臺灣博碩士論文加值系統

研究背景與動機
癌症病患罹患憂鬱症是一般人的三倍，約有20~25%的癌症病患曾經有憂鬱的情況發生，隨著疾病的發展過程，其憂鬱症盛行率會增加至77%。更有研究指出憂鬱症在肝癌病患中的發病率明顯高於一般人及一般慢性疾病患者(包括其他癌症類別之患者)，約有83%肝癌病患在疾病過程中，曾產生憂鬱的狀態，顯示肝癌病患之憂鬱發生率相當高。而肝癌患者所經歷之疾病症狀與癌症相關治療，以及未來可能面臨復發與死亡的威脅，都會造成心理的壓力，此外，癌症病患若合併憂鬱的症狀，亦會影響其存活率，由此可見，肝癌與精神疾病之相關議題，相當值得研究與探討。
研究目的
一、探討肝癌病患確診後有無合併焦慮症、憂鬱症與其人口學特性、臨床特性之相關因子。
二、探討肝癌病患確診後有無合併焦慮症、憂鬱症，對於醫療資源利用之差異。
三、探討肝癌病患確診後有無合併焦慮症、憂鬱症，對於存活情形之差異。
研究方法
本研究採用次級資料分析法，以回溯性縱貫研究(Longitudinal study)，根據1996年至2010年全民健康保險研究資料庫-百萬抽樣歸人檔，研究對象為CD檔及DD檔ICD-9-CM前三碼為155者，篩選出之原發性肝癌病患，依所需資料根據1996年至2010年全民健康保險研究資料庫-百萬抽樣歸人檔之門診處方及治療明細檔(CD檔)、住院醫療費用清單明細檔(DD檔)、承保資料檔(ID檔)、醫事機構基本資料檔(HOSB檔)、醫事人員基本資料主檔(PER檔)之資料庫進行串聯，最後利用SPSS 19.0版統計套裝軟體，進行統計分析，以SAS 9.3版進行研究樣本傾向分數配對。
研究結果
研究對象總共10,025人，其中焦慮症組為2,686人、憂鬱症組為35人、焦慮&憂鬱症組為223人，和無精神疾病組為7,081人。
一、年齡(OR=1.01，p<0.001)與有無化療(OR=1.45，p<0.001)與焦慮症呈現正相關，性別(OR=0.52，p<0.001)、合併症嚴重度指數(OR=0.93，p<0.001)、有無肝硬化(OR=0.67，p<0.001)、有無呼吸系統疾病(OR=0.78，p=0.019)、以及有無症狀_徵兆和不明原因(OR=0.78，p=0.001)與焦慮症呈現負相關。人口學特性、臨床特性與發生憂鬱症未存有相關性。性別(OR=0.55，p<0.001)、合併症嚴重度指數(OR=0.88，p=0.015)以及有無肝硬化(OR=0.65，p=0.004)，與焦慮&憂鬱症呈現負相關。
二、門診次數部分，與無精神疾病組相較之下，焦慮症組患者一、三、五年門診次數分別顯著多20次、38次、52次；憂鬱症組患者一、三、五年門診次數分別顯著多19次、31次、33次；焦慮&憂鬱症組患者一、三、五年門診次數分別顯著多46次、75次、88次。在門診費用部分，焦慮症組患者一、三、五年門診費用分別顯著多15,659元、31,949元、46,303元；憂鬱症組患者一、三、五年門診費用分別顯著多85,293元、126,417元、139,889元；焦慮&憂鬱症組患者一、三、五年門診費用分別顯著多50,803元、89,624元、102,024元。
三、住院天數部分，與無精神疾病組相較之下，憂鬱症組患者一、三、五年住院天數分別顯著多28天、33天、34天；焦慮&憂鬱症組患者一、三、五年住院天數分別顯著多10天、14天、17天。在住院費用部分，憂鬱症組患者一、三、五年住院費用分別顯著多110,857元、151,821元、159,958元；焦慮&憂鬱症組患者一、三、五年住院費用分別顯著多47,275元、58,007元、63,405元。
四、總醫療費用部分，與無精神疾病組相較之下，焦慮症組患者一、三、五年總醫療費用分別顯著多15,605元、35,171元、55,531元；憂鬱症組患者一、三、五年總醫療費用分別顯著多198,229元、278,802元、298,654元；焦慮&憂鬱症組患者一、三、五年總醫療費用分別顯著多92,019元、147,720元、165,242元。
五、經傾向分數配對後，焦慮症組與焦慮&憂鬱症組一年、三年、五年整體存活(月數)、整體存活率等變項均顯著性高於無精神疾病組。無精神疾病組與憂鬱症組兩組中，一年、三年、五年整體存活(月數)、整體存活率等變項均未達顯著性差異。
結論與建議
一、建議臨床醫師及護理人員應在第一線照顧病患時，培養對癌症患者焦慮症及憂鬱症的敏銳度，特別是針對年紀較年長者、女性、有接受化療治療的癌症病患，提供對於焦慮症及憂鬱症相關衛教和情緒支持，提供適當的轉介，讓精神科醫師做完整的評估，以免延遲病患接受治療的時機。
二、除了培養對病患焦慮症、憂鬱症的敏銳度之外，為減少轉診精神科的困難，建議醫護人員在與病患溝通時，減少如憂鬱症、精神病等敏感用語，建議可考慮如：治療失眠、治療緊張、治療記憶力減退等用詞，以提高病患就診意願，使其能即時接受到適當的治療，提高其存活率。
三、建議針對所有初診斷及復發的癌症病患，都應安排初步的心理評估，已篩選出有心理問題的病患，及早介入心理輔導或治療，如此應可改善癌症病患的心理健康，甚至進一步找出有自殺傾向的高危險病患，以減少家庭、社會的損失。

關鍵詞：肝癌、焦慮症、憂鬱症、醫療資源利用、存活分析

Background
The incidence of cancer patients with depression is three times than the normal population. About 20~25% cancer patients have experienced depressed mood. The incidence of depression in hepatocellular cancer (HCC) patients is higher than that in normal population and patients with chronic diseases (including other cancer types). About 83% HCC patient developed depression, which revealed the high incidence of depression. The symptoms and treatments of the disease and death lead to the stress of HCC patients. Besides, anxiety and depression are also related to the prognosis of HCC patients. Thus, the issue of the relationship between HCC and psychological disorders is interesting for further study.
Purpose
1. To investigate the demographic and clinical factors related to HCC patients with or without anxiety and depression disorders;
