Assessment of mental well-being and psychological distress in Moroccan breast cancer patients

Haddou, Meryam Belhaj; El Mouaddib, Hicham; Haddou, Zakaria Belhaj; Khouchani, Mouna; Khoudri, Noureddine El

doi:10.1590/1980-5764-DN-2024-0145

Brasil

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Original Article • Dement. neuropsychol. 18 • 2024 • https://doi.org/10.1590/1980-5764-DN-2024-0145 linkcopy

Assessment of mental well-being and psychological distress in Moroccan breast cancer patients

Avaliação do bem-estar mental e angústia psicológica em pacientes marroquinas com câncer de mama

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The quality of life of breast cancer patients is strongly affected by physical pain, psychological distress, and uncertainty about vital prognosis.

Objective: To assess breast cancer patients’ mental well-being and level of psychological distress at the Mohammed VI University Hospital in Marrakech.

Methods: Cross-sectional study carried out from April to December 2023 at the Mohammed VI University Hospital of Marrakech. The data were collected via a questionnaire comprising a sociodemographic section and a section reserved for the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Kessler Psychological Distress Scale (K10). Data analysis was performed using SPSS software, version 25.

Results: A total of 38.3% of patients experienced severe psychological distress. However, their mental well-being was high with a mean of 54.59 (±11.29). Older patients (>50 years) exhibited better mental well-being (56.46±10.39 vs. 52.99±11.81; p=0.020) and lower psychological distress (26.27±7.21 vs. 28.44±8.19; p=0.034) compared to their younger counterparts (≤50 years). As for the stage of cancer, patients with localized cancer presented a higher mental well-being score than patients with metastatic cancer (55.53±10.93 vs. 50.40±12.03; p=0.008). However, no statistically significant difference was recorded between mastectomy and lumpectomy patients regarding mental well-being or psychological distress.

Conclusion: Breast cancer has not only a physical but also a psychological and emotional impact on patients. Thus, early diagnosis and referral to appropriate psychosocial services can improve patients’ mental well-being.

Keywords: Breast Neoplasms; Mastectomy; Mastectomy, Segmental; Psychological Distress; Quality of Life; Psychological Well-Being

Variables	Modalities	All (n=230) n (%)	Mastectomy (n=116) n (%)	Lumpectomy (n=114) n (%)	p-value
Age (years)	≤50	124 (53.9)	55 (47.4)	69 (60.5)	0.046 ^* * χ2 test;
Age (years)	>50	106 (46.1)	61 (52.6)	45 (39.5)	0.046 ^* * χ2 test;
Marital status	Married	145 (63.0)	69 (59.5)	76 (66.7)	0.003 ^* * χ2 test;
	Single	26 (11.3)	10 (8.6)	16 (14.0)
	Divorced	23 (10.0)	9 (7.8)	14 (12.3)
	Widow	36 (15.7)	28 (24.1)	8 (7.0)
Level of education	Uneducated	84 (36.5)	44 (37.9)	40 (35.1)	0.002 ^† † Fisher's exact test.
	Koranic level	33 (14.3)	25 (21.6)	8 (7.0)
	Primary	55 (23.9)	29 (25.0)	26 (22.8)
	Middle/High School	47 (20.4)	17 (14.7)	30 (26.3)
	University	11 (4.8)	1 (0.9)	10 (8.8)
Number of children	No children	30 (13.0)	12 (10.3)	18 (15.8)	0.065^* * χ2 test;
	1–3	102 (44.3)	46 (39.7)	56 (49.1)
	≥4	98 (42.6)	58 (50.0)	40 (35.1)
Habitat	Urban	147 (63.9)	72 (62.1)	75 (65.8)	0.557^* * χ2 test;
Habitat	Rural	83 (36.1)	44 (37.9)	39 (34.2)	0.557^* * χ2 test;
Live	With family	141 (61.3)	67 (57.8)	74 (64.9)	0.265^* * χ2 test;
Live	Alone	89 (38.7)	49 (42.2)	40 (35.1)	0.265^* * χ2 test;
Work	Yes	50 (21.7)	24 (20.7)	26 (22.8)	0.697^* * χ2 test;
Work	No	180 (78.3)	92 (79.3)	88 (77.2)	0.697^* * χ2 test;
Health coverage	Yes	178 (77.4)	89 (76.7)	89 (78.1)	0.638^* * χ2 test;
Health coverage	No	52 (22.6)	27 (23.3)	25 (21.9)	0.638^* * χ2 test;
Monthly income	No Income	180 (78.3)	93 (80.2)	87 (76.3)	0.033 ^† † Fisher's exact test.
	<2500 Dhs	24 (10.4)	16 (13.8)	8 (7.0)
	2500-5000 Dhs	20 (8.7)	6 (5.2)	14 (12.3)
	5000-7000 Dhs	6 (2.6)	1 (0.9)	5 (4.4)

