Research ArticleClinical studies

Agreement Between Hopelessness/Helplessness and Montgomery-Asberg Depression Rating Scale in Healthy Individuals and in Patients with Benign Breast Disease and Breast Cancer: A Prospective Case-Control Study in Finland

MATTI ESKELINEN, RIIKA KORHONEN, TUOMAS SELANDER and PAULA OLLONEN
Anticancer Research April 2015, 35 (4) 2215-2221;

Abstract

Background: The relation between scoring for hopelessness/helplessness and the Montgomery-Asberg Depression Rating Scale (MADRS) in healthy study subjects (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared in a prospective study. We, therefore, investigated hopelessness and helplessness scores versus the MADRS in 115 patients. Patients and Methods: In the Kuopio Breast Cancer Study, 115 women with breast symptoms were evaluated for hopelessness and helplessness, and for the MADRS before any diagnostic procedures were carried out. Results: In the self-rating score (SRS), hopelessness/helplessness versus the MADRS were highly significantly positively correlated in the HSS, BBD and BC groups. In the SRS, the weighted kappa values for hopelessness/helplessness versus the MADRS in the HSS, BBD and BC groups were also statistically significant. There was also a significant positive correlation in the examiner-rating score (ERS) for hopelessness versus the MADRS in the HSS, BBD and BC groups and for helplessness versus the MADRS in the HSS, BBD and BC groups. The unweighted kappa values in the ERS for hopelessness versus the MADRS were statistically highly significant for the HSS, BBD and BC groups and those for helplessness versus the MADRS in the HSS and BBD groups were statistically significant. Conclusion: A new finding with clinical relevance in the present work is the agreement between hopelessness/helplessness scores and MADRS in the SRS and ERS. In the breast cancer diagnostic unit, the identification of hopeless/helpless persons is essential in suicide prevention and it is important to assess and treat hopelessness/helplessness even though an individual may report few depressive symptoms.

Depression is one of the most common psychological disorders and cross-sectional studies have found an association between depression and depression-associated symptoms such as hopelessness/helplessness in terminally-ill cancer patients (1); hopelessness/helplessness may also occur as a precursor of depression (2-6). Hintikka et al. in Finland showed an 11.7% prevalence of depression in a general popu la tion sample (7) and 10-34% of women were shown to have depression and depression-like symptoms in a general population cohort (8). Many studies have clearly demonstrated that depres sion and depression-associated symptoms such as hopelessness/helplessness affect compliance with cancer the rapy, and reduce survival and quality of life (7, 9-11).

The Montgomery-Asberg Depression Rating Scale (MADRS) was developed more than 20 years ago as an inventory for the rapid screening of depression by British and Swedish researchers, especially as an adjunct to the Hamilton Rating Scale for Depression (12). It is used to measure the severity of depressive episodes in patients with mood disorders.

We assessed hopelessness versus helplessness in patients with breast cancer (BC) and benign breast disease (BBD), and in healthy study subjects (HSS) (9, 10). Our results suggested a specific link between hopelessness and helplessness attitude characteristics in breast disease. However, the results of hopelessness/helplessness scores and MADRS in healthy study patients (HSS) and in patients with benign breast disease (BBD) and breast cancer (BC) has not been compared in a prospective study. Because BC is a hormonally-responsive neoplasm with great psychological impact, it is the tumor type most extensively investigated for possible psychological variables associated with risk and survival (13). Hormonal factors, such as early age at menarche, later age at menopause, later age at first full-term pregnancy and hormone replacement therapy, are known to be the main risk factors for sporadic BC (14-17). In addition, lifestyle factors, such as obesity, smoking, alcohol consumption and lack of physical activity, appear to contribute to an increased risk for this malignancy, although the results concerning such factors are inconsistent (18-20).

View this table:
Table I.

Characteristics of the study participants. Results are shown for the patients with breast cancer (BC), for those with benign breast disease (BBD) and for the healthy study participants (HSS).