2. To explore the difference in medical resource utilization in HCC patients with or without anxiety and depression disorders;
3. To explore the difference in survival in HCC patients with or without anxiety and depression disorders.
Methods
This is a population-based retrospective longitudinal study using secondary data analysis. The data is from National Health Insurance Research Database (NHIRD) during 1996 to 2010. The primary HCC patients were extracted using ICD-9-CM 155. The study parameters include outpatient prescriptions and treatments, inpatient medical cost, medical institution and physician information. The statistical analysis and propensity score method were employed by using the SPSS 19.0 and SAS 9.3 respectively.
Results
In the study, 2,686 patients were anxiety group, 35 were depression group, 223 were both anxiety and depression group and 7,081 were non-psychiatric group. It showed age (odds ratio OR=1.01, p<0.001), chemotherapy (OR=1.45, p<0.001), Sex (OR=0.52, p<0.001), Charlson Co-morbidity Index (OR=0.93, p<0.001), liver cirrhosis (OR=0.67, p<0.001), respiratory disease (OR=0.78, p=0.019) and clinical symptoms (OR=0.78, p=0.001) were significantly associated with anxiety disorder. Moreover, sex (OR=0.55, p<0.001), Charlson co-morbidity Index (OR=0.88, p=0.015), liver cirrhosis (OR=0.65, p=0.004) were significantly associated with both anxiety and depression disorders.
Compared with non-psychiatric disease group, the clinical visits at the 1-, 3-, and 5- year were significantly higher in anxiety group (20, 38, and 52, respectively), depression group (19, 31, and 33, respectively) and both anxiety and depression group (46, 75, and 88, respectively). Besides, the outpatient costs at the 1-, 3-, and 5- year were significantly higher in anxiety group ($15,659, $31,949, and $46,303, respectively), depression group ($85,293, $126,417, and $139,889, respectively) and both anxiety and depression group ($50,803, $89,624, and $102,024, respectively). On the other hand, compared with non-psychiatric disease group, total length of stay (LOS) at the 1-, 3-, and 5-year were significantly higher in anxiety group (28 days, 33 days, and 34 days, respectively) and both anxiety and depression group (10 days, 14 days, and 17 days, respectively). Besides, total inpatient costs at the 1-, 3-, and 5- year were significantly higher in anxiety group ($110,857, $151,821, and $159,958, respectively) and both anxiety and depression group ($47,275, $58,007, and $63,405, respectively). Additionally, total medical costs at the 1-, 3-, and 5- year were significantly higher in anxiety group ($15,605, $35,171, and $55,531, respectively), depression group ($198,229, $278,802, and $298,654, respectively) and both anxiety and depression group ($92,019, $147,720, and $165,242, respectively). Finally, the cumulative survival at the 1-, 3-, and 5- year in anxiety group and in both anxiety and depression group were better than non-psychiatric disease group. No statistically significance between depression group and non-psychiatric disease group in cumulative survival and overall survival at the 1-, 3-, and 5- year.