Variables	Modalities	All (n=230) n (%)	Mastectomy (n=116) n (%)	Lumpectomy (n=114) n (%)	p-value*
Time since diagnosis	≤2 years	92 (40.0)	49 (42.2)	43 (37.7)	0.484
Time since diagnosis	>2 years	138 (60.0)	67 (57.8)	71 (62.3)	0.484
Associated pathologies	Yes	101 (43.9)	63 (54.3)	38 (33.3)	0.001
Associated pathologies	No	129 (56.1)	53 (45.7)	76 (66.7)	0.001
Family antecedents of cancer	Yes	113 (49.1)	58 (50.0)	55 (48.2)	0.790
Family antecedents of cancer	No	117 (50.9)	58 (50.0)	59 (51.8)	0.790
Cancer stage	Metastatic	42 (18.3)	37 (31.9)	5 (4.4)	0.004
Cancer stage	Located	188 (81.7)	79 (68.1)	109 (95.6)	0.004
Chemotherapy	Yes	175 (76.1)	110 (94.8)	65 (57.0)	0.000
Chemotherapy	No	55 (23.9)	6 (5.2)	49 (43.0)	0.000
Radiotherapy	Yes	155 (67.4)	58 (50.0)	97 (85.1)	0.000
Radiotherapy	No	75 (32.6)	58 (50.)	17 (14.9)	0.000
Hormonotherapy	Yes	94 (40.9)	58 (50.0)	36 (31.6)	0.000
Hormonotherapy	No	136 (59.1)	58 (50.0)	78 (68.4)	0.000

WEMWBS		All (n=230) Mean (SD)	Mastectomy (n=116) Mean (SD)	Lumpectomy (n=114) Mean (SD)	p-value
WEMWBS		54.59 (11.29)	53.45 (11.02)	55.74 (11.48)	0.077^* * Mann-Whitney U test;
K10	Probability of being in good health	34 (14.8)	15 (12.9)	19 (16.7)	0.217^† † χ2 test.
	Probability of suffering from a mild disorder	46 (20.0)	20 (17.2)	26 (22.8)
	Probability of suffering from a moderate disorder	62 (27.0)	38 (32.8)	24 (21.1)
	Probability of suffering from a severe disorder	88 (38.3)	43 (37.1)	45 (39.5)

		WEMWBS	K10
WEMWBS	Pearson correlation	1	-.478^* * The correlation is significant at the 0.010 (bilateral);
	Sig, (bilateral)		<0.001 ^† † The correlation is significant at the 0.050 (bilateral).
	number	230	230
K10	Pearson Correlation	-0.478^* * The correlation is significant at the 0.010 (bilateral);	1
	Sig, (bilateral)	<0.001 ^† † The correlation is significant at the 0.050 (bilateral).
	number	230	230

