Beyond the Physical: Mental Health and Sleep Issues in Benign Breast Lesions

Beyond the Physical: Mental Health and Sleep Issues in Benign Breast Lesions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond the Physical: Mental Health and Sleep Issues in Benign Breast Lesions Alper Varman, Necati Uzun, Mehmet Akif Akıncı This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6399388/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Breast lesions are a common clinical condition in women and a frequent reason for hospital admissions. While hospital visits for suspected malignancy are known to cause significant psychological distress, there is limited data on the psychological impact of benign breast lesions (BBL). This study aims to address this gap by evaluating psychological symptoms in women with BBL. Methods: The study included 103 women diagnosed with BBL as the patient group and 69 women as the control group. All participants completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI). All women participating in the study were given detailed information about the study and their consent was obtained. Results: Women with BBL had statistically significantly higher BDI, BAI, and PSQI scores compared to the control group. Furthermore, a positive correlation was identified between BDI, BAI, and PSQI scores. Women with BBL had significantly higher symptoms of anxiety, depression and varying degrees of sleep disturbance compared to controls. Conclusions: A diagnosis of BBL is associated with increased symptoms of depression, anxiety, and sleep disturbances. Additionally, these symptoms exhibit a linear relationship, emphasizing the need for psychological evaluation and support for women with BBL to mitigate potential mental health issues. Introduction Benign breast lesions (BBL) refer to a clinical condition encompassing a range of disorders, from minor developmental issues within breast tissue to lesions that increase malignancy risk several-fold ( 1 ). BBL, which is frequently observed in women, includes various clinical conditions such as developmental abnormalities, inflammatory lesions (e.g., mastitis), duct ectasia, fat necrosis, fibrocystic changes, adenomas, and others ( 2 ). While some of these lesions remain asymptomatic throughout life, a significant proportion of affected women experience symptoms such as breast pain, palpable lumps, fullness, and nipple discharge at some point, prompting hospital visits ( 3 ). For diagnostic evaluation, non-invasive methods—such as direct radiography, ultrasonography, and magnetic resonance imaging—are commonly used, alongside interventional procedures like biopsy ( 4 ). For diagnostic evaluation, non-invasive methods—such as direct radiography, ultrasonography, and magnetic resonance imaging—are commonly used, alongside interventional procedures like biopsy. Given that symptoms prompting hospital admission may resemble those of breast cancer, patients may experience psychological distress ( 5 ). Most studies on the psychological impact of breast lesions focus on malignant cases, while research on the mental health effects of BBL, despite its broad clinical spectrum and prevalence, remains limited. Existing studies indicate that patients may encounter various mental health challenges from clinical presentation to the diagnostic process ( 6 ). This study aims to examine the mental health symptoms and sleep characteristics of patients diagnosed with BBL. Method Seventy-two patients who presented to the General Surgery outpatient clinic, were diagnosed with benign breast lesions (BBL) based on anamnesis, physical examination, and imaging, and met the study’s inclusion and exclusion criteria were included as the patient group. Additionally, sixty-nine participants without a BBL diagnosis, free from any chronic physical or mental illness, and meeting the inclusion and exclusion criteria, were included as the control group. After obtaining verbal and written consent, all participants agreeing to participate in the study completed the Sociodemographic Data Form, Beck Depression Inventory, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index. Participants who had used any psychotropic medications within the six months preceding the study, or who had a chronic physical, psychiatric, or neurological disease, were excluded. This study was approved by the local ethics committee of Necmettin Erbakan University (Decision number: 2020/2797) and all procedures were conducted in accordance with the Declaration of Helsinki and local laws and regulations. The participants gave their written informed consent after the investigators explained the aim and course of the study. Oral assent was also obtained from all participants. Sociodemographic Data Form A data form developed by the researchers to collect various sociodemographic data, including age, gender, socioeconomic status, height, weight, and body mass index (BMI) of the study participants. Beck