Conclusions and suggestions
Firstly, physicians and nurses should pay more attention to the patients with anxiety disorder and depression disorder and should provide the related education and emotional support to the aged, female patients and those undergoing chemotherapy. Referral to psychiatrist for complete assessment is necessary in order to avoid delaying the timing of treatment. Seconsly, to decrease the difficulty in referral to psychiatrists, both physicians and nurses should use the wording, such as treatment of insomnia, tense and memory loss instead of depression and mental disorders. Then the patients will be willing to visit the psychiatrics to have adequate treatment for better prognosis. Finally, to improve the mental health of the cancer patients and to identify the high-risk patients with suicide tendency, psychological assessments should be arranged for those who were initially diagnosed or had disease recurrence to find the patients with psychiatric disease for early intervention.

Key words: hepatocellular carcinoma, anxiety disorder, depression disorder, medical resources utilization, survival analysis

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 預期貢獻 4
第四節 名詞解釋 5
第二章 文獻探討 6
第一節 肝癌簡介 6
第二節 焦慮症、憂鬱症簡介 24
第三節 癌症與焦慮症、憂鬱症之相關性實證研究 27
第四節 癌症與焦慮症、憂鬱症之醫療資源利用情形 39
第五節 癌症、焦慮症、憂鬱症與存活情形之相關性研究 49
第三章 研究方法 54
第一節 研究架構與研究假說 54
第二節 資料庫研究資料與研究對象 56
第三節 研究變項定義 60
第四節 資料處理與統計方法分析 68
第四章 研究結果 70
第一節 肝癌確診後有無合併焦慮症、憂鬱症對於各變項之差異 70
第二節 探討人口學特性、臨床特性是否為肝癌病患合併焦慮症、憂鬱症之影響因子 80
第三節 探討肝癌病患確診後有無合併焦慮症、憂鬱症對於醫療資源利用之差異 85
第四節 探討肝癌病患確診後有無合併焦慮症、憂鬱症對於存活情形之差異 92
第五章 討論與建議 97
第一節 探討人口學特性、臨床特性是否為肝癌病患合併焦慮症、憂鬱症之影響因子 97
第二節 探討肝癌病患確診後有無合併焦慮症、憂鬱症對於醫療資源利用之差異 100
第三節 探討肝癌病患確診後有無合併焦慮症、憂鬱症對於存活情形之差異 103
第四節 結論與建議 105
第五節 研究限制 105
第六節 未來研究建議 107
參考文獻 108
中文部分 108
英文部分 112

方曉喻. (2003). 由性格因素探討婦女憂鬱焦慮之共病現象. 成功大學行為醫學研究所學位論文(2003 年), 1-94.
王士晉. (2012). 術前肝動脈化學栓塞的使用對可切除性肝癌病人術後醫療資源耗用與存活之研究-系統性回顧與整合分析. 高雄醫學大學醫務管理學研究所學位論文(2012 年).
王春展. (2006). 高中職生情緒智慧, 憂鬱傾向與情緒調整之研究. 嘉南學報 (人文類)(32), 484-507.
王湘茹. (2009). 肝癌病患接受肝切除術與經導管肝動脈化學栓塞之健康相關生活品質之探討. 高雄醫學大學醫務管理學研究所學位論文(2009 年).
吳季倫, & 楊銘欽. (1998). 肝癌患者罹病成本與其相關因子之探討: 以某醫學中心患者為例. 中華公共衛生雜誌, 17(2), 148-157.
呂庭輝, 楊長興, 黃昱瞳, & 林明慧. (2007). 醫院, 醫師手術量與肝癌病人術後死亡率之關係. 澄清醫護管理雜誌, 3(1), 46-51.
宋瑞樓. (1997). 在台灣控制肝細胞癌及肝硬化盛行有關的研究與措施及其成效. 臺灣醫學, 1(1), 1-11.
宋翠葉. (2007). 肝癌病患之疲憊、憂鬱、社會支持與希望感的相關性探討. (碩士), 輔仁大學, 新北市. Retrieved from
李宛臻. (2007). 台灣地區肝癌治療療效與醫療資源利用探討. 高雄醫學大學醫務管理學研究所學位論文(2007 年).
李明濱. (1985). 癌症住院病人之精神疾病: 135 例照會個案及對照組之比較研究.
李彩雲. (2011). 癌症病患初始階段醫療資源耗用與死亡率分佈趨勢 及影響因素之探討-以肺癌, 肝癌, 結直腸癌, 乳癌, 胃癌為例. 高雄醫學大學醫務管理學研究所碩士在職專班學位論文(2011 年), 1-137.
李耀泰, 陳福民, 林愛惜, 朱益志, & 郭宗正. (2007). 癌症與疲倦. 中華民國婦癌醫學雜誌(2007 年 2), 66-72.
周嘉揚. (2008). 肝切除治療肝細胞癌. 中華民國癌症醫學會雜誌, 24(5), 311-317.
