The link between ambivalence over emotional expression and depressive symptoms among Chinese breast cancer survivors

Pathways Linking Parental Care and Control to Loneliness in Breast Cancer Patients with A History of Childhood Maltreatment: Exploring the Mediating Roles of Ambivalence Over Emotional Expression and Self-Discrepancy

Childhood maltreatment is a risk factor for loneliness and is linked to breast cancer. Parental bonding experienced during one's childhood also plays a significant role in increasing or decreasing the risk of loneliness later in life. Previous research has highlighted the significance of ambivalence over emotional expression (AEE) and self-discrepancy in the psychological adaptation of breast cancer patients, particularly concerning the impact of parental care and control experienced by patients in their relationship with their parents during childhood. Nevertheless, previous studies have not examined the mediating effects of AEE and self-discrepancy on parental care and control, as well as loneliness, in breast cancer patients. This study aimed to investigate whether AEE and self-discrepancy mediate the association of childhood parental care and control with loneliness in breast cancer patients with a history of childhood maltreatment. One hundred and thirty-three breast cancer patients who were receiving chemotherapy within the first 3 months post-diagnosis were recruited from one private and three public hospitals in Tabriz, Iran, to complete questionnaires. Parental bonding, loneliness, AEE, and self-discrepancy were assessed using the Parental Bonding Instrument (PBI), University of California Los Angeles (UCLA) Loneliness Scale, Ambivalence over the Expression of Emotion Questionnaire (AEQ), and Self-Discrepancies Scale (S-DS). Mediation models were tested using structural equation modeling. Effects of parental care (β = -.17, p < .05) and control (β = .21, p < .001) on loneliness were significant. Furthermore, both AEE (β = .19, p < .05) and self-discrepancy (β = .23, p < .01) significantly predicted loneliness. The pathway between parental care and AEE was significant (β = -.21, p < .001), as was the direct effect of parental control on self-discrepancy (β = .19, p < .05). Bootstrapping results showed that AEE significantly mediated the relationship between parental care and loneliness (95% confidence interval [CI] [-0.09, -0.01]). In addition, there was a significant indirect effect from parental control to loneliness via self-discrepancy (95% CI [0.11, 0.01]). These findings suggest that AEE and self-discrepancy could potentially be utilized in preventing or addressing loneliness in breast cancer patients who have a history of childhood maltreatment. Future research could, for example, assess whether integrating psychosocial interventions focusing on these variables as part of medical care can improve the mental health status of this subgroup of breast cancer patients who have experienced childhood maltreatment.

A systematic review of risk factors associated with depression and anxiety in cancer patients

Depression and anxiety are common comorbid conditions associated with cancer, however the risk factors responsible for the onset of depression and anxiety in cancer patients are not fully understood. Also, there is little clarity on how these factors may vary across the cancer phases: diagnosis, treatment and depression. We aimed to systematically understand and synthesise the risk factors associated with depression and anxiety during cancer diagnosis, treatment and survivorship. We focused our review on primary and community settings as these are likely settings where longer term cancer care is provided. We conducted a systematic search on PubMed, PsychInfo, Scopus, and EThOS following the PRISMA guidelines. We included cross-sectional and longitudinal studies which assessed the risk factors for depression and anxiety in adult cancer patients. Quality assessment was undertaken using the Newcastle-Ottawa assessment checklists. The quality of each study was further rated using the Agency for Healthcare Research and Quality Standards. Our search yielded 2645 papers, 21 of these were eligible for inclusion. Studies were heterogenous in terms of their characteristics, risk factors and outcomes measured. A total of 32 risk factors were associated with depression and anxiety. We clustered these risk factors into four domains using an expanded biopsychosocial model of health: cancer-specific, biological, psychological and social risk factors. The cancer-specific risk factors domain was associated with the diagnosis, treatment and survivorship phases. Multifactorial risk factors are associated with the onset of depression and anxiety in cancer patients. These risk factors vary across cancer journey and depend on factors such as type of cancer and individual profile of the patients. Our findings have potential applications for risk stratification in primary care and highlight the need for a personalised approach to psychological care provision, as part of cancer care.

Changes in Symptom Clusters Among Asian American Breast Cancer Survivors in Technology-Based Coaching Intervention

BACKGROUND

Limited research studies have focused on examining the impact of technology-based interventions in changing symptom clusters among Asian American breast cancer survivors.

OBJECTIVE

The aim of this study was to understand the longitudinal impact of a technology-based program on the symptom cluster experience of Asian American breast cancer survivors.

METHODS

This is a secondary data analysis that used exploratory factor analysis at each time point (baseline, post-1 month, post-3 months) for the control and intervention groups (N = 199).

RESULTS

The number of symptom clusters remained the same, and the same symptoms remained in similar clusters across the 2 groups. The control group experienced psychological cluster, fatigue cluster, and neck/skin cluster at baseline; psychological cluster, fatigue/dizzy cluster, and neck/skin cluster at post-1 month; and psychological cluster, fatigue/dizzy cluster, and somatic cluster at post-3 months. The intervention group experienced psychological cluster, neck cluster, and appetite/itching cluster at baseline; somatic/anticholinergic cluster, psychological/sexual cluster, and appetite cluster at post-1 month; and psychological cluster, neck cluster, and itching cluster at post-3 months. The psychological and neck clusters shared similar core symptoms of feeling nervous, dry mouth, and cough between the control and intervention groups.

CONCLUSION

The different symptom cluster experiences may be due to the technology-based intervention where the intervention group receives individual/group coaching/support that may have changed symptom clusters over time. Yet, the true efficacy of the intervention on symptom clusters warrants further investigation.

IMPLICATIONS FOR PRACTICE

Clinicians should understand the changes in symptom clusters as well as the presence of core symptoms and take a targeted symptom cluster approach in clinical settings.

The Relationship between Ambivalence over Emotional Expression and Nonsuicidal Self-Injury Among Chinese Adolescents: A Longitudinal Moderated Mediation Model

BACKGROUND

Nonsuicidal self-injury (NSSI) has become a significant mental health concern for adolescents. Previous empirical studies have shown that ambivalence over emotional expression is positively associated with negative emotions and behaviors. However, little is known about the relationship between ambivalence over emotional expression and NSSI among adolescents. Therefore, this study used a longitudinal design to examine the relationship between ambivalence over emotional expression and NSSI among Chinese adolescents, and also to explore the mediating and moderating mechanisms underlying this relationship.

METHOD

A total of 1,672 students (45.8% males; Mage = 16.12 years, SD = 1.56) in a middle school in Guangzhou were tracked. The investigation was conducted twice, with an interval of 6 months.

RESULTS

