Postsurgical depressive symptoms and proinflammatory cytokine elevations in women undergoing primary treatment for breast cancer

Laura C. Bouchard, Michael H Antoni, Bonnie B Blomberg, Jamie M. Stagl, Lisa M. Gudenkauf, Devika R. Jutagir, Alain Diaz, Suzanne C Lechner, Stefan Glück, Robert P. Derhagopian, Charles S Carver

Research output: Contribution to journalArticle

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Abstract

Objective: Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and patients with cancer. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early-stage BCa before beginning adjuvant treatment. Methods: Women with Stage 0-III BCa were recruited approximately 4 to 8 weeks after surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression, and blood samples were collected to quantify circulating levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. Analyses of covariance were used to test for group differences (elevated versus low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. Results: Thirty-six (40%) of 89 patients showed elevated levels of depressive symptoms and, in adjusted models, had marginally higher levels of IL-1β (mean [M] = 14.49 [95% confidence interval {CI} = 6.11-32.65] versus M = 4.68 [95% CI = 1.96-9.86] and IL-6 [M = 88.74 {95% CI = 33.28-233.96} versus M = 61.52 {95% CI = 27.44-136.40}]) significantly higher levels of TNF-α (M = 17.07 [95% CI = 8.27-34.32] versus M = 6.94 [95% CI = 3.58-12.80]) than did women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1β (β = 0.06, p =.006, R2 = 0.25) and TNF-α (β = 0.06, p =.003, R2 = 0.27). Conclusions: Postsurgery and preadjuvant treatment for early-stage BCa, depressive symptoms covary with elevated levels of multiple proinflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation.

Original languageEnglish (US)
Pages (from-to)26-37
Number of pages12
JournalPsychosomatic Medicine
Volume78
Issue number1
DOIs
StatePublished - 2016

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Depression
Breast Neoplasms
Cytokines
Confidence Intervals
Therapeutics
Interleukin-1
Inflammation
Depressive Symptoms
Breast Cancer
Elevation
Interleukin-6
Receptors, Tumor Necrosis Factor, Type II
Confidence Interval
Breast Diseases
Disease Progression
Neoplasms
Tumor Necrosis Factor-alpha
Enzyme-Linked Immunosorbent Assay
Regression Analysis

Keywords

  • Breast cancer
  • Depression
  • Proinflammatory cytokines

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology
  • Arts and Humanities (miscellaneous)
  • Developmental and Educational Psychology

Cite this

Postsurgical depressive symptoms and proinflammatory cytokine elevations in women undergoing primary treatment for breast cancer. / Bouchard, Laura C.; Antoni, Michael H; Blomberg, Bonnie B; Stagl, Jamie M.; Gudenkauf, Lisa M.; Jutagir, Devika R.; Diaz, Alain; Lechner, Suzanne C; Glück, Stefan; Derhagopian, Robert P.; Carver, Charles S.

In: Psychosomatic Medicine, Vol. 78, No. 1, 2016, p. 26-37.

Research output: Contribution to journalArticle

Bouchard, Laura C. ; Antoni, Michael H ; Blomberg, Bonnie B ; Stagl, Jamie M. ; Gudenkauf, Lisa M. ; Jutagir, Devika R. ; Diaz, Alain ; Lechner, Suzanne C ; Glück, Stefan ; Derhagopian, Robert P. ; Carver, Charles S. / Postsurgical depressive symptoms and proinflammatory cytokine elevations in women undergoing primary treatment for breast cancer. In: Psychosomatic Medicine. 2016 ; Vol. 78, No. 1. pp. 26-37.
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abstract = "Objective: Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and patients with cancer. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early-stage BCa before beginning adjuvant treatment. Methods: Women with Stage 0-III BCa were recruited approximately 4 to 8 weeks after surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression, and blood samples were collected to quantify circulating levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. Analyses of covariance were used to test for group differences (elevated versus low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. Results: Thirty-six (40{\%}) of 89 patients showed elevated levels of depressive symptoms and, in adjusted models, had marginally higher levels of IL-1β (mean [M] = 14.49 [95{\%} confidence interval {CI} = 6.11-32.65] versus M = 4.68 [95{\%} CI = 1.96-9.86] and IL-6 [M = 88.74 {95{\%} CI = 33.28-233.96} versus M = 61.52 {95{\%} CI = 27.44-136.40}]) significantly higher levels of TNF-α (M = 17.07 [95{\%} CI = 8.27-34.32] versus M = 6.94 [95{\%} CI = 3.58-12.80]) than did women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1β (β = 0.06, p =.006, R2 = 0.25) and TNF-α (β = 0.06, p =.003, R2 = 0.27). Conclusions: Postsurgery and preadjuvant treatment for early-stage BCa, depressive symptoms covary with elevated levels of multiple proinflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation.",
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AU - Bouchard, Laura C.

AU - Antoni, Michael H

AU - Blomberg, Bonnie B

AU - Stagl, Jamie M.

AU - Gudenkauf, Lisa M.

AU - Jutagir, Devika R.

AU - Diaz, Alain

AU - Lechner, Suzanne C

AU - Glück, Stefan

AU - Derhagopian, Robert P.

AU - Carver, Charles S

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N2 - Objective: Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and patients with cancer. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early-stage BCa before beginning adjuvant treatment. Methods: Women with Stage 0-III BCa were recruited approximately 4 to 8 weeks after surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression, and blood samples were collected to quantify circulating levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. Analyses of covariance were used to test for group differences (elevated versus low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. Results: Thirty-six (40%) of 89 patients showed elevated levels of depressive symptoms and, in adjusted models, had marginally higher levels of IL-1β (mean [M] = 14.49 [95% confidence interval {CI} = 6.11-32.65] versus M = 4.68 [95% CI = 1.96-9.86] and IL-6 [M = 88.74 {95% CI = 33.28-233.96} versus M = 61.52 {95% CI = 27.44-136.40}]) significantly higher levels of TNF-α (M = 17.07 [95% CI = 8.27-34.32] versus M = 6.94 [95% CI = 3.58-12.80]) than did women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1β (β = 0.06, p =.006, R2 = 0.25) and TNF-α (β = 0.06, p =.003, R2 = 0.27). Conclusions: Postsurgery and preadjuvant treatment for early-stage BCa, depressive symptoms covary with elevated levels of multiple proinflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation.

AB - Objective: Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and patients with cancer. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early-stage BCa before beginning adjuvant treatment. Methods: Women with Stage 0-III BCa were recruited approximately 4 to 8 weeks after surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression, and blood samples were collected to quantify circulating levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. Analyses of covariance were used to test for group differences (elevated versus low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. Results: Thirty-six (40%) of 89 patients showed elevated levels of depressive symptoms and, in adjusted models, had marginally higher levels of IL-1β (mean [M] = 14.49 [95% confidence interval {CI} = 6.11-32.65] versus M = 4.68 [95% CI = 1.96-9.86] and IL-6 [M = 88.74 {95% CI = 33.28-233.96} versus M = 61.52 {95% CI = 27.44-136.40}]) significantly higher levels of TNF-α (M = 17.07 [95% CI = 8.27-34.32] versus M = 6.94 [95% CI = 3.58-12.80]) than did women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1β (β = 0.06, p =.006, R2 = 0.25) and TNF-α (β = 0.06, p =.003, R2 = 0.27). Conclusions: Postsurgery and preadjuvant treatment for early-stage BCa, depressive symptoms covary with elevated levels of multiple proinflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation.

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