林志陵, & 高嘉宏. (2008). 肝癌的流行病學. 中華民國癌症醫學會雜誌, 24(5), 277-281.
林品伶. (2007). 台灣地區憂鬱症患者門診醫療利用情形及其相關因素之探討. (碩士), 國立台北護理學院, 台北市. Retrieved from
林彥鴻. (2003). 焦慮症, 憂鬱症及混合焦慮與憂鬱症之婦女在史楚普作業及回想作業上的差異.
林玲華, 陳景彥, 劉嘉逸, & 陳美伶. (2002). 癌症住院病患憂鬱狀態的盛行率及預測因素. 臺灣醫學, 6(4), 535-545.
林雯萱. (2006). 頭頸癌病人治療期間營養狀態與心理困擾之現況探討. (碩士), 國防醫學院, 台北市. Retrieved from
林維君. (2010). 癌症患者失眠的認知行為治療: 系統性的文獻回顧. 中華心理學刊, 52(2), 173-188.
邱泰源. (1998). 癌末病人瀕死症狀與存活期之相關研究.
洪福建, 鄭逸如, 邱泰源, 胡文郁, 陳慶餘, & 吳英璋. (1999). 癌末患者的心理社 會問題, 因應策略與負向情緒.
胡文郁. (1999). 淺談癌末病患之生活品質評估.
凌宜男. (2008). 肝癌病患接受肝切除術之健康相關生活品質探討. 高雄醫學大學醫務管理學研究所學位論文(2008 年).
殷紹閔, 邱鈺雯, & 黃洽鑽. (2009). 某醫學中心安寧住院病人存活因子的比較. 臺灣家庭醫學研究, 7(1), 12-18.
張青蕙. (2003). 住院癌症病患疲憊問題及其相關因素之探討.
張瑞益. (2011). 新罹患癌症病人逛醫院行為之資源耗用探討-以肝癌, 結腸直腸癌為例.
莊閔仁. (2008). 肝癌術後病人營養狀況與其相關因素探討. 臺北醫學大學護理學研究所學位論文(2008 年).
陳佩英, 史麗珠, 王正旭, 賴裕和, 張獻崑, & 陳美伶. (1999). 疼痛對癌症病患焦慮與憂鬱之影響. 臺灣醫學, 3(4), 373-382.
陳怡靜, & 陳彰惠. (2006). 婦癌患者身體心像, 社會支持和憂鬱的相關性研究. 實證護理, 2(4), 293-300.
陳玉馨(2003). 比較單純憂鬱症, 單純焦慮症及混合焦慮與憂鬱症之婦女在行為抑制系統與行為激發系統? 能上之差異.
陳慶餘, 邱泰源, 釋宗惇, 姚建安, 蔡兆勳, & 胡文郁. (2003). 癌末病人死亡恐懼影響因素之分析. 安寧療護雜誌, 8(2), 134-142.
黃光琪, 吳興盛, 梁挋, & 蔡高宗. (2005). 骨科患者手術前後焦慮程度與不確定感之相關性研究. 臺灣復健醫學雜誌, 33(1), 1-10.
黃采薇, & 林佳靜. (2009). 接受肝動脈栓塞術前肝癌病患之睡眠品質, 憂鬱與生活品質間之關係. 新臺北護理期刊, 11(2), 33-45.
黃俊仁. (2005). 精神疾病對於糖尿病患者醫療資源利用影響評估. 高雄醫學大學公共衛生學研究所碩士在職專班學位論文(2005 年).
黃建勳, 鄭逸如, 邱泰源, 呂碧鴻, & 陳慶餘. (2003). 癌末病人的憂鬱問題. 安寧療護雜誌, 8(2), 185-198.
黃琇詩. (2005). 台灣女性肝細胞癌之危險因子探討.  
黃憶君. (2006). 台灣地區肝癌患者施行肝切除術者術後療效與醫療利用探討: 1996-2003 年八年間之手術個案探討. 高雄醫學大學醫務管理學研究所學位論文(2006 年).
黃麟傑. (2007). 憂鬱症患者的反芻與活動參與. 臺灣大學職能治療研究所學位論文(2007 年).
楊少萱. (2003). 肝癌患者醫療成本分析-以某醫學中心患者為例.
楊懷壹. (2006). B 型肝炎病毒因子與肝癌肝硬化之流行病學研究. 臺灣大學流行病學研究所學位論文(2006 年).
葉峻岦. (2007). 憂鬱症疾患醫療利用之分析-透過分量迴歸. 臺北大學財政學系學位論文(2007 年).
詹其峰. (2005). 台灣地區社區肝癌篩檢.
雷永耀、周嘉揚、吳秋文、彭芳谷. (2004). 肝臟腫瘤學.
