Objective To explore the influencing factors of anxiety and depression in patients after breast cancer (BC) surgery and construct a nomogram prediction model.

Methods A total of 520 BC patients who underwent surgical treatment at Yibin First People's Hospital from January 2022 to December 2024 were selected. The occurrence of anxiety and depression in patients was assessed using Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS), and patients were divided into anxiety-depression group and non-anxiety-depression group. Logistic regression analysis was used to identify potential influencing factors. The R language and the rms package were used to establish the nomogram model. The calibration and discrimination of the nomogram model were evaluated using the Hosmer-Lemeshow test and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) was used to predict the net benefit of the model.

Results A total of 265 cases of anxiety and depression occurred, with an incidence rate of 50.96%. There were statistically significant differences between the anxiety-depression group and the non-anxiety-depression group in terms of age, Pittsburgh Sleep Quality Index (PSQI) score, Visual Analogue Scale (VAS) score, disease cognition score, Perceived Social Support Scale (PSSS) score, Functional Assessment of Cancer Therapy-Breast (FACT-B) score, Connor-Davidson Resilience Scale (CD-RISC) score, Social Impact Scale (SIS) score, Fear of Progression Questionnaire-Short Form (FoP-Q-SF) score, medical insurance type, surgical method, and TNM clinical stage compared with the non-anxiety-depression group (P < 0.05). After variable screening by Lasso regression and Logistic regression analysis, it was found that younger age, higher TNM clinical stage, lower PSSS score, and lower FACT-B score were risk factors for anxiety and depression in patients after BC surgery, with OR (95%CI) of 1.106 (1.077 to 1.135), 4.438 (2.404 to 8.190), 1.100 (1.056 to 1.145), and 1.043 (1.021 to 1.065), respectively. Lower VAS score, lower SIS score, and lower FoP-Q-SF score were protective factors for anxiety and depression in patients after BC surgery, with OR (95%CI) of 0.777 (0.666 to 0.906), 0.928 (0.893 to 0.965), and 0.896 (0.860 to 0.934), respectively. The constructed nomogram model had good discrimination and calibration. The AUCs of the ROC curves for the model group, internal validation group, and external validation group were 0.885, 0.859, and 0.856, respectively. The maximum deviations for the model group, internal validation group, and external validation group were 0.029 (P=0.921), 0.042 (P=0.867), and 0.038 (P=0.894), respectively.

Conclusion The nomogram model established based on Logistic regression analysis can better predict the risk of anxiety and depression in patients after BC surgery.