OBJECTIVES: Although the psychological effect of breast cancer (BC) diagnosis is well documented, less is known about the prevalence of, and risk factors for depression and anxiety in the BC patients. METHODS: Women initially diagnosed with breast cancer (ICD 10: C50) between January 2009 and December 2013 (indexdate) were identified from 1,202 general practitioner’s (GP) and 244 gynecologist’s (GYN) practices in the IMS Disease Analyzer database. Patients were included only if they did not have any diagnosis of depression or anxiety within 12 months before index date.. The main outcome measure was the first diagnosis of either depression or anxiety disease within one year after indexdate. A total of 23,709 patients at GPs and 19,977 at GYN were available for the analysis. RESULTS: Baseline characteristics of study patients were as follows: mean age was 64.3 years, 9% had a private health insurance, 9.4% of patients had a metastatic BC. After 1 year of follow-up, 17.4% of patients at GPs and 19.2% at gynecologists were diagnosed with depression or anxiety. There was a significantly higher risk of depression/anxiety in the age groups 41-50 (HR: 1.27, p<0.001) and 51-60 (HR: 1.30, p<0.001) compared to <=40 years. There was a much higher risk of depression/anxiety in patients with metastatic breast cancer (HR: 1.20, p<0.001) and patients with depression/anxiety episodes in the past (>1 year prior to indexdate (HR: 1.91, p<0.001). Private health insurance was associated with a significantly lower depression/anxiety risk (HR: 0.43, p<0.001). CONCLUSIONS: Analysis of real-world data from German primary care practices identified potential risk factors for the development of depression/anxiety disorder among BC patients. Being aware of these risk factors could facilitate early prevention and support for affected patients with potentially beneficial implications for their overall therapy. Further research has to be done to investigate these risk factors in more detail.