廖慧娟, 楊喬茵, 顧雅利, 蕭雅莉, & 江明珠. (2005). 肝癌病患不確定感之相關因素探討. 長庚護理, 16(3), 252-263.
劉大忠. (2009). 肝癌患者施行肝動脈化學栓塞後療效與醫療資源利用的探討. 高雄醫學大學醫務管理學研究所碩士在職專班學位論文(2009 年).
蔡宜蓁. (2012). 肝癌患者併發特定精神疾患及其影響之相關研究探討. 高雄醫學大學醫務管理學研究所碩士在職專班學位論文(2012 年).
蔡欣玲, 林小玲, 林惠蘭, & 梁麗麗. (2000). 癌症病人疼痛, 情緒困擾及睡眠情形之探討. 榮總護理, 17(1), 1-14.
蔡述信. (1992). 以台灣全民健保承保抽樣歸人檔案分析憂鬱症病患的醫療利用; An Analysis of Depression Patients''Health Services Utilization--Using National Health Insurance Registry for Beneficiaries Claims Data Files.
蔡麗雲, 顧乃平, 張澤芸, & 賴裕和. (2001). 癌痛病患的焦慮, 憂鬱及其相關因素之探討. 新臺北護理期刊, 3(1), 23-33.
盧勝男, 顏毅豪, 林芷芸, 紀廣明, & 王景弘. (2008). 肝細胞癌之臨床分期. 中華民國癌症醫學會雜誌, 24(5), 295-303.
蕭奕宗, & 黃怡翔. (2004). 簡介肝癌的分期系統. 臨床醫學, 54, 399-406.
賴世華. (2010). 頭頸癌症患者復發擔憂對癌症關連疲勞之影響-以因應型態及負向情緒為中介變項. 中原大學心理學研究所學位論文(2010 年).
賴虹均. (2008). 癌症患者的憂鬱症. 腫瘤護理雜誌, 8(1), 1-11.
霍德義. (2002). 肝癌經皮穿刺療法的現況. 臨床醫學, 50(6), 412-414.
謝毅興, 何慧貞, & 林彥鴻. (2007). 憂鬱症, 焦慮症, 以及焦慮和憂鬱共病婦女對負面情緒的因應. 臺灣精神醫學, 21(2), 117-126.
鍾孟樺. (2005). 台灣肝癌患者之症狀群集現象.
簡以嘉. (2004). 台灣全民健保精神疾病盛行率、醫療利用及費用分析研究. (博士), 國立陽明大學, 台北市. Retrieved from  
羅尹禎. (2012). 精神科門診與其他科別門診醫療利用比較之探討. (碩士), 高雄醫學大學, 高雄市. Retrieved from
嚴冬, 張建軍, 初玉苹, & 黃冬方. (2002). 癌症患者抑鬱狀態的臨床研究. 北京醫學, 24(1), 18-19.
釋慧岳, 釋宗惇, & 陳慶餘. (2007). 癌末病人憂鬱症之靈性照顧. 安寧療護雜誌, 12(3), 273-286.
Aass, N, Fossa, SD, Dahl, AA, & Moe, TJ. (1997). Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. European journal of cancer (Oxford, England: 1990), 33(10), 1597.
Ahles, Tim A, Blanchard, Edward B, & Ruckdeschel, John C. (1983). The multidimensional nature of cancer-related pain. Pain, 17(3), 277-288.
Alloy, Lauren B, Kelly, Kelly A, Mineka, Susan, & Clements, Caroline M. (1990). Comorbidity of anxiety and depressive disorders: A helplessness-hopelessness perspective.
Ashbury, Fredrick D, Madlensky, Lisa, Raich, Peter, Thompson, Mark, Whitney, Geoff, Hotz, Ken, . . . Edell, William S. (2003). Antidepressant prescribing in community cancer care. Supportive care in cancer, 11(5), 278-285.
Becker, Eni S, Roth, Walton T, Andrich, Matthias, & Margraf, Jurgen. (1999). Explicit memory in anxiety disorders. Journal of Abnormal Psychology, 108(1), 153.
Bottomley, A. (1998). Depression in cancer patients: a literature review. European journal of cancer care, 7(3), 181.
Boyes, Allison W, Girgis, Afaf, D''Este, Catherine, & Zucca, Alison C. (2011). Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6months after diagnosis. Journal of affective disorders, 135(1), 184-192.
Breier, Alan, Charney, Dennis S, & Heninger, George R. (1986). Agoraphobia with panic attacks: development, diagnostic stability, and course of illness. Archives of General Psychiatry, 43(11), 1029.
Breitbart, William. (1994). Psycho-oncology: depression, anxiety, delirium. Paper presented at the Seminars in oncology.
Brintzenhofe-Szoc, Karlynn M, Levin, Tomer T, Li, Yuelin, Kissane, David W, & Zabora, James R. (2009). Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type. Psychosomatics, 50(4), 383-391.