Variables	Scales	Modalities	Mean (SD)	p-value^* * Student's t-test.
Age	WEMWBS	≤50 years	52.99 (11.81)	0.020
	WEMWBS	>50 years	56.46 (10.39)	0.020
	K-10	≤50 years	28.44 (8.19)	0.034
	K-10	>50 years	26.27 (7.21)	0.034
Marital status	WEMWBS	Married	54.72 (9.68)	0.785
	WEMWBS	Not married	54.36 (13.67)	0.785
	K-10	Married	27.64 (7.89)	0.630
	K-10	Not married	27.09 (7.72)	0.630
Level of education	WEMWBS	Instructed	55.66 (10.65)	0.057
	WEMWBS	Uninstructed	53.56 (11.83)	0.057
	K-10	Instructed	26.83 (7.27)	0.269
	K-10	Uninstructed	28.03 (8.29)	0.269
Number of children	WEMWBS	No children	53.9 (14.1)	0.522
	WEMWBS	Has children	54.7 (10.85)	0.522
	K-10	No children	27.27 (7.71)	0.674
	K-10	Has children	27.47 (7.85)	0.674
Habitat	WEMWBS	Urban	54.95 (11.2)	0.520
	WEMWBS	Rural	53.95 (11.49)	0.520
	K-10	Urban	26.86 (7.8)	0.133
	K-10	Rural	28.47 (7.78)	0.133
Live alone	WEMWBS	With family	54.22 (11.95)	0.531
	WEMWBS	Alone	55.18 (10.21)	0.531
	K-10	With family	28.18 (8.58)	0.071
	K-10	Alone	26.27 (6.28)	0.071
Work	WEMWBS	Yes	53.26 (11.81)	0.347
	WEMWBS	No	54.96 (11.15)	0.347
	K-10	Yes	27.1 (7.28)	0.729
	K-10	No	27.53 (7.97)	0.729
Monthly income	WEMWBS	No Income	54.92 (10.93)	0.114
	WEMWBS	At monthly income	53.4 (12.55)	0.114
	K-10	No Income	27.66 (7.94)	0.827
	K-10	At monthly income	26.64 (7.35)	0.827
Health coverage	WEMWBS	No coverage	51.9 (10.73)	0.112
	WEMWBS	Health coverage	55.38 (11.36)	0.112
	K-10	No coverage	29.19 (8.04)	0.391
	K-10	Health coverage	26.93 (7.69)	0.391

Variables	Scales	Modalities	Mean (SD)	p-value^* * Student's t-test.
Duration of the disease	WEMWBS	≤2years	54.05 (12.69)	0.557
	WEMWBS	>2years	54.95 (10.29)	0.557
	K-10	≤2years	28.07 (8.46)	0.322
	K-10	>2years	27.02 (7.36)	0.322
Associated pathologies	WEMWBS	Yes	53.52 (12.09)	0.206
	WEMWBS	No	55.43 (10.6)	0.206
	K-10	Yes	28.38 (8.01)	0.108
	K-10	No	26.71 (7.6)	0.108
Family antecedents of cancer	WEMWBS	Yes	55.77 (11.2)	0.120
	WEMWBS	No	53.45 (11.31)	0.120
	K-10	Yes	27.68 (8.32)	0.645
	K-10	No	27.21 (7.32)	0.645
Chemotherapy	WEMWBS	Yes	54.75 (11.45)	0.697
	WEMWBS	No	54.07 (10.85)	0.697
	K-10	Yes	27.18 (7.6)	0.366
	K-10	No	28.27 (8.49)	0.366
Radiotherapy	WEMWBS	Yes	55.28 (11.08)	0.186
	WEMWBS	No	53.17 (11.67)	0.186
	K-10	Yes	27.28 (7.7)	0.653
	K-10	No	27.77 (8.08)	0.653
Hormonotherapy	WEMWBS	Yes	54.97 (11.09)	0.675
	WEMWBS	No	54.33 (11.46)	0.675
	K-10	Yes	27.02 (7.82)	0.502
	K-10	No	27.73 (7.82)	0.502
Cancer stage	WEMWBS	Metastatic	50.4 (12.03)	0.008
	WEMWBS	Located	55.53 (10.93)	0.008
	K-10	Metastatic	28.62 (8.43)	0.280
	K-10	Located	27.18 (7.67)	0.280

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[TFN1] Abbreviations: Dhs, Dirham Moroccan currency.

[TFN2] Notes: Bold indicates p-value<0.05.

[TFN3] ^*
χ² test;

[TFN4] ^†
Fisher's exact test.