Psychological distress, anxiety, depression and suicide ideation in women with breast cancer in Windhoek
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Date
2024
Authors
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Publisher
University of Namibia
Abstract
Breast cancer is the second leading cause of death in women worldwide and the most
common cancer diagnosed in women. Additionally, it is the most prevalent malignancy
among African women. In Namibia, breast cancer was the leading cause of cancer in
women between 2010 and 2014, accounting for 1,579 cases, and constituted for 27.4% of
all female cancer cases. Psychological distress is a normal response to a cancer diagnosis
and its treatment. However, psychological distress often goes unrecognized and untreated
in breast cancer patients due to priority given to the physical aspects of the disease.
Psychological distress exists in the form of natural feelings of vulnerability, melancholy,
and dread to more serious ailments including depression, anxiety, panic attacks, social
isolation, and existential and spiritual crises. Distress and a psychological condition such
as anxiety or depression exist on a continuum. Anxiety is prevalent in a cancer patient
during critical events, such as the beginning of a new cancer treatment, receiving a
recurrence diagnosis, or advancement of the illness. Depression is frequently cited as a
psychological side effect of cancer, and it is one of the most researched psychological
experiences. To the researcher's knowledge, there have been studies on psychological
distress, anxiety and depression in Namibia, however, there are no studies in Namibia that
have specifically focused on suicidal ideation in women with breast cancer. This study
aimed to explore the levels of psychological distress, anxiety, depression, and suicide
ideation among women diagnosed with breast cancer, as well as the relationships between
the variables. The research employed a quantitative, correlational, descriptive, and cross sectional design. Three self-report instruments and a self-designed sociodemographic
questionnaire were utilized. These instruments included the Hospital Anxiety and
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Depression Scale (HADS) to assess the levels of anxiety and depressive symptoms, the
Emotion Thermometer (ET) to screen for psychological distress, and the Columbia–
Suicide Severity Rating Scale (C-SSRS) to assess suicide ideation. SPSS (version 29) was
used to analyse the data. The levels of psychological distress, anxiety, depression, and
suicide ideation are described through descriptive statistics, that is, means, standard
deviations, range of scores, and frequencies. The study involved 101 participants.
Approximately 27.7% and 32.6% had significant levels of depression and anxiety,
respectively. Approximately 47.5% (from the total ET score) displayed mild to severe
levels of psychological distress, 30.7% had significant levels of psychological distress
from the total HADS score, and 12.9% of the participants reported suicidal ideation.
Strong positive correlations were identified between anxiety (measured by HADS-A) and
depression (measured by HADS-D) (r = 0.64 , n = 101, p < 0.01). Additionally, significant
strong positive correlations were observed between anxiety (measured by HADS-A) and
psychological distress (total ET score) (r = 0.72 , n = 101, p < 0.01), and between
depression (measured by HADS-D) and psychological distress (total ET score) (r = 0.52,
n = 101, p < 0.01). Furthermore, a significant, strong, positive correlation existed between
anxiety (measured by HADS-A) and suicide ideation (r = 0.53, n = 101, p < 0.01), while
there was a significant, moderate, positive correlation between depression (measured by
HADS-D) and suicide ideation (r = 0.34, n = 101, p < 0.01). Finally, there was also a
significant, strong, positive correlation between psychological distress (total ET score)
and suicide ideation (r = 0.50, n =101, p < 0.01). The study's findings align with global
literature concerning the psychological challenges faced by women living with breast
cancer. Given the prevalence of psychological distress, depression, anxiety, psychological
distress, and suicidal ideation in this sample, the study advocates for psychological
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interventions for women diagnosed with breast cancer. Distress can be minimized by
having a supportive family, social networks, and access to beneficial knowledge. Anxiety,
depression and suicide ideation are mental health conditions that in severe cases requires
evidence-based treatments. Psychotherapy or medication can be used to manage and treat
symptoms. Furthermore, it is recommended that future research in Namibia consider
qualitative approaches to better understand women's unique experiences with breast
cancer
Description
A thesis submitted in fulfilment of the requirements for the degree of Master’s in Nursing Science
Keywords
Psychological distress, Anxiety, Depression, Suicide ideation, Psycho oncology, HADS, ET, C-SSRS, University of Namibia