Psychological factors, such as stressful and adverse life events, are widely thought to play a role in the aetiology of BC (21-42). To our knowledge, the associations between hopelessness/helplessness scores and the MADRS are rarely considered together. Therefore, we carried out this prospective study to examine the concordance between hopelessness/helplessness score and the MADRS in women with breast symptoms referred by physicians to the Kuopio University Hospital.

Patients and Methods

The Kuopio BC Study was a multi-disciplinary cooperative project conducted by different departments of the University of Kuopio and Kuopio University Hospital, and included all women who were referred to the hospital for breast examination between April 1990 and December 1995. The Kuopio BC Study followed the protocol of the International Collaborative Study of Breast and Colorectal Cancer coordinated by the European Institute of Oncology in Milan, and was initiated as a SEARCH program of the International Agency for Research on Cancer. The collaborative study is based on the assumption that BC and colorectal cancer may have common risk factors. Study centres for the BC study are situated in Canada, Finland, Greece, Ireland, Italy, Russia, Slovakia, Spain and Switzerland (43). The study participants showed BC symptoms (a lump in the breast or in the axilla, pain in the breast, bleeding from the nipple, nipple discharge or skin dimpling), or an abnormality of the breast and the indications for referral in this study were in line with our previous investigations in a BC Diagnostic Unit in Finland (44, 45).

This case-control study was an extension of the Kuopio BC Study (46, 47) and was approved by the Joint Committee of the University of Kuopio and Kuopio University Hospital (approval number 14/12/1989). Women referred from January 1991 to June 1992 were included. Participation was based on written consent. One hundred and fifteen women participated and were interviewed (to determine the level of emotional depression) by a psychiatrist (P.O.) before any diagnostic procedures, so neither the interviewer nor the patient knew the diagnosis at the time of the interview. The interviews were recorded and the ratings were completed before the final diagnosis. The clinical examination, mammography and biopsy showed BC in 34 (29.6%) patients, BBD in 53 (46.1%) patients and 28 (23.4%) HSS (Table I).

MADRS. The examiner (P.O.) completed the MADRS with 10 variables and the MADRS was used as a continuous variable in this study. The questionnaire items measuring depression in the MADRS test are following: apparent sadness; reported sadness; inner tension; reduced sleep; reduced appetite; concentration difficulties; lassitude; inability to feel; pessimistic thoughts; suicidal thoughts. Each MADRS item yields a score of 0 to 6, with the test total score ranging from 0 to 60. The final score was rated as follows: grade I: score 0, no depression; grade II: scores 1-6, little depression; grade III: score 7-19, mild depression; grade IV: score 20-34, moderate depression; and grade V: score 35-60, severe depression.

Scoring of hopelessness. The questionnaire items measuring hopelessness in the self-rating score (Hopelessness SRS) and in the examiners-rating score (Hopelessness ERS) were assessed before any diagnostic procedures for the HSS, BBD and BC groups and are given in detail in our earlier report of hopelessness (9). The mean duration (SD) of the interview for the patients with BC was 126.5 (21.6) minutes, for the patients with BBD was 127.3 (23.3) minutes, and for the HSS group 123.0 (23.3) minutes (p=0.72).

Scoring of helplessness. The questionnaire items measuring helplessness (10) in the SRS were: grade I, ‘I feel self-supporting and have no helplessness’ (true or false); grade II, ‘I feel independent, but have a little helplessness’ (true or false); grade III, ‘I feel balanced, but have some helplessness’ (true or false), grade IV, ‘I feel dependent and have clear helplessness’ (true or false) and grade V, ‘I have strong helplessness’ (true or false). The helplessness characteristics in the ERS for the HSS, BBD and BC groups were on a 5-point Likert-scale: grade I, no helplessness, self-supporting; grade II, little helplessness, independent; grade III, some helplessness, balanced; grade IV, clear helplessness, dependent and grade V, strong helplessness.

Figure 1.
Figure 1.

Scatter plots of the invidual values of the self-rating scores (SRS) measuring hopelessness (A) and helplessness (B) and examiner-rating scores (ERS) measuring hopelessness (C) and helplessness (D) versus MADRS, as a continuous variable for healthy study participants (HSS), for those with benign breast disease (BBD) and for patients with breast cancer (BC).

