A retrospective study on the association between psychological distress and benign breast diseases

open_access
Open Access
Author:
Gali, Pavithra
Graduate Program:
Clinical Research
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
March 17, 2026
Committee Members:
Kristin Sznajder, Thesis Advisor/Co-Advisor
Li Wang, Committee Member
Shouhao Zhou, Committee Member
Ritika Baweja, Committee Member
Jessica M Yingst, Program Head/Chair
Keywords:
Benign Breast Disease
BBD
Psychological distress
Anxiety
Depression
Retrospective study
Mental Health
Women Health
TriNetX
Breast cancer
Abstract:
Background: Benign breast disease (BBD) comprises a heterogeneous group of non-cancerous breast conditions, including fibroadenomas, fibrocystic changes, mastitis, and other benign neoplasms that affect a substantial proportion of women across the lifespan, particularly during the reproductive years. Although these conditions do not carry the same mortality risk as breast cancer, they are highly prevalent and frequently recurrent symptoms, requiring repeated diagnostic evaluations and persistent concern regarding malignancy, affecting approximately 70% of women at some point in their lifetime, particularly those between 20 and 50 years of age. The physical symptoms associated with BBD, such as breast pain, tenderness, and palpable masses, are often accompanied by substantial psychological distress, including anxiety and depression. Despite this, the psychosocial burden of BBD remains underrecognized and understudied in clinical and epidemiologic research. Current literature states that women with BBD experience heightened anxiety about malignancy, diagnostic uncertainty, and repeated evaluations. Depression is also more common among them than healthy controls. However, many studies have been limited by small sample sizes, cross-sectional designs, or a lack of integration between clinical and psychosocial outcomes. This creates a gap in understanding the prevalence, patterns, and determinants of psychological distress among women with BBD using real-world clinical data. Objectives: This thesis presents a retrospective cohort study using the TriNetX database from the Penn State Health system to examine the association between BBD and psychological distress. The primary aims are: (1) To evaluate the prevalence and patterns of psychological distress among women with BBD, and (2) To examine longitudinal changes in depression and anxiety before and after BBD diagnosis. Methods: We conducted a retrospective cohort study of 1,760 women aged 18–50 years with BBD documented in the Penn State Health system (2020–2025). BBD subtypes were classified using ICD-10 codes (D24, N60, N61, N63). Psychological distress was defined by ICD-10 diagnoses of anxiety, depression, or both (F41, F43, F32, F33). Prevalence estimates were stratified by BBD subtype and demographics. McNemar’s tests assessed paired changes in distress before and after BBD, and multivariable logistic regression evaluated predictors of post-BBD distress. Results: Overall, 42.4% of women experienced psychological distress: 16.1% anxiety only, 4.5% depression only, and 21.8% both. Distress was observed across all BBD subtypes, particularly in mastitis without abscess, benign neoplasms, and multiple BBD diagnoses. Asian women and Hispanic/Latino women had lower odds of distress compared with White and non-Hispanic women, respectively. Depression prevalence remained stable across the diagnostic interval (McNemar’s p = 0.25), whereas anxiety showed a significant shift post-BBD (McNemar’s p = 0.0006). Prior mental health diagnoses were the strongest predictors of post-BBD distress (adjusted OR for depression = 1.94, 95% CI: 1.41–2.69; adjusted OR for anxiety = 0.54, 95% CI: 0.38–0.75). When models accounted for the correlation of repeated observations within individuals, there was no association between depression (before and after), with an estimated p-value of 0.2738 for depression. But there was an association for anxiety (before and after BBD) with an estimated p-value of 0.0003 for anxiety. Conclusions: Psychological distress is common among women with BBD, with anxiety particularly sensitive to diagnostic timing. Screening for prior mental health conditions and integrating psychosocial support into BBD care may improve patient outcomes. These findings highlight the need for targeted interventions to address the emotional burden of BBD.