Depression Inventory (BDI) The Beck Depression Inventory (BDI) is a self-report scale consisting of 21 items used to assess depressive symptoms and determine the severity of depression ( 7 ). BDI is widely recognized in the literature as a reliable tool for measuring depression. Validity and reliability studies specific to the country have demonstrated sufficient reliability and validity ( 8 ). Each item on the scale is scored between 0 and 3 points, resulting in a total possible score range of 0 to 63. Higher scores indicate greater severity of depressive symptoms. Beck Anxiety Inventory (BAI) The Beck Anxiety Inventory (BAI) is a 21-item, 4-point Likert-type self-report scale designed to assess the severity of anxiety symptoms ( 9 ). Each item is scored from 0 to 3 points, with a possible score range from 0 to 63. Validity and reliability studies have confirmed the scale’s suitability for use in this population ( 10 ). Pittsburgh Sleep Quality Index (PSQI) The Pittsburgh Sleep Quality Index (PSQI) is a psychometric tool that evaluates sleep quality and associated issues, comprising 19 items across seven subscales: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction ( 11 ). Each item is rated on a scale of 0 to 3 points, with higher scores indicating poorer sleep quality and more significant sleep issues. Validity and reliability studies have been conducted for this country ( 12 ). Statistical Analysis Data analysis was performed using SPSS version 20.0. Descriptive statistics are presented as frequencies, percentages, and mean ± standard deviation. The chi-square test was used to analyze categorical variables. The Shapiro-Wilk test assessed data normality. For normally distributed data, independent t-tests were applied, while the Mann-Whitney U test was used for non-normally distributed data. Pearson or Spearman correlation analyses were conducted based on distribution characteristics. Statistical significance was set at p < 0.05. Results The study included 103 female participants diagnosed with BBL and 68 female controls. The mean age of the case group was 37.97 ± 10.77 years, while that of the control group was 38.36 ± 11.50 years. There was no statistically significant difference in age between the case and control groups (p = 0.676). Similarly, no statistically significant differences were observed between the groups in terms of height, weight, and BMI (p = 0.295, p = 0.908, and p = 0.420, respectively). Psychometric evaluations revealed that depression levels, as measured by BDI scores, were statistically significantly higher in the case group compared to the control group (p < 0.001). Furthermore, anxiety levels, as assessed by BAI scores, were significantly higher in the case group than in the control group (p = 0.012). The total PSQI scores, which reflect sleep-related processes, were also significantly higher in the case group compared to the control group (p = 0.01). Details regarding psychometric variables are presented in Table 1 . Correlation analyses of the psychometric variables demonstrated that BAI scores were positively correlated with both BDI scores (r = 0.583, p < 0.001) and total PSQI scores (r = 0.412, p < 0.001). Additionally, a positive correlation was identified between BDI scores and total PSQI scores (r = 0.444, p < 0.001). Discussion This study aimed to investigate the differences between women diagnosed with benign breast lesions (BBL) and a control group in terms of psychological problems, including anxiety, depression, and sleep disturbances. The findings revealed that the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI) scores, which evaluate anxiety, depression, and sleep problems, respectively, were statistically significantly higher in the BBL group compared to the control group. These results suggest the importance of screening individuals with BBL for psychological symptoms, as well as providing appropriate follow-up and treatment when necessary. Breast lesions are a significant reason for hospital visits among women, with the majority being benign. Diagnosis often involves non-invasive and invasive methods, such as ultrasonography, mammography, and biopsy. The incidence of BBL typically begins to rise in the 20s and peaks in the 40s, with causes ranging from developmental abnormalities and infections to fibrocystic changes and adenomas ( 13 , 14 ). While studies have shown that breast lesions can lead to psychiatric symptoms, most research has focused on malignant breast lesions ( 14 ). Evidence indicates that addressing psychiatric symptoms in patients with breast lesions improves their coping mechanisms and contributes positively to their overall well-being ( 15 ). However, studies specifically exploring psychiatric symptoms in BBL patients are limited. Previous research has reported that women with BBL exhibit higher levels of depression and anxiety compared to controls. For instance, one study demonstrated that even benign breast lesions can