Statistical analysis. Significance of the results was calculated with the SPSS/PC statistical package (SPSS Inc., Chicago, IL, USA). Correlations and differences between the study groups (BC, BBD and HSS groups) were measured with the two-sided chi-square test and non-parametric Kruskal-Wallis variance analyses. Results were considered statistically significant at a p-value <0.05. The agreement between ERS and SRS was assessed using unweighted kappa statistic (Cohens's kappa), where all disagreements were arbitrarily regarded as having equal importance (48, 49), and the weighted kappa statistic, where weight matrix cells located on the diagonal (upper-left to bottom-right) represent agreement and thus contain zero (50). The kappa statistic provides a measure of agreement after exclusion of the proportion of agreement expected by chance, and can vary from +1, indicating perfect agreement, to 0, indicating agreement no greater than that expected by chance, and can assume negative values up to −1 when agreement is less than expected by chance.

Results

Although the patients in the BC group were older than those in the BBD and HSS groups (51.5 versus 47.5 and 45.7 years, respectively), the age difference was not statistically significant (p=0.12). The majority of patients (85/115, 74%) were married or living in a steady relationship. The groups differed only slightly from each other as to the factors of the reproductive life of the women (Table I).

View this table:
Table II.

The Spearman correlation coefficients and kappa values between the self-rating score (SRS) for hopelessness and helplessness versus Montgomery-Asberg Depression Rating Scale (MADRS) and the examiner rating score (ERS) for hopelessness and helplessness versus the MADRS in the HSS, BBD and BC groups.

The Spearman correlation coefficients and kappa values for hopelessness/helplessness by the SRS versus MADRS in the HSS, BBD and BC groups are shown in Table II. In the SRS, hopelessness and the helplessness scores were highly significantly positively correlated with the MADRS in the HSS, BBD and BC groups. In the SRS, the weighted kappa values for hopelessness and helplessness versus the MADRS in the HSS, BBD and BC groups were also statistically significant.

The Spearman correlation coefficients and kappa values between hopelessness/helplessness by the ERS versus MADRS in the HSS, BBD and BC groups are also shown in Table II. There was also a significant positive correlation of ERS for hopelessness with the MADRS in the HSS, BBD and BC groups and of the ERS for helplessness with the MADRS in the HSS, BBD and BC groups. The unweighted kappa values between the ERS for hopelessness and the MADRS in the HSS, BBD and BC groups were statistically highly significant and those between the ERS for helplessness and the MADRS in the HSS and BBD groups were statistically significant.

Figure 1 shows the scatter plots of the individual values of the SRS and the ERS measuring hopelessness and helplessness versus MADRS as a continuous variable for the HSS, BBD and BC groups.

Discussion

The MADRS is one of the most widely used and validated rating scales monitoring the severity of depression (51-55). A higher MADRS score indicates more severe depression. There is also a self-rating version of this scale (MADRS-S) available for rapid screening of depression even in family practice and the MADRS-S correlates reasonably well with physicians' ratings (54). The MADRS is a short and concise scale designed to follow symptoms identified as selective and sensitive. The MADRS is a good instrument for the prediction of the treatment response to modern anti depressive medicines in patients with depression (55). Hermens et al. compared a face-to-face MADRS scale with a telephone MADRS rating in 66 primary-care patients with minor or mild/major depression (56). During a face-to-face interview at the patient's home a trained interviewer administered the MADRS rating. A few days later the MADRS rating was administered again but by telephone and by a different interviewer. The intra-class correlation coefficient (ICC) for the full rating was 0.65 and Hermens et al. concluded that the MADRS rating can be reliably administered by telephone.

The most common correlation coefficient is Pearson's correlation coefficient. However, the Pearson correlation coefficient is sensitive only to a linear relationship between two variables. Spearman's correlation coefficient is a rank correlation coefficient measuring the extent to which as one variable increases the other variable tends to increase. From a mathematical point of view, Spearman's correlation coefficient measures a different type of relationship from that by Pearson's correlation coefficient.

