Marjan Vaez

Predictors of return to work ten months after primary breast cancer surgery

Background. The most common female cancer in Western countries is breast cancer and women diagnosed with this disease are often under 65 years old. With increasing prevalence of survivors it is important to shed light on problems facing these women after diagnosis and treatment. The aim of this study was to assess factors predicting return to work (RTW) in women with early-stage breast cancer. Material and methods. A cohort of 102 women aged 18–64 with early-stage breast cancer who had undergone curative primary surgery with or without systemic adjuvant therapy were followed for 10 months using data from questionnaires and medical files. Results. Ten months after primary surgery, 59% of the women had returned to work while 41% were sick-listed part-time or full-time. After adjusting for age, health status, life satisfaction, vocational situation, and irradiation to the breast/chest wall and regional nodes, a multivariate logistic regression revealed the following factors as being negatively associated with RTW: a high-demand job (OR=0.1, 95% CI 0.0–0.8), axillary node dissection (OR=0.1, 95% CI 0.0–0.6), and treatment with chemotherapy (OR=0.1, 95% CI 0.0–0.7). Discussion. Treatment factors and high demands at work play an important role in RTW for women with early-stage breast cancer.

The share of suicide in injury deaths in the South African context: sociodemographic distribution

This study describes the sociodemographic distribution of suicide deaths compared with other injury deaths in South Africa. Cross-sectional data for 26,354 cases were extracted from an injury surveillance database. These included all manners of injury death from 10 mortuaries for 1999-2000 (approximately 18-20% coverage of all injury deaths per year). They were used to examine the distribution of suicide across different sex, race and age groupings, and the relative involvement of alcohol across manners of death. The share of suicide as a cause of death was comparable for males and females, but varied considerably across races and age groups. It was twice as high for Whites as for Asians, and four times as high as for Coloureds and Blacks. For all races except Whites, suicides were concentrated in the younger age groups. Only among Whites was the proportion of alcohol-positive suicides higher or comparable with that for other manners of death. While homicides and unitentional injury deaths outnumbered suicides overall, the relative importance of suicide in some social groups is reason for concern. South Africa is a country undergoing profound transformations, and differences in the distribution of suicide across sociodemographic groups deserve attention.

Self-reported depression in first-year nursing students in relation to socio-demographic and educational factors: a nationwide cross-sectional study in Sweden

BackgroundHigher education has been associated with distress and depression in students, and concerns that the proportion students afflicted is increasing have been raised. Findings on student depression have often been based on age-homogeneous samples leaving the results vulnerable to a confounding of student experience, transition from adolescence to adulthood and age on depression. We investigated self-reported depression and its associations with sociodemographic and educational factors in a demographically diverse student population of first-year nursing students in Sweden.MethodsA base-line survey in a nation-wide cohort of 1,700 first-year nursing students was conducted in the fall of 2002. The participants answered a mailed questionnaire containing questions on sociodemography, educational factors, and health. Depression was measured by the Major Depression Inventory and associations to sociodemographic and educational factors were tested in logistic regressions.ResultsThe overall response rate was 72.9%, and 10.2% (5.7% men, 10.7% women) reported depression. Younger age (<30), female gender, immigration from outside of Europe, high workload, dissatisfaction with education, low self-efficacy, and conflicts between personal and college demands were associated with high prevalence of depression. Prior work experience, less need for financial support, and work for pay during term time were related to low prevalence of depression. Older students and those who were parents reported home-college conflicts more often.ConclusionsNursing students as a group show high levels of self-reported depression but the prevalence is affected by age with a higher proportion depressed among younger students. Even though older students and those who were parents show less depression, they were more vulnerable to home–college conflicts. As older students and parents constitute a large proportion of nursing students, it is of importance to find ways to lessen the effects of the obstacles they encounter in the education.

Age-specific suicide mortality following non-fatal self-harm: national cohort study in Sweden

BACKGROUND Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm. METHOD The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990-1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9-19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome. RESULTS The 1-year HR for suicide among younger males (10-19 years) was 14.6 [95% confidence interval (CI) 4.1-51.9] for violent method and 8.4 (95% CI 1.8-40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in the youngest females. Among patients aged ⩾20 years, the 1-year HR for violent method was 4.6 (95% CI 3.8-5.4) for males and 10.4 (95% CI 8.3-13.0) for females. HRs for repeated self-harm during years 2-9 of follow-up were higher in 10- to 19-year-olds (males: HR 4.0, 95% CI 2.0-7.8; females: HR 3.7, 95% CI 2.1-6.5). The ⩾20 years age groups had higher HRs than the youngest, particularly for females and especially within 1 year. CONCLUSIONS Violent method and mental disorder increase the 1-year suicide risk in young male self-harm patients. Further, violent method increases suicide risk within 1 year in all age and gender groups except the youngest females. Repeated self-harm may increase the long-term risk more in young patients. These aspects should be accounted for in clinical suicide risk assessment.

Adjustment and social support at work early after breast cancer surgery and its associations with sickness absence

As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work‐related problems caused by treatments. Most previous studies have focused on individual and disease‐related factors, whereas few have focused on work‐related factors such as work adjustment and social support. The aim of this study was to investigate received and perceived social support from supervisor and colleagues as well as work adjustments, and their associations with sickness absence, among women who recently had had breast cancer surgery.

Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: Patterns of transiency and severity of the distress response

BACKGROUND Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress. AIM To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery. METHODS Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemars test, and logistic regression. RESULTS There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness. DISCUSSION The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.

Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence

BackgroundMental health problems are common in the work force and influence work capacity and sickness absence. The aim was to examine self-assessed mental health problems and work capacity as determinants of time until return to work (RTW).MethodsEmployed women and men (n=6140), aged 19–64 years, registered as sick with all-cause sickness absence between February 18 and April 15, 2008 received a self-administered questionnaire covering health and work situation (response rate 54%). Demographic data was collected from official registers. This follow-up study included 2502 individuals. Of these, 1082 were currently off sick when answering the questionnaire. Register data on total number of benefit compensated sick-leave days in the end of 2008 were used to determine the time until RTW. Self-reported persistent mental illness, the WHO (Ten) Mental Well-Being Index and self-assessed work capacity in relation to knowledge, mental, collaborative and physical demands at work were used as determinants. Multinomial and binary logistic regression analyses were used to estimate odds ratios with 95% confidence intervals (CI) for the likelihood of RTW.ResultsThe likelihood of RTW (≥105 days) was higher among those with persistent mental illness OR= 2.97 (95% CI, 2.10-4.20) and those with low mental well-being OR= 2.89 (95% CI, 2.31-3.62) after adjusting for gender, age, SES, hours worked and sick leave 2007. An analysis of employees who were off sick when they answered the questionnaire, the likelihood of RTW (≥105 days) was higher among those who reported low capacity to work in relation to knowledge, mental, collaborative and physical demands at work. In a multivariable analysis, the likelihood of RTW (≥105 days) among those with low mental well-being remained significant OR=1.93 (95% CI 1.46-2.55) even after adjustment for all dimensions of capacity to work.ConclusionSelf-assessed persistent mental illness, low mental well-being and low work capacity increased the likelihood of prolonged RTW. This study is unique because it is based on new sick-leave spells and is the first to show that low mental well-being was a strong determinant of RTW even after adjustment for work capacity. Our findings support the importance of identifying individuals with low mental well-being as a way to promote RTW.

Change in depressive symptoms over higher education and professional establishment - a longitudinal investigation in a national cohort of Swedish nursing students

BackgroundThere are indications of a high prevalence of psychological distress among students in higher education and also that distress increases over the course of study. However, not all studies on student distress controlled for sociodemographic differences and few followed development of distress over an extended period through professional establishment. We investigated if there is an independent effect of time in education and the first two years in the profession on depressive symptoms and mapped change over the period in a national cohort of students.MethodsData came from LANE, a nation-wide longitudinal panel survey of Swedish nursing students (N = 1700) who responded to annual questionnaires over five years from 2002 to 2007. Depressive symptoms were measured by the Major Depression Inventory and change over time analysed in a linear mixed effects model for repeated measures.ResultsThere was a significant change in level of depressive symptoms over time: an increase from the first to later years in education and a decrease to levels similar to baseline after graduation and a year in the profession. The change in symptoms remained significant after adjustment for sociodemographic factors (p < 0.01). Symptom levels differed due to age, gender, household composition and prior nurse assistant training but change over time was similar in all groups. The correlation among the repeated measures, representing within individual correlation over time, varied between 0.44-0.60.ConclusionsThe findings indicate an independent but transitional effect of time in education and professional establishment on depressive symptoms. We think heightened distress over education abates as the graduate accommodates to the profession. Nevertheless, within education, the differences in depressive symptoms associated to demographic factors can help identify student groups more vulnerable to distress. Also, as individual differences in distress seem to persist over time, perhaps students highly distressed in the beginning of education can be helped by awareness among educators of the elevated levels of distress in late education.

Sickness Absence following Coronary Revascularisation. A National Study of Women and Men of Working Age in Sweden 1994–2006

Background Evidence based and gender specific knowledge about sickness absence following coronary revascularisation is lacking. The objective was to investigate sickness absence after a first coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) among women and men in a national Swedish study. Materials and Methods All patients 30–63 years of age, who underwent a first CABG (n = 22,985, 16% women) or PCI (40,891, 22% women) in Sweden between 1994 and 2006 were included. Information on sickness absence, co-morbidity, and other patient characteristics was obtained from national registers. Long-term sickness absence (LTSA) was defined as >180 and >90 sick-leave days in the first sick-leave spell following CABG and PCI, respectively. Prevalence ratio (PR) and 95% confidence interval (CI) of LTSA were calculated. Findings LTSA followed the interventions in 41% and 36% for CABG and PCI patients, respectively. Women had more often LTSA compared with men, (CABG PR = 1.23: 95% CI 1.19–1.28 and PCI PR = 1.19; 95% CI 1.16–1.23). A history of sickness absence the year before the intervention increased the risk for LTSA after the intervention in both genders. Among women, older age, or being self employed or unemployed was associated with a lower risk for LTSA. Among men previous cardiovascular disease, diabetes and low socio-economic position increased the risk. During the observation period, there was no change in sickness absence rates among PCI patients but an increase among CABG patients adjusting for patient characteristics. Conclusion This national study covering a 13-year period shows that long-term sickness absence following coronary revascularisation is common in Sweden, especially among women, and is associated with socio-economic position, co-morbidity, and sickness absence during the year before the intervention. Gender specific scientific knowledge about use and effects of sickness absence following coronary revascularisation is warranted for the patients, the treating physicians, the healthcare sector, and the society.

Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship

Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.