Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Leah M. Ferrucci

Abstract

Background: Breast cancer patients have up to a five-fold higher risk of depression compared with the general population, with an estimated prevalence of depressive symptoms of 25%. Depressive symptoms among breast cancer patients can affect treatment adherence, quality of life, and mortality. Some studies indicate lifestyle interventions can lower depression symptoms in general population samples; however, few studies have examined changes in depression among breast cancer survivors enrolled in lifestyle interventions. The purpose of this study was to examine the effect of a 6-month diet-and exercise-induced weight loss intervention versus usual care on depressive symptomatology among breast cancer survivors.Methods: 151 breast cancer survivors with body mass index (BMI) ≥25kg/m² were randomly assigned to a 6-month lifestyle-based weight loss intervention (n=93) or usual care (n=58). Change in Center for Epidemiological Studies Depression (CES-D) score was the primary outcome in this secondary analysis. A mixed-effects model was used to assess the 6-month change in CES-D score between the intervention and usual care arms. Results: Women were 58.0 ± 7.9 years, 88.7% were non-Hispanic white, and 49.3% had stage I breast cancer. The baseline prevalence of depression based on the CES-D score ≥ 16 was 26%. At 6 months, the weight loss intervention had no statistically significant effect on depressive symptomatology compared to the usual care group (p=0.54). There was no evidence of effect modification by baseline CES-D score, age, advance disease stage, or marital status. Conclusion: The findings of this secondary analysis of the LEAN trial indicate that a 6-month weight loss intervention vs. usual care did not significantly improve depressive symptomatology among breast cancer survivors with overweight or obesity. These findings highlight the need for larger, more diverse studies to evaluate the effectiveness of lifestyle intervention in reducing depressive symptomatology among breast cancer survivors with elevated depression level at baseline.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/16/2026

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