Psychological and somatic symptoms among breast cancer patients in four European countries: A cross-lagged panel model

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Psychological and physical health among women with breast cancer are linked. However, more research is needed to test the interrelations between psychological and somatic symptoms, over time and throughout the different phases of breast cancer treatment, to determine when and which interventions should be prioritized. Six hundred and eighty nine women from four countries (Finland, Israel, Italy and Portugal) completed questionnaires during their first clinical consultation following diagnosis with breast cancer, and again after 3 and 6 months. The questionnaires included self-reported measures of psychological symptoms (Hospital Anxiety and Depression Scale; the Positive and Negative Affect Schedule Short Form) and somatic symptoms [selected items from the International European Organization for Research and Treatment of Cancer (EORTC) questionnaires]. Psychological and somatic symptoms were relatively stable across the three time-points. Cross-lagged paths leading from somatic to psychological symptoms (beta coefficients of 0.08–0.10), as well as vice-versa (beta 0.11–0.12), were found to be significant. No evidence was found for cross-cultural differences in mutual effects of psychological and somatic symptoms. The findings of this study call for tailoring personal interventions for breast cancer patients—either from a somatic perspective or a psychological perspective—and adjust them to the specific experiences of the individual patient.

Original languageAmerican English
Pages (from-to)474-482
Number of pages9
JournalStress and Health
Issue number2
StatePublished - Apr 2023

Bibliographical note

Funding Information:
Albino J. Oliveira‐Maia was national coordinator for Portugal of a non‐interventional study (EDMS‐ERI‐143085581, 4.0) to characterize a Treatment‐Resistant Depression Cohort in Europe, sponsored by Janssen‐Cilag, Ltd (2019–2020), is recipient of a grant from Schuhfried GmBH for norming and validation of cognitive tests, and is national coordinator for Portugal of trials of psilocybin therapy for treatment‐resistant depression, sponsored by Compass Pathways, Ltd (EudraCT number 2017‐003288‐36 and 2020‐001348‐25), and of Esketamine for treatment‐resistant depression, sponsored by Janssen‐Cilag, Ltd (EudraCT NUMBER: 2019‐002992‐33). The remaining authors have no potential conflicts of interest to declare.

Funding Information:
This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 777167. Dr Kelada is supported by the Golda Meir Post‐Doctoral Fellowship Fund.

Publisher Copyright:
© 2022 The Authors. Stress and Health published by John Wiley & Sons Ltd.


  • breast cancer
  • psychological symptoms
  • somatic symptoms
  • theory of unpleasant symptoms


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