Wu Salene M, Yang Hae-Chung, Thayer Julian F, Andersen Barbara L
From the Department of Psychology (S.M.W., J.F.T., B.L.A.), The Ohio State University, Columbus, Ohio; Yongmoon Graduate School of Counseling Psychology (H.-C.Y.), Seoul, Korea; and Comprehensive Cancer Center and Solove Research Institute (B.L.A.), The Ohio State University, Columbus, Ohio.
Psychosom Med. 2014 May;76(4):252-6. doi: 10.1097/PSY.0000000000000060.
The literature on the relationship of depressive symptoms and stress hormones after cancer diagnosis has been mixed, with some studies showing a relationship and other studies showing none. Time since diagnosis may explain these contradictory findings. This study examined the relationship of depressive symptoms to stress hormones in patients with breast cancer using 12-month longitudinal data.
Patients with Stage II or III breast cancer (n = 227) were assessed every 4 months from diagnosis/surgery to 12 months. They completed the Centers for Epidemiological Studies Depression Scale (CES-D) Iowa Short Form and the Perceived Stress Scale and blood samples were obtained to measure stress hormones (i.e., cortisol, adrenocorticotropin hormone, norepinephrine, and epinephrine).
Depressive symptoms were negatively related to cortisol levels (β= -0.023, p = .002) but were positively related to rate of change in cortisol (β = 0.003, p = .003). Adrenocorticotropin hormone, epinephrine, and norepinephrine did not covary with depressive symptoms (all p values > .05). When the CES-D and Perceived Stress Scale were both used to predict cortisol, only the CES-D was significantly related (β = -0.025, p = .017).
Depressive symptoms were negatively related to cortisol, but this relationship changed from the time of diagnosis/surgery through 12 months. Cortisol may initially provide a buffering effect against depression during the stress of initial diagnosis and treatment, but this relationship seems to change over time.
关于癌症诊断后抑郁症状与应激激素之间关系的文献结果不一，一些研究显示存在关联，而另一些研究则未发现关联。诊断后的时间可能解释了这些相互矛盾的结果。本研究使用12个月的纵向数据，考察了乳腺癌患者抑郁症状与应激激素之间的关系。
对227例II期或III期乳腺癌患者从诊断/手术至12个月期间每4个月进行一次评估。他们完成了流行病学研究中心抑郁量表（CES-D）爱荷华简表和感知压力量表，并采集血样以测量应激激素（即皮质醇、促肾上腺皮质激素、去甲肾上腺素和肾上腺素）。
抑郁症状与皮质醇水平呈负相关（β = -0.023，p = .002），但与皮质醇的变化率呈正相关（β = 0.003，p = .003）。促肾上腺皮质激素、肾上腺素和去甲肾上腺素与抑郁症状无协变关系（所有p值 > .05）。当同时使用CES-D和感知压力量表来预测皮质醇时，只有CES-D具有显著相关性（β = -0.025，p = .017）。
抑郁症状与皮质醇呈负相关，但这种关系从诊断/手术时到12个月期间发生了变化。在初始诊断和治疗的应激期间，皮质醇可能最初对抑郁起到缓冲作用，但这种关系似乎会随时间而改变。
