A longitudinal study of emotional distress and the use of complementary and alternative medicine in women with breast cancer

Abstract

This longitudinal study explored emotional distress, coping response and complementary and alternative medicine (CAM) use at two time points early after diagnosis with breast cancer. Participants were women of Caucasian, Native Hawaiian, Japanese, and other Asian (Chinese, Filipino and Korean) ethnicities living in Hawaii and recruited through two breast cancer clinics and the American Cancer Society. Self-report questionnaires included the State-Trait Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, the Mental Adjustment to Cancer scale, a measure of CAM use designed for the study, and questions about demographics and treatment history. Seventy-one women completed the survey at T1 (on average three months post-diagnosis), and 40 women completed the follow-up survey at T2 (nine months post-diagnosis). Eighty-seven percent of participants used at least one CAM therapy, averaging 3.3 (SD=2.9) different types of CAM at T1 and 3.8 (SD=2.7) at T2. Thirty-six percent of participants reached suggested cut-offs for worse psychological functioning on one or more scales. Cross-sectional and repeated measures analysis found no effect for anxiety or depression at T1 and T2 on CAM use at either time point. Rather, coping response, specifically anxious preoccupation, as well as younger age and single marital status emerged as significant correlates of greater CAM use. In multiple regression analysis, earlier CAM use was related to later anxiety and depression, with the effect varying by type of CAM used. Specifically, greater use at T1 of alternative medical systems was related to significantly worse anxiety and depression scores at T2. In contrast, greater use at T1of biologically based treatments was related to significantly better anxiety and depression scores at T2. Greater use at T1 of energy therapies also was related to significantly worse anxiety scores but not depression scores at T2. While not significant, greater use at T1 of mind-body therapies approached significance as a correlate of less anxiety but not depression at T2. The results contradict and expand on previous research looking at emotional distress as a predictor of CAM use. Further studies should focus on factors influencing psychological outcomes correlated with different kinds of CAM therapies.