Article of the Month

Depression in husbands of breast cancer patients: relationships to coping and social support

Bigatti SM, Wagner CD, Lydon-Lam JR, Steiner JL, Miller KD

Support Care Cancer (2011) 19:455-466

Data in the literature show that between 20% and 30% of spouses of patients with cancer suffer from mood disturbances: the data also suggests that:

• partners who experience depressive symptoms may be less supportive of the patient than those who are adjusting well.
• patients with supportive husbands do better physically and emotionally.
• when patients draw support from sources other than a partner, it does not compensate for the negative effects of a relationship that is not helpful.

Husbands of breast cancer patients (HBC) are the most frequent providers of support. The recognition of depressive symptoms in these men should alert the clinician of the need for intervention.

The objective of this study was to better understand the relationships of social support and coping strategies employed by husbands of women with breast cancer (HBC) compared to husbands of women without a chronic illness.

The Center for Epidemiological Studies Depression Scale (CES-D) was used to assess mood, where as, coping strategies were measured using the Ways of Coping Questionnaire and social support was assessed by means of the Interpersonal Support Evaluation List, an instrument designed to assess the role social support plays in protecting people from the pathogenic effects of stress.

119 HBC participated in the study and 81 (68%) returned completed questionnaires, 3 had missing data on the CES-D and were excluded from the analysis. A comparative group included 122 husbands of women without a chronic illness of which 99 returned completed questionnaires.

Data about wives’ health status and cancer experience were obtained solely from husbands. The findings were:

• the average time since diagnosis of breast cancer was 35 months
• diagnosis was made within the past year in 46% of the patients and during the prior 10 years in 9%
• 20.3% were stage III and 17.7% stage IV, but 10% of husbands were unable to recall the stage of their wives’ disease
• 9% of the patients had no surgery, 46% had mastectomy, 34% lumpectomy and 11.4% both.
• 97% of the patients received chemotherapy, 44.3% radiation and 25.3 % hormone therapy

The stage of the disease in the wives, the time since diagnosis, the type of surgery and the nature of adjuvant treatments were all unrelated to the husbands’ depressive symptoms (p>0.05).

HBC reported higher levels of depressive symptoms (mean 11.26 , SD =8.93) than the comparison group of husbands (mean 7.60, SD =7.78) p=0.007.

The cut off for depression (CES-D score) is 16. Thirty percent of HBC scored at or above 16 and were therefore classified as depressed while only 11% of comparison husband were depressed p =0.006.

There was no significant difference in perceived social support between HBC and comparison husbands. A significant difference was found in coping strategies: HBC utilized less confrontive, distancing, self-controlling, social support seeking, accepting responsibility and planful problem solving than the comparison group of husbands. No differences were found between the two groups in the degree to which they utilized escape-avoidance and positive reappraisal coping.

Among HBC, higher social support was associated with lower scores on depression while higher use of escape-avoidance, distancing, accepting responsibility and confrontive coping were associated with higher scores on depression. In the comparison group, higher social support was also associated with lower depression, but scape-avoidance and accepting responsibility coping were associated with higher depression.

There was a significant difference between the 2 groups regarding the relationship between depression and social support (p=0.035), distancing (p<0.001) and confrontive coping (p<0.001). The relationship between social support and positive reappraisal (p<0.001) and distancing (p<0.001) was also significantly different.

Why I choose this article

In the palliative care setting great emphasis is given to the care of the patients and their families. This study shows that husbands of breast cancer patients can have problems with both depression and coping even when the health status of their wives is not in the terminal stage.

Are we paying enough attention to family members of cancer patients in our clinical practice? Are we aware that if we find needs and provide support to families we are also helping the patient during the course of his/her illness?

Much more effort should be given to assessing and supporting patients and their families.

 Reviewed by Dr. Carla Ripamonti (Italy). Dr. Ripamonti is a member of the IAHPC Board and her bio may be viewed at http://www.hospicecare.com/Bio/c_ripamonti.htm