Although there are no previous reports with this study design available for sufficient comparison, some reports of the MADRS versus hopelessness/helplessness scoring can be obtained. In earlier studies, hopelessness was found to be associated with depression (57-59), and in a non-clinical cohorts it has been shown to be a predictor of depressive symptoms in the future (60, 61). It has been suggested that the identification of hopeless/helpless persons is essential in suicide prevention and it is important to assess and treat hopelessness/helplessness even though an individual may reports few depressive symptoms.

We assessed hopelessness/helplessness scoring versus the Beck Depression Inventory (BDI) in BC and BBD, and in HSS. Our results suggested a specific link between hopelessness/helplessness scores and the BDI in breast disease (62). However, the BDI is a self-rating scale, and relatively little is known about hopelessness/helplessness scores versus MADRS depression scale in breast cancer diagnosis. The purpose of the present study was to investigate scoring of hopeles sness/helplessness compared to the MADRS in BC dia gnosis and thus to increase awareness of this issue, since this knowledge may be useful in preventive health care. This study shows that hopelessness and helplessness scores in the BC, BBD and HSS groups are reliably related to MADRS classification. We have earlier discussed that the development of suitable criteria for the identification of clinical symptoms and signs may lead to the reduction of the variability between observers (63, 64).

Conclusion

A new finding with clinical relevance in the present work is the agreement between hopelessness/helplessness scores and MADRS in the SRS and ERS. In the breast cancer diagnostic Unit, the identification of hopeless/helpless persons is essential in suicide prevention and it is important to assess and treat hopelessness/helplessness even though an individual may report few depressive symptoms.

Acknowledgements

The support from the Academy of Finland, Paavo Koistinen Foundation and EVO funds from Kuopio University Hospital is gratefully acknowledged. The Authors would also like to thank Ms A.K. Lyytinen, R.N. for help in data collection and Ms E. Oittinen for excellent technical assistance.

Footnotes

  • This article is freely accessible online.

  • Conflicts of Interest

    No conflicts of interest exists. The Authors alone are responsible for the content and writing of this article.

  • Received January 8, 2015.
  • Revision received January 26, 2015.
  • Accepted January 28, 2015.