Brogaard, Trine, Neergaard, Mette A, Sokolowski, Ineta, Olesen, Frede, & Jensen, Anders B. (2012). Congruence between preferred and actual place of care and death among Danish cancer patients. Palliative medicine.
Brown, Kirk W, Levy, Adrian R, Rosberger, Zeev, & Edgar, Linda. (2003). Psychological distress and cancer survival: a follow-up 10 years after diagnosis. Psychosomatic Medicine, 65(4), 636-643.
Buccheri, G. (1998). Depressive reactions to lung cancer are common and often followed by a poor outcome. European Respiratory Journal, 11(1), 173-178.
Butler, Lorna, Downe-Wamboldt, Barbara, Melanson, Patricia, Coulter, Lynn, Keefe, Janice, Singleton, Jerome, & Bell, David. (2006). Prevalence, correlates, and costs of patients with poor adjustment to mixed cancers. Cancer nursing, 29(1), 9-16.
Carlson, Linda E, & Bultz, Barry D. (2003). Cancer distress screening: needs, models, and methods. Journal of psychosomatic research, 55(5), 403-409.
Carroll, Brendan T, Kathol, Roger G, Noyes, Russell, Wald, Tina G, & Clamon, Gerald H. (1993). Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. General hospital psychiatry, 15(2), 69-74.
Chen, Yi-Hua, & Lin, Herng-Ching. (2011). Increased risk of cancer subsequent to severe depression—A nationwide population-based study. Journal of affective disorders, 131(1), 200-206.
Chida, Yoichi, Hamer, Mark, Wardle, Jane, & Steptoe, Andrew. (2008). Do stress-related psychosocial factors contribute to cancer incidence and survival? Nature clinical practice Oncology, 5(8), 466-475.
Chow, Edward, Tsao, May N, & Harth, Tamara. (2004). Does psychosocial intervention improve survival in cancer? A meta-analysis. Palliative medicine, 18(1), 25-31.
Costantini, M., Musso, M., Viterbori, P., Bonci, F., Del Mastro, L., Garrone, O., . . . Morasso, G. (1999). Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale. Support Care Cancer, 7(3), 121-127.
Derogatis, Leonard R, Morrow, Gary R, Fetting, John, Penman, Doris, Piasetsky, Sheryl, Schmale, Arthur M, . . . Carnicke Jr, Charles LM. (1983). The prevalence of psychiatric disorders among cancer patients. JAMA: the journal of the American Medical Association, 249(6), 751-757.
Deyo, Richard A, Cherkin, Daniel C, & Ciol, Marcia A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of clinical epidemiology, 45(6), 613-619.
DiMartini, A, Dew, MA, Chaiffetz, D, Fitzgerald, MG, Devera, ME, & Fontes, P. (2011). Early Trajectories of Depressive Symptoms after Liver Transplantation for Alcoholic Liver Disease Predicts Long‐Term Survival. American Journal of Transplantation, 11(6), 1287-1295.
Dimick, Justin B, Pronovost, Peter J, Cowan Jr, John A, & Lipsett, Pamela A. (2003). Postoperative complication rates after hepatic resection in Maryland hospitals. Archives of Surgery, 138(1), 41.
Edwards, Ben, & Clarke, Valerie. (2003). The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients'' illness characteristics on depression and anxiety. Psycho‐Oncology, 13(8), 562-576.
Freyer, G, Geay, J-F, Touzet, S, Provencal, J, Weber, B, Jacquin, J-P, . . . Pujade-Lauraine, E. (2005). Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Annals of oncology, 16(11), 1795-1800.
Frick, E, Tyroller, M, & Panzer, M. (2006). Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross‐sectional study in a community hospital outpatient centre. European journal of cancer care, 16(2), 130-136.
Gil, Francisco, Grassi, Luigi, Travado, Luzia, Tomamichel, Michele, & Gonzalez, Juan Ramon. (2005). Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients. Supportive care in cancer, 13(8), 600-606.
Haggerty Jr, John J, & Holmes, Valerie. (1986). Depression in women treated for gynecological cancer: clinical and neuroendocrine assessment. Am J Psychiatry, 143, 447-452.
Hsieh, Ching-Hui. (2006). The Effects of The “Intensive Treatment Program” on Health Care Utilization and Expenditures for Patients with Hepatitis B or C.
Huang, Tsai-Wei, & Lin, Chia-Chin. (2009). The mediating effects of depression on sleep disturbance and fatigue: symptom clusters in patients with hepatocellular carcinoma. Cancer nursing, 32(5), 398.
Jadoon, Nauman, Munir, Waqar, Shahzad, Mohammad, & Choudhry, Zeshan. (2010). Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study. BMC cancer, 10(1), 594.