significantly affect patients' mental health ( 16 ). Similarly, a study conducted in China found that depression and anxiety symptoms were elevated in women with BBL and negatively impacted their quality of life ( 17 ). In line with this limited literature, our study confirmed that depression and anxiety levels are statistically significantly higher in women with BBL compared to controls. Additionally, our study identified a novel finding not previously reported: sleep disturbances, as assessed by PSQI scores, were significantly more prevalent in women with BBL. This suggests that patients with BBL experience not only heightened anxiety and depression but also significant sleep-related issues. orrelation analyses further revealed that PSQI scores were positively associated with BDI and BAI scores, indicating that sleep problems increase as anxiety and depression symptoms worsen in patients with BBL. This highlights the interrelated nature of these psychological challenges and underscores the importance of a comprehensive evaluation of mental health in this population. In conclusion, the literature on the mental health challenges faced by BBL patients remains sparse. The elevated levels of anxiety and depression observed in previous studies—and confirmed by this study—highlight the potential benefits of mental health evaluations for these patients. Furthermore, the novel finding that sleep problems are more prevalent in women with BBL, alongside the linear relationship between sleep disturbances, anxiety, and depression, underscores the need for integrating sleep assessments into the evaluation and follow-up of these patients. This study has some limitations. The assessment of psychiatric symptoms was based on self-report scales in a cross-sectional design, without face-to-face psychiatric evaluations, and the sample size was relatively small. However, our study is the first to report data on sleep problems in women with BBL, which represents a significant strength. Future studies with larger samples, longitudinal designs, and comprehensive psychiatric evaluations will further enhance understanding in this area. Table 1 Comparison of participants' BDI, BAI and PSQI total scores Variables Case Group n: 103 Control Group n: 69 Statistical Analyses p BDI 13.16 ± 9.18 7.77 ± 6.29 < 0.001 BAI 14.34 ± 10.62 8.90 ± 8.15 0.012 PSQI Total 6.36 ± 3.48 4.38 ± 3.11 0.01 BDI: Beck Depression Inventory BAI: Beck Anxiety Inventory PSQI: Pittsburgh Sleep Quality Index Declarations Author Contribution A. V. and N. U. wrote the main manuscript textM. A. A. prepared tables and statistical analysisA. V. Literature reviewAll authors reviewed the manuscript Acknowledgement We would like to thank Prof. Dr. Ahmet Mithat Elmacı, whose academic motivation and guiding light we have always benefited from. References Cordiner R, et al. Pre-Operative Haematological Markers and Prognosis in Early Breast Cancer. Cancer Res. 2011;71(24Supplement):2–12. Guray M, Sahin AA. Benign Breast Diseases: Classification, Diagnosis, and Management. Oncologist. 2006;11(5):435–49. Pollitt J, Twine C, Gateley CA. Benign breast disease. Women’s Health Med. 2006;3(1):1–4. Moss HA, et al. How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population? Clin Radiol. 1999;54(10):676–82. Compas BE, Luecken L. Psychological Adjustment to Breast Cancer. Curr Dir Psychol Sci. 2002;11(3):111–4. Kamath J, et al. Symptom Distress Associated with Biopsy in Women with Suspect Breast Lesions. ISRN Oncol. 2012;2012:1–9. Beck AT, et al. Beck depression inventory (BDI). Arch gen psychiatry. 1961;4(6):561–71. Hisli N. Beck Depresyon Envanterinin gecerliligi uzerine bir calisma (A study on the validity of Beck Depression Inventory). Psikol Derg. 1988;6:118–22. Beck AT, et al. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56(6):893–7. Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cogn Psychother. 1998;12(2):163. Buysse DJ, et al. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. Agargun MY. Pittsburgh uyku kalitesi indeksinin gecerligi ve guvenirligi. Turk Psikiyatri Dergisi. 1996;7:107–15. Sasaki J, et al. Etiology and Management of Benign Breast Disease. The Breast. Elsevier; 2018. pp. 79–e925. Kissane DW, et al. Psychiatric Disorder in Women with Early Stage and Advanced Breast Cancer: a Comparative Analysis. Australian New Z J Psychiatry. 2004;38(5):320–6. Chen CC, et al. strategies and psychiatric morbidity in women attending breast assessment clinics. J Psychosom Res. 1996;40(3):265–70. Srivastava V, et al. study of anxiety and depression in benign breast disease. J Midlife Health. 2020;11(4):200. Lou Z, et al. Affects of Anxiety and Depression on Health-Related Quality of Life among Patients with Benign Breast Lumps Diagnosed via Ultrasonography in China. Int J Environ Res Public Health. 2015;12(9):10587–601. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6399388","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":439868979,"identity":"bc936c60-2d62-47c3-88d3-d407d74e83e5","order_by":0,"name":"Alper Varman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYDACdjiL+QCQkJAhrIUZzmJLAGnhIUULjwGYJKiDv5n3ADNPzb1o/tk9n1/dqLHgYWA/fHQDPi0Sh/kSmHmOFefOuHN2m3XOMaDDeNLSbuC15jCPAeMMtoTchhu524xz2IBaJHjM8GqRB2v5l5A7/0bOM+Ocf0RoMQBqYfjYlpC74UYO8+PcNiK0GAL9cuBjX0LuxhtpZsy5fRI8bIT8Ine89+CDhG8JufNuJD/+nPOtTo6f/fAx/N4HRsQBKItNAkziVw7RAgPMHwirHgWjYBSMgpEIAOJbRoOKGwYaAAAAAElFTkSuQmCC","orcid":"","institution":"Necmettin Erbakan University","correspondingAuthor":true,"prefix":"","firstName":"Alper","middleName":"","lastName":"Varman","suffix":""},{"id":439868983,"identity":"0022bae6-b5e2-4871-bf2e-2a686108014f","order_by":1,"name":"Necati Uzun","email":"","orcid":"","institution":"Necmettin Erbakan University","correspondingAuthor":false,"prefix":"","firstName":"Necati","middleName":"","lastName":"Uzun","suffix":""},{"id":439868984,"identity":"ace45f46-6f75-4d09-a7ff-84c3e571909e","order_by":2,"name":"Mehmet Akif Akıncı","email":"","orcid":"","institution":"Atatürk University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Akif","lastName":"Akıncı","suffix":""}],"badges":[],"createdAt":"2025-04-08 05:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6399388/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6399388/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82518229,"identity":"debea33b-1c5e-4867-9f0f-0f8c64fa477b","added_by":"auto","created_at":"2025-05-12 12:16:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":366962,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6399388/v1/b7cba4b4-875d-471d-a5c0-99c6ecaca536.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond the Physical: Mental Health and Sleep Issues in Benign Breast Lesions ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBenign breast lesions (BBL) refer to a clinical condition encompassing a range of disorders, from minor developmental issues within breast tissue to lesions that increase malignancy risk several-fold (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). BBL, which is frequently observed in women, includes various clinical conditions such as developmental abnormalities, inflammatory lesions (e.g., mastitis), duct ectasia, fat necrosis, fibrocystic changes, adenomas, and others (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While some of these lesions remain asymptomatic throughout life, a significant proportion of affected women experience symptoms such as breast pain, palpable lumps, fullness, and nipple discharge at some point, prompting hospital visits (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). For diagnostic evaluation, non-invasive methods\u0026mdash;such as direct radiography, ultrasonography, and magnetic resonance imaging\u0026mdash;are commonly used, alongside interventional procedures like biopsy (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor diagnostic evaluation, non-invasive methods\u0026mdash;such as direct radiography, ultrasonography, and magnetic resonance imaging\u0026mdash;are commonly used, alongside interventional procedures like biopsy. Given that symptoms prompting hospital admission may resemble those of breast cancer, patients may experience psychological distress (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Most studies on the psychological impact of breast lesions focus on malignant cases, while research on the mental health effects of BBL, despite its broad clinical spectrum and prevalence, remains limited. Existing studies indicate that patients may encounter various mental health challenges from clinical presentation to the diagnostic process (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aims to examine the mental health symptoms and sleep characteristics of patients diagnosed with BBL.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eSeventy-two patients who presented to the General Surgery outpatient clinic, were diagnosed with benign breast lesions (BBL) based on anamnesis, physical examination, and imaging, and met the study\u0026rsquo;s inclusion and exclusion criteria were included as the patient group. Additionally, sixty-nine participants without a BBL diagnosis, free from any chronic physical or mental illness, and meeting the inclusion and exclusion criteria, were included as the control group. After obtaining verbal and written consent, all participants agreeing to participate in the study completed the Sociodemographic Data Form, Beck Depression Inventory, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index. Participants who had used any psychotropic medications within the six months preceding the study, or who had a chronic physical, psychiatric, or neurological disease, were excluded.\u003c/p\u003e \u003cp\u003e This study was approved by the local ethics committee of Necmettin Erbakan University (Decision number: 2020/2797) and all procedures were conducted in accordance with the Declaration of Helsinki and local laws and regulations. The participants gave their written informed consent after the investigators explained the aim and course of the study. Oral assent was also obtained from all participants.