References

  1. ↵
    1. Breitbart W,
    2. Rosenfeld B,
    3. Pessin H,
    4. Kaim M,
    5. Funesti-Esch J,
    6. Galietta M,
    7. Nelson CJ,
    8. Brescia R
    : Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284: 2907-2911, 2000.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Haatainen K,
    2. Tanskanen A,
    3. Kylmä J,
    4. Antikainen R,
    5. Hintikka J,
    6. Honkalampi K,
    7. Koivumaa-Honkanen H,
    8. Viinamäki H
    : Life events are important in the course of hopelessness-a 2-year follow-up study in a general population. Soc Psychiatry Psychiatr Epidemiol 38: 436-441, 2003.
    OpenUrlCrossRefPubMed
    1. Haatainen K,
    2. Tanskanen A,
    3. Kylmä J,
    4. Honkalampi K,
    5. Koivumaa-Honkanen H,
    6. Hintikka J,
    7. Viinamäki H
    : Factors associated with hopelessness-a population study. Int J Soc Psychiatry, 50: 142-152, 2004.
    OpenUrlAbstract/FREE Full Text
    1. Dunn SL
    : Hopelessness as a response to physical Illness. J Nurs Scholarship 37: 148-154, 2005.
    OpenUrlCrossRef
    1. Hirsch JK,
    2. Conner KR
    : Dispositional and explanatory style optimism as potential moderators of the relationship between hopelessness and suicidal ideation. Suicide Life Threat Behav 36: 661-669, 2006.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Valtonen M,
    2. Laaksonen D,
    3. Tolmunen T,
    4. Nyyssönen K,
    5. Viina mäki H,
    6. Kauhanen J,
    7. Niskanen L
    : Hopelessness-novel facet of the metabolic syndrome. Scand J Public Health 36: 795-802, 2008.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Hintikka J,
    2. Honkalampi K,
    3. Lehtonen J,
    4. Viinamäki H
    : Are alexithymia and depression distinct or overlapping constructs? A study in general population. Compr Psychiatry 42: 234-239, 2001.
    OpenUrlPubMed
  8. ↵
    1. Klerman GL,
    2. Weissman MM
    : Increasing rates of depression. JAMA 261: 2229-2235, 1989.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Eskelinen M,
    2. Ollonen P
    : Measurement of pessimism: hopelessness scale in healthy study subjects, and in patients with benign breast disease and breast cancer: A prospective case-control study in Finland. Anticancer Res 31: 4019-4023, 2011.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Eskelinen M,
    2. Korhonen R,
    3. Selander T,
    4. Ollonen P
    : The Self-Rating Score (SRS) versus the Examiner Rating Score (ERS) in measuring helplessness in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland. Anticancer Res 34: 5677-5682, 2014.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Ell K,
    2. Sanchez K,
    3. Vourlekis B,
    4. Lee P-J,
    5. Dwight-Johnson M,
    6. Lagomasino I,
    7. Muderspach L,
    8. Russell C
    : Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. J Clin Oncol 23: 3052-3060, 2005.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Montgomery SA,
    2. Asberg M
    : A new depression scale to be sensitive to change. Br J Psych 134: 382-389, 1979.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Key JA,
    2. Verkasalo PK,
    3. Banks E
    : Epidemiology of breast cancer. Lancet Oncol 2: 133-140, 2001.
    OpenUrlCrossRefPubMed
  14. ↵
    1. Aaltomaa S,
    2. Lipponen P,
    3. Eskelinen M,
    4. Kosma VM,
    5. Marin S,
    6. Alhava E,
    7. Syrjänen K
    : Hormone receptors as prognostic factors in female breast-cancer. Ann Med 23: 643-648, 1991.
    OpenUrlPubMed
    1. Zhu ZR,
    2. Agren J,
    3. Männistö S,
    4. Pietinen P,
    5. Eskelinen M,
    6. Syrjanen K,
    7. Uusitupa
    : Fatty-acid composition of breast adipose-tissue in breast cancer patients and in patients with benign breast disease. Nutr Cancer 24: 151-160, 1995.
    OpenUrlPubMed
    1. Mitrunen K,
    2. Kataja V,
    3. Eskelinen M,
    4. Kosma VM,
    5. Kang D,
    6. Benhamou S,
    7. Vainio H,
    8. Uusitupa M,
    9. Hirvonen A
    : Combined COMT and GST genotypes and hormone replacement therapy-associated breast cancer risk. Pharmacogenetics 12: 67-72, 2002.
    OpenUrlCrossRefPubMed
  17. ↵
    1. Eskelinen M,