Kanwal, Fasiha, Gralnek, Ian M, Hays, Ron D, Zeringue, Angelique, Durazo, Francisco, Han, Steven B, . . . Spiegel, Brennan MR. (2009). Health-related quality of life predicts mortality in patients with advanced chronic liver disease. Clinical Gastroenterology and Hepatology, 7(7), 793-799.
Lansky, Shirley B, List, MA, Herrmann, CA, Ets-Hokin, EG, DasGupta, TK, Wilbanks, GD, & Hendrickson, FR. (1985). Absence of major depressive disorder in female cancer patients. Journal of Clinical Oncology, 3(11), 1553-1560.
Lemogne, C, Niedhammer, I, Khlat, M, Ravaud, JF, Guillemin, F, Consoli, SM, . . . Chau, N. (2011). Gender differences in the association between depressive mood and mortality: A 12-year follow-up population-based study. Journal of affective disorders.
Lim, Leslie, Jin, Ai-Zhen, & Ng, Tze-Pin. (2012). Anxiety and depression, chronic physical conditions, and quality of life in an urban population sample study. Social psychiatry and psychiatric epidemiology, 47(7), 1047-1053.
Lloyd-Williams, Mari. (2006). Depression, anxiety and confusion. ABC of palliative care, 56, 36.
Luber, M Philip, Hollenberg, James P, Williams-Russo, Pamela, DiDomenico, Tara N, Meyers, Barnett S, Alexopoulos, George S, & Charlson, Mary E. (2000). Diagnosis, treatment, comorbidity, and resource utilization of depressed patients in a general medical practice. International Journal of Psychiatry in Medicine, 30(1), 1-14.
Massie, Mary Jane. (2004). Prevalence of depression in patients with cancer. JNCI Monographs, 2004(32), 57-71.
Massie, Mary Jane, Gagnon, Pierre, & Holland, Jimmie C. (1994). Depression and suicide in patients with cancer. Journal of pain and symptom management, 9(5), 325-340.
Massie, MJ, & Popkin, MK. (1998). Depressive disorders. Psycho-oncology, 518-540.
Miller, Kimberley, & Massie, Mary Jane. (2006). Depression and anxiety. The Cancer Journal, 12(5), 388.
Montazeri, A., Milroy, R., Hole, D., McEwen, J., & Gillis, C. R. (1998). Anxiety and depression in patients with lung cancer before and after diagnosis: findings from a population in Glasgow, Scotland. J Epidemiol Community Health, 52(3), 203-204.
Morse, Rachel, Kendell, Kate, & Barton, Stephen. (2005). Screening for depression in people with cancer: the accuracy of the hospital anxiety and depression scale. Clinical Effectiveness in Nursing, 9(3), 188-196.
Ng, Chong Guan, Dijkstra, Ellen, Smeets, Hugo, Wit, Niek J de, & Boks, Marco PM. (2013). Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: a comparison between patients with cancer and heart failure. British Journal of General Practice, 63(606), e63-e68.
Pasquini, Massimo, Biondi, Massimo, Costantini, Anna, Cairoli, Francesca, Ferrarese, G, Picardi, Angelo, & Sternberg, Cora. (2006). Detection and treatment of depressive and anxiety disorders among cancer patients: feasibility and preliminary findings from a liaison service in an oncology division. Depression and anxiety, 23(7), 441-448.
Penninx, B. W., Geerlings, S. W., Deeg, D. J., van Eijk, J. T., van Tilburg, W., & Beekman, A. T. (1999). Minor and major depression and the risk of death in older persons. Arch Gen Psychiatry, 56(10), 889-895.
Pinquart, M, & Duberstein, PR. (2010). Depression and cancer mortality: a meta-analysis. Psychological medicine, 40(11), 1797.
Poon, Ronnie Tung-Ping, Fan, Sheung-Tat, Lo, Chung-Mau, Ng, Irene Oi-Lin, Liu, Chi-Leung, Lam, Chi-Ming, & Wong, John. (2001). Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Annals of surgery, 234(1), 63.
Rogal, SS, Dew, MA, Fontes, P, & DiMartini, AF. (2013). Early Treatment of Depressive Symptoms and Long‐Term Survival After Liver Transplantation. American Journal of Transplantation.
Ross, L, Boesen, EH, Dalton, SO, & Johansen, C. (2002). Mind and cancer: does psychosocial intervention improve survival and psychological well-being? European journal of cancer (Oxford, England: 1990), 38(11), 1447.
Salkovskis, Paul M. (1989). Obsessions and compulsions.
Shekelle, Richard B, Raynor Jr, William J, Ostfeld, Adrian M, Garron, David C, Bieliauskas, Linas A, Liu, Shuguey C, . . . Paul, OGLESBY. (1981). Psychological depression and 17-year risk of death from cancer. Psychosomatic medicine, 43(2), 117-125.