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic Data Form\u003c/h2\u003e \u003cp\u003eA data form developed by the researchers to collect various sociodemographic data, including age, gender, socioeconomic status, height, weight, and body mass index (BMI) of the study participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBeck Depression Inventory (BDI)\u003c/h3\u003e\n\u003cp\u003eThe Beck Depression Inventory (BDI) is a self-report scale consisting of 21 items used to assess depressive symptoms and determine the severity of depression (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). BDI is widely recognized in the literature as a reliable tool for measuring depression. Validity and reliability studies specific to the country have demonstrated sufficient reliability and validity (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Each item on the scale is scored between 0 and 3 points, resulting in a total possible score range of 0 to 63. Higher scores indicate greater severity of depressive symptoms.\u003c/p\u003e\n\u003ch3\u003eBeck Anxiety Inventory (BAI)\u003c/h3\u003e\n\u003cp\u003eThe Beck Anxiety Inventory (BAI) is a 21-item, 4-point Likert-type self-report scale designed to assess the severity of anxiety symptoms (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Each item is scored from 0 to 3 points, with a possible score range from 0 to 63. Validity and reliability studies have confirmed the scale\u0026rsquo;s suitability for use in this population (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003ePittsburgh Sleep Quality Index (PSQI)\u003c/h3\u003e\n\u003cp\u003eThe Pittsburgh Sleep Quality Index (PSQI) is a psychometric tool that evaluates sleep quality and associated issues, comprising 19 items across seven subscales: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Each item is rated on a scale of 0 to 3 points, with higher scores indicating poorer sleep quality and more significant sleep issues. Validity and reliability studies have been conducted for this country (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using SPSS version 20.0. Descriptive statistics are presented as frequencies, percentages, and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The chi-square test was used to analyze categorical variables. The Shapiro-Wilk test assessed data normality. For normally distributed data, independent t-tests were applied, while the Mann-Whitney U test was used for non-normally distributed data. Pearson or Spearman correlation analyses were conducted based on distribution characteristics. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 103 female participants diagnosed with BBL and 68 female controls. The mean age of the case group was 37.97\u0026thinsp;\u0026plusmn;\u0026thinsp;10.77 years, while that of the control group was 38.36\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50 years. There was no statistically significant difference in age between the case and control groups (p\u0026thinsp;=\u0026thinsp;0.676). Similarly, no statistically significant differences were observed between the groups in terms of height, weight, and BMI (p\u0026thinsp;=\u0026thinsp;0.295, p\u0026thinsp;=\u0026thinsp;0.908, and p\u0026thinsp;=\u0026thinsp;0.420, respectively).\u003c/p\u003e \u003cp\u003ePsychometric evaluations revealed that depression levels, as measured by BDI scores, were statistically significantly higher in the case group compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, anxiety levels, as assessed by BAI scores, were significantly higher in the case group than in the control group (p\u0026thinsp;=\u0026thinsp;0.012). The total PSQI scores, which reflect sleep-related processes, were also significantly higher in the case group compared to the control group (p\u0026thinsp;=\u0026thinsp;0.01). Details regarding psychometric variables are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eCorrelation analyses of the psychometric variables demonstrated that BAI scores were positively correlated with both BDI scores (r\u0026thinsp;=\u0026thinsp;0.583, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and total PSQI scores (r\u0026thinsp;=\u0026thinsp;0.412, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, a positive correlation was identified between BDI scores and total PSQI scores (r\u0026thinsp;=\u0026thinsp;0.444, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate the differences between women diagnosed with benign breast lesions (BBL) and a control group in terms of psychological problems, including anxiety, depression, and sleep disturbances. The findings revealed that the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI) scores, which evaluate anxiety, depression, and sleep problems, respectively, were statistically significantly higher in the BBL group compared to the control group. These results suggest the importance of screening individuals with BBL for psychological symptoms, as well as providing appropriate follow-up and treatment when necessary.