    2. Norden T,
    3. Lindgren A,
    4. Wide L,
    5. Adami HO,
    6. Holmberg L
    : Preoperative serum levels of follicle-stimulating hormone (FSH) and prognosis in invasive breast cancer. Eur J Surg Oncology 30: 495-500, 2004.
    OpenUrl
  18. ↵
    1. Pietiläinen T,
    2. Lipponen P,
    3. Aaltomaa S,
    4. Eskelinen M,
    5. Kosma V-M,
    6. Syrjänen K
    : Expression of retinoblastoma gene protein (RB) in breast cancer as related to established prognostic factors and survival. Eur J Cancer 31: 329-333, 1995.
    OpenUrlCrossRef
    1. Metsola K,
    2. Kataja V,
    3. Sillanpää P,
    4. Siivola P,
    5. Heikinheimo L,
    6. Eskelinen M,
    7. Kosma VM,
    8. Uusitupa M,
    9. Hirvonen A
    : XRCC1 and XPD genetic polymorphisms, smoking and breast cancer risk in a Finnish case-control study. Breast Cancer Research 7: R987-997, 2005.
    OpenUrlCrossRefPubMed
  20. ↵
    1. Sillanpää P,
    2. Hirvonen A,
    3. Kataja V,
    4. Eskelinen M,
    5. Kosma V-M,
    6. Uusitupa M,
    7. Vainio H,
    8. Mitrunen K
    : NAT2 slow acetylator genotype as an important modifier of breast cancer risk. Int J Cancer 114: 579-584, 2005.
    OpenUrlCrossRefPubMed
  21. ↵
    1. Chen CC,
    2. David AS,
    3. Nunnerley H,
    4. Michell M,
    5. Dawson JL,
    6. Berry H,
    7. Dobbs J,
    8. Fahy T
    : Adverse life events and breast cancer: case-control study. BMJ 311: 1527-1530, 1995.
    OpenUrlAbstract/FREE Full Text
    1. Roberts FD,
    2. Newcomb PA,
    3. Trentham-Dietz A,
    4. Storer BE
    : Self-reported stress and risk of breast cancer. Cancer 77: 1089-1093, 1996.
    OpenUrlCrossRefPubMed
    1. Protheroe D,
    2. Turvey K,
    3. Horgan K,
    4. Benson E,
    5. Bowers D,
    6. House A
    : Stressful life events and difficulties and onset of breast cancer: case-control study. BMJ 319: 1027-1030, 1999.
    OpenUrlAbstract/FREE Full Text
    1. Price MA,
    2. Tennant CC,
    3. Butow PN,
    4. Smith RC,
    5. Kennedy SJ,
    6. Kossoff MB,
    7. Dunn SM
    : The role of psychosocial factors in the development of breast carcinoma: Part II. Life event stressors, social support, defense style, and emotional control and their interactions. Cancer 91: 686-697, 2001.
    OpenUrlCrossRefPubMed
    1. Duijts SFA,
    2. Zeegers MPA,
    3. VD Borne B
    : The association between stressful life events and breast cancer risk: a meta-analysis. Int J Cancer 107: 1023-10, 2003.
    OpenUrlCrossRefPubMed
    1. Ollonen P,
    2. Lehtonen J,
    3. Eskelinen M
    : Stressful and adverse life experiences in patients with breast symptoms; a prospective case-control study in Kuopio, Finland. Anticancer Res 25: 531-536, 2005.
    OpenUrlAbstract/FREE Full Text
    1. Ollonen P,
    2. Lehtonen J,
    3. Eskelinen M
    : Anxiety, depression and the history of psychiatric symptoms in patients with breast disease: a prospective case-control study in Kuopio, Finland. Anticancer Res 25: 2527-2534, 2005.
    OpenUrlAbstract/FREE Full Text
    1. Ollonen P,
    2. Lehtonen J,
    3. Eskelinen M
    : Coping and defending as risk factors for breast cancer in patients with breast disease: a prospective case-control study in Kuopio, Finland. Anticancer Res 25: 4623-4630, 2005.
    OpenUrlAbstract/FREE Full Text
    1. Ollonen P,
    2. Eskelinen M
    : Idealization as risk factor for breast cancer in patients with breast disease: a prospective case-control study in Kuopio, Finland. Anticancer Res 27: 1625-1630, 2007.
    OpenUrlAbstract/FREE Full Text
    1. Ginzburg K,
    2. Wrensch M,
    3. Rice T,
    4. Farren G,
    5. Spiegel D
    : Breast cancer and psychosocial factors: early stressful life events, social support, and well-being. Psychosomatics 49: 407-412, 2008.
    OpenUrlCrossRefPubMed
    1. Eskelinen M,
    2. Ollonen P
