG. The transition from breast cancer 'patient' to 'survivor'. Psychooncology. 2009;18:71-8.


Qiu J, Yang M, Chen W et al. Prevalence and correlates of major depressive disorder in breast cancer survivors in Shanghai, China. Psychooncology. 2012;21:1331-7.


Popoola AO, Adewuya AO. Prevalence and correlates of depressive disorders in outpatients with breast cancer in Lagos, Nigeria. Psychooncology. 2012;21:675-9.


Park BW, Hwang SY. Unmet needs of breast cancer patients relative to survival duration. Yonsei Med J. 2012;53:118-25.

PMid:22187241 PMCid:PMC3250332

Pan L, Han Y, Sun X, et al. FDG-PET and other imaging modalities for the evaluation of breast cancer recurrence and metastases: a meta-analysis. J Cancer Res Clin Oncol. 2010;136:1007-22.

PMid:20091186 PMCid:PMC2874488

Luthar SS, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2000;71(3):543-62.

PMid:10953923 PMCid:PMC1885202

Gotay CC, Isaacs P, Pagano I. Quality of life in patients who survive a dire prognosis compared to control cancer survivors. Psychooncology. 2004;13(12):882-92.


Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.


Windle G, Bennett KM, Noyes J. A methodological review of resilience measurement scales. Health Qual Life Outcomes. 2011;9:8.

PMid:21294858 PMCid:PMC3042897

Zigmond, AS; Snaith, RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67(6):361–370.


Vodermaier A, Millman RD. Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis. Support Care Cancer 2011;19(12):1899-908.


Singer S, Kuhnt S, Götze H, Hauss J, Hinz A, Liebmann A, Krauss O, Lehmann A, Schwarz R. Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. Br J Cancer 2009;100(6):908-12.

PMid:19240713 PMCid:PMC2661775

Min JA1, Yoon S, Lee CU, Chae JH, Lee C, Song KY, Kim TS. Psychological resilience contributes to low emotional distress in cancer patients. Sup-port Care Cancer. 2013;21(9):2469-76.


Steinhardt M, Dolbier C. Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. J Am Coll Health. 2008;56(4):445-53.




How to Cite

Ristevska-Dimitrоvska G, Stefanovski P, Smichkoska S, Raleva M, Dejanova B. Depression and Resilience in Breast Cancer Patients. Open Access Maced J Med Sci [Internet]. 2015 Nov. 13 [cited 2021 Jun. 25];3(4):661-5. Available from:



B - Clinical Sciences

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