\u003c/p\u003e \u003cp\u003eBreast lesions are a significant reason for hospital visits among women, with the majority being benign. Diagnosis often involves non-invasive and invasive methods, such as ultrasonography, mammography, and biopsy. The incidence of BBL typically begins to rise in the 20s and peaks in the 40s, with causes ranging from developmental abnormalities and infections to fibrocystic changes and adenomas (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). While studies have shown that breast lesions can lead to psychiatric symptoms, most research has focused on malignant breast lesions (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Evidence indicates that addressing psychiatric symptoms in patients with breast lesions improves their coping mechanisms and contributes positively to their overall well-being (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, studies specifically exploring psychiatric symptoms in BBL patients are limited.\u003c/p\u003e \u003cp\u003ePrevious research has reported that women with BBL exhibit higher levels of depression and anxiety compared to controls. For instance, one study demonstrated that even benign breast lesions can significantly affect patients' mental health (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Similarly, a study conducted in China found that depression and anxiety symptoms were elevated in women with BBL and negatively impacted their quality of life (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In line with this limited literature, our study confirmed that depression and anxiety levels are statistically significantly higher in women with BBL compared to controls. Additionally, our study identified a novel finding not previously reported: sleep disturbances, as assessed by PSQI scores, were significantly more prevalent in women with BBL. This suggests that patients with BBL experience not only heightened anxiety and depression but also significant sleep-related issues. orrelation analyses further revealed that PSQI scores were positively associated with BDI and BAI scores, indicating that sleep problems increase as anxiety and depression symptoms worsen in patients with BBL. This highlights the interrelated nature of these psychological challenges and underscores the importance of a comprehensive evaluation of mental health in this population.\u003c/p\u003e \u003cp\u003eIn conclusion, the literature on the mental health challenges faced by BBL patients remains sparse. The elevated levels of anxiety and depression observed in previous studies\u0026mdash;and confirmed by this study\u0026mdash;highlight the potential benefits of mental health evaluations for these patients. Furthermore, the novel finding that sleep problems are more prevalent in women with BBL, alongside the linear relationship between sleep disturbances, anxiety, and depression, underscores the need for integrating sleep assessments into the evaluation and follow-up of these patients.\u003c/p\u003e \u003cp\u003eThis study has some limitations. The assessment of psychiatric symptoms was based on self-report scales in a cross-sectional design, without face-to-face psychiatric evaluations, and the sample size was relatively small. However, our study is the first to report data on sleep problems in women with BBL, which represents a significant strength. Future studies with larger samples, longitudinal designs, and comprehensive psychiatric evaluations will further enhance understanding in this area.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of participants' BDI, BAI and PSQI total scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase Group\u003c/p\u003e \u003cp\u003en: 103\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003cp\u003en: 69\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical Analyses\u003c/p\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.34\u0026thinsp;\u0026plusmn;\u0026thinsp;10.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSQI Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBDI: Beck Depression Inventory\u003c/p\u003e \u003cp\u003eBAI: Beck Anxiety Inventory\u003c/p\u003e \u003cp\u003ePSQI: Pittsburgh Sleep Quality Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA. V. and N. U. wrote the main manuscript textM. A. A. prepared tables and statistical analysisA. V. Literature reviewAll authors reviewed the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Prof. Dr. Ahmet Mithat Elmacı, whose academic motivation and guiding light we have always benefited from.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCordiner R, et al. Pre-Operative Haematological Markers and Prognosis in Early Breast Cancer. Cancer Res. 2011;71(24Supplement):2\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuray M, Sahin AA. Benign Breast Diseases: Classification, Diagnosis, and Management. Oncologist. 