    : Psychosocial risk scale (PRS) for breast cancer in patients with breast disease: a prospective case-control study in Kuopio, Finland. Anticancer Res 29: 4765-4770, 2009.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : The body image drawing analysis in women with breast disease and breast cancer: anxiety, colour and depression categories. Anticancer Res 30: 683-691, 2010.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Evaluation of women with breast disease using body image drawing analysis. Anticancer Res 30: 2399-2406, 2010.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Life stress due to losses and deficit in childhood and adolescence as breast cancer risk factor: a prospective case-control study in Kuopio, Finland. Anticancer Res 30: 4303-4308, 2010.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Life stress and losses and deficit in adulthood as breast cancer risk factor: a prospective case-control study in Kuopio, Finland. In Vivo 24: 899-904, 2010.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Beck Depression Inventory (BDI) in patients with breast disease and breast cancer: a prospective case-control study. In Vivo 25: 111-116, 2011.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Forsen Psychological Risk Inventory for breast cancer patients: a prospective case-control study with special reference to the use of psychiatric medications. Anticancer Res 31: 739-744, 2011.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Montgomery-Asberg depression rating scale (MADRS) in healthy study subjects, in patients with breast disease and breast cancer: a prospective case-control study. Anticancer Res 31: 1065-1069, 2011.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Assessment of general anxiety in patients with breast disease and breast cancer using the Spielberger STAI self evaluation test: a prospective case-control study in Finland. Anticancer Res 31: 1801-1806, 2011.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Sifneos Alexithymia Questionnaire in assessment of general alexithymia in patients with breast disease and breast cancer: a prospective case-control study in Finland. Anticancer Res 31: 3101-3106, 2011.
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Ollonen P
    : Assessment of ‘cancer-prone personality’ characteristics in healthy study subjects and, in patients with breast disease and breast cancer using the Commitment Questionnaire: A prospective case-control study in Finland. Anticancer Res 31: 4013-4017, 2011.
    OpenUrlAbstract/FREE Full Text
  42. ↵
    1. Kruk J
    : Self-reported psychosocial stress and the risk of breast cancer: A case-control study. Stress 15: 162-171, 2012.
    OpenUrlPubMed
  43. ↵
    1. Boyle P
    : SEARCH programme of the International Agency for Research on Cancer. Eur J Cancer 26: 547-549, 1990.
    OpenUrlCrossRefPubMed
  44. ↵
    1. Eskelinen MJ,
    2. Pajarinen P,
    3. Collan Y,
    4. Pesonen E,
    5. Alhava E,
    6. Kettunen K,
    7. Nordling S
    : Relationship between DNA ploidy and survival in patients with primary breast cancer. Br J Surg 76: 830-834, 1989.
    OpenUrlPubMed
  45. ↵
    1. Eskelinen MJ,
    2. Lipponen PK,
    3. Collan Y,
    4. Syrjänen KJ
    : The role of nucleolar organizer regions as prognostic factors in breast cancer. Eur J Cancer 27: 989-992, 1991.
    OpenUrlPubMed
  46. ↵
    1. Mitrunen K,
    2. Jourenkova N,
    3. Kataja V,
    4. Eskelinen M,
    5. Kosma VM,
    6. Benhamou S,
    7. Vainio H,
    8. Uusitupa M,
    9. Hirvonen A
    : Steroid metabolism gene CYP17 polymorphism and the develop ment of breast cancer. Cancer Epidemiol Biomarkers Prev 9: 1343-1348, 2000.
    OpenUrlAbstract/FREE Full Text
  47. ↵
    1. Mitrunen K,
    2. Jourenkova N,
    3. Kataja V,
    4. Eskelinen M,
    5. Kosma VM,
    6. Benhamou S,
    7. Vainio H,
    8. Uusitupa M,
    9. Hirvonen A
    : Glutathione-S-transferase M1, M3, P1 and T1 genetic polymorphism and susceptibility to breast cancer. Cancer Epidemiol Biomarkers Prev 10: 229-236, 2001.
    OpenUrlAbstract/FREE Full Text
  48. ↵
    1. Cohen J
    : A coefficient of agreement for nominal scales. Educ Psychol Meas 20: 37-46, 1960.
    OpenUrlCrossRef
  49. ↵
    1. Boyd NF,
    2. Pater JL,
    3. Ginsburg AD,
    4. Myers RE
    : Observer variation in the classification of information from medical records. J Chron Dis 32: 327-332, 1979.