Singh, Nina, Gayowski, Timothy, Wagener, Marilyn M, & Marino, Ignazio R. (1997). Depression in Patients with Cirrhosis (Impact on Outcome). Digestive diseases and sciences, 42(7), 1421-1427.
Slaviero, Kellie A, Read, Jane A, Clarke, Stephen J, & Rivory, Laurent P. (2003). Baseline nutritional assessment in advanced cancer patients receiving palliative chemotherapy. Nutrition and cancer, 46(2), 148-157.
Spoletini, Ilaria, Gianni, Walter, Repetto, Lazzaro, Bria, Pietro, Caltagirone, Carlo, Bossu, Paola, & Spalletta, Gianfranco. (2008). Depression and cancer: An unexplored and unresolved emergent issue in elderly patients. Critical reviews in oncology/hematology, 65(2), 143.
Stark, D, Kiely, M, Smith, A, Velikova, G, House, A, & Selby, P. (2002). Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. Journal of Clinical Oncology, 20(14), 3137-3148.
Steel, Jennifer L, Geller, David A, Gamblin, T Clark, Olek, Marion C, & Carr, Brian I. (2007). Depression, immunity, and survival in patients with hepatobiliary carcinoma. Journal of clinical oncology, 25(17), 2397-2405.
Stiegelis, Heidi E, Ranchor, Adelita V, & Sanderman, Robbert. (2004). Psychological functioning in cancer patients treated with radiotherapy. Patient Education and Counseling, 52(2), 131-141.
Stommel, Manfred, Given, Barbara A, & Given, Charles W. (2002). Depression and functional status as predictors of death among cancer patients. Cancer, 94(10), 2719-2727.
Tchekmedyian, N Simon, Kallich, Joel, McDermott, Anne, Fayers, Peter, & Erder, M Haim. (2003). The relationship between psychologic distress and cancer‐related fatigue. Cancer, 98(1), 198-203.
Teunissen, SCCM, De Graeff, A, Voest, EE, & de Haes, JCJM. (2007). Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients. Palliative medicine, 21(4), 341-346.
Valente, Sharon M, & Saunders, Judith M. (1997). Diagnosis and treatment of major depression among people with cancer. Cancer nursing, 20(3), 168.
Wang, X., Li, J., Peng, Y., Dai, Y., & Xu, W. (2011). Influence of preoperative transarterial chemoembolization on the prognosis for patients with resectable hepatocellular carcinoma: a meta-analysis of randomized trials. Hepatogastroenterology, 58(107-108), 869-874.
Wasan, Ajay D, Artamonov, Mikhail, & Nedeljkovic, Srdjan S. (2005). Delirium, depression, and anxiety in the treatment of cancer pain. Techniques in Regional Anesthesia and Pain Management, 9(3), 139-144.
Watson, M, Haviland, JS, Greer, S, Davidson, J, & Bliss, JM. (1999). Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet (London, England), 354(9187), 1331-1336.
Wilson, K. G., Chochinov, H. M., Skirko, M. G., Allard, P., Chary, S., Gagnon, P. R., . . . Clinch, J. J. (2007). Depression and anxiety disorders in palliative cancer care. Journal of pain and symptom management, 33(2), 118-129.
Wittchen, Hans-Ulrich, Essau, Cecilia Ahmoi, Zerssen, Detlev, Krieg, Jurgen-Christian, & Zaudig, Michael. (1992). Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. European archives of psychiatry and clinical neuroscience, 241(4), 247-258.
WU, Si-ying, YANG, Shu-juan, & LI, Huang-yuan. (2011). STUDY ON THE RELATIONSHIP BETWEEN THE PSYCHOLOGICAL-SOCIAL FACTORS AND THE REHABILITATION OF PATIENTS AFTER STOMACH CANCER SURGERY. Modern Preventive Medicine, 11, 039.
Wyman, Lisa, Crum, Rosa M, & Celentano, David. (2012). Depressed mood and cause-specific mortality: a 40-year general community assessment. Annals of Epidemiology.
Yu1, , Hui, Wang, Yaoxian, Ge, Xin, Wu, Xiaoke, & Mao, Xiaoqin. (2012). Depression and Survival in Chinese Patients with Gastric Cancer: A Prospective Study. Asian Pacific Journal of Cancer Prevention, 13, 391-394.
Yuen, M-F, & Lai, C-L. (2003). Screening for hepatocellular carcinoma: survival benefit and cost-effectiveness. Annals of oncology, 14(10), 1463-1467.
Zhang, Zhijian, Liu, Qi, He, Jia, Yang, Jiamei, Yang, Guangshun, & Wu, Mengchao. (2000). The effect of preoperative transcatheter hepatic arterial chemoembolization on disease‐free survival after hepatectomy for hepatocellular carcinoma. Cancer, 89(12), 2606-2612.