2006;11(5):435\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePollitt J, Twine C, Gateley CA. Benign breast disease. Women\u0026rsquo;s Health Med. 2006;3(1):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoss HA, et al. How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population? Clin Radiol. 1999;54(10):676\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCompas BE, Luecken L. Psychological Adjustment to Breast Cancer. Curr Dir Psychol Sci. 2002;11(3):111\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamath J, et al. Symptom Distress Associated with Biopsy in Women with Suspect Breast Lesions. ISRN Oncol. 2012;2012:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck AT, et al. Beck depression inventory (BDI). Arch gen psychiatry. 1961;4(6):561\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHisli N. Beck Depresyon Envanterinin gecerliligi uzerine bir calisma (A study on the validity of Beck Depression Inventory). Psikol Derg. 1988;6:118\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck AT, et al. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56(6):893\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlusoy M, Sahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cogn Psychother. 1998;12(2):163.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuysse DJ, et al. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193\u0026ndash;213.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgargun MY. Pittsburgh uyku kalitesi indeksinin gecerligi ve guvenirligi. Turk Psikiyatri Dergisi. 1996;7:107\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki J, et al. Etiology and Management of Benign Breast Disease. The Breast. Elsevier; 2018. pp. 79\u0026ndash;e925.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKissane DW, et al. Psychiatric Disorder in Women with Early Stage and Advanced Breast Cancer: a Comparative Analysis. Australian New Z J Psychiatry. 2004;38(5):320\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen CC, et al. strategies and psychiatric morbidity in women attending breast assessment clinics. J Psychosom Res. 1996;40(3):265\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrivastava V, et al. study of anxiety and depression in benign breast disease. J Midlife Health. 2020;11(4):200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLou Z, et al. Affects of Anxiety and Depression on Health-Related Quality of Life among Patients with Benign Breast Lumps Diagnosed via Ultrasonography in China. Int J Environ Res Public Health. 2015;12(9):10587\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6399388/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6399388/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Breast lesions are a common clinical condition in women and a frequent reason for hospital admissions. While hospital visits for suspected malignancy are known to cause significant psychological distress, there is limited data on the psychological impact of benign breast lesions (BBL). This study aims to address this gap by evaluating psychological symptoms in women with BBL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The study included 103 women diagnosed with BBL as the patient group and 69 women as the control group. All participants completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI). All women participating in the study were given detailed information about the study and their consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Women with BBL had statistically significantly higher BDI, BAI, and PSQI scores compared to the control group. Furthermore, a positive correlation was identified between BDI, BAI, and PSQI scores. Women with BBL had significantly higher symptoms of anxiety, depression and varying degrees of sleep disturbance compared to controls.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e A diagnosis of BBL is associated with increased symptoms of depression, anxiety, and sleep disturbances. Additionally, these symptoms exhibit a linear relationship, emphasizing the need for psychological evaluation and support for women with BBL to mitigate potential mental health issues.\u003c/p\u003e","manuscriptTitle":"Beyond the Physical: Mental Health and Sleep Issues in Benign Breast Lesions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-15 08:46:53","doi":"10.21203/rs.3.rs-6399388/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"407c9f83-0981-492b-8ada-e0574f2695ad","owner":[],"postedDate":"April 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-12T12:08:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-15 08:46:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6399388","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6399388","identity":"rs-6399388","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}