    OpenUrlCrossRef
  50. ↵
    1. Cohen J
    : Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70: 213-220, 1968.
    OpenUrlCrossRefPubMed
  51. ↵
    1. Maier W,
    2. Philipp M
    : Comparative analysis of observer depression scales. Acta Psychiatr Scand 72: 239-245, 1985.
    OpenUrlCrossRefPubMed
    1. Svanborg P,
    2. Åsberg M
    : A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Åsberg Depression Rating Scale (MADRS). J Affect Disord 64: 203-216, 2001.
    OpenUrlCrossRefPubMed
    1. Williams JBW,
    2. Kobak KA
    : Development and reliability of a structured interview guide for the Montgomery-Åsberg Depression Rating Scale (SIGMA). BJP 192: 52-58, 2008.
    OpenUrl
  54. ↵
    1. Cunningham JL,
    2. Wernroth L,
    3. von Knorring L,
    4. Berglund L,
    5. Ekselius L
    : Agreement between physicians' and patients rating on the Montgomery-Åsberg Depression Rating Scale. J Affect Disord 135: 148-153, 2011.
    OpenUrlCrossRefPubMed
  55. ↵
    1. Takahashi H,
    2. Yoshida K,
    3. Higuchi H,
    4. Kamata M,
    5. Inoue K,
    6. Suzuki T,
    7. Ishigooka J
    : Bcl1 Polymorphism of the Glucocorticoid Receptor Gene and Treatment Response to Milnacipran and Fluvoxamine in Japanese Patients with Depression. Neuropsycho biology 70: 173-180, 2014.
    OpenUrl
  56. ↵
    1. Hermens MLM,
    2. Ader HJ,
    3. van Hout HPJ,
    4. Terluin B,
    5. van Dyck R,
    6. de Haan M
    : Administering the MADRS by telephone or face-to-face: a validity study. Ann Gen Psych 5: 3, 2006 doi:10.1186/1744-859X-5-3
    OpenUrl
  57. ↵
    1. Prezant DW,
    2. Neimeyr RA
    : Cognitive predictors of depression suicide ideation. Suicide Life Threat Behav 18: 259-264, 1988.
    OpenUrlPubMed
    1. Nimeus A,
    2. Träskman-Bendz L,
    3. Alsen M
    : Hopelessness and suicidal behaviour. J Affect Disord 42: 137-144, 1997.
    OpenUrlCrossRefPubMed
  59. ↵
    1. Reich M,
    2. Lesur A,
    3. Perdrizet-Chevallier C
    : Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat 110: 9-17, 2008.
    OpenUrlCrossRefPubMed
  60. ↵
    1. Riskind JH,
    2. Rholes WS
    : Cognitive model of depression and mood-induction procedures. Behav Res Ther 23: 663-666, 1985.
    OpenUrlPubMed
  61. ↵
    1. Alford BA,
    2. Lester JM,
    3. Patel RJ,
    4. Buchanan JP,
    5. Giunta LC
    : Hopelessness predicts future depressive symptoms: a prospective analysis of cognitive vulnerability and cognitive content specificity. J Clin Psychol 51: 331-339, 1995.
    OpenUrlPubMed
  62. ↵
    1. Eskelinen M,
    2. Korhonen R,
    3. Selander T,
    4. Ollonen P
    : The relation of hopelessness/helplessness versus Beck Depression Inventory (BDI) in healthy individuals and in patients with benign breast disease and breast cancer: a prospective case-control study in Finland. Anticancer Res 35: 941-948, 2015.
    OpenUrlAbstract/FREE Full Text
  63. ↵
    1. Eskelinen M,
    2. Ollonen P
    : Contribution of emotional distance and reserve in patient-physician communication in healthy study patients, and in patients with benign breast disease and breast cancer: A prospective case-control study in Finland. Anticancer Res 34: 1269-1274, 2014.
    OpenUrlAbstract/FREE Full Text
  64. ↵
    1. Eskelinen M,
    2. Korhonen R,
    3. Selander T,
    4. Ollonen P
    : Emotional personality/proximity versus emotional authenticity in patient-physician communication in healthy study participants, and in patients with benign breast disease and breast cancer: A prospective case-control study in Finland. Anticancer Res 35: 1627-1634, 2015.
    OpenUrlAbstract/FREE Full Text
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Agreement Between Hopelessness/Helplessness and Montgomery-Asberg Depression Rating Scale in Healthy Individuals and in Patients with Benign Breast Disease and Breast Cancer: A Prospective Case-Control Study in Finland
MATTI ESKELINEN, RIIKA KORHONEN, TUOMAS SELANDER, PAULA OLLONEN
Anticancer Research Apr 2015, 35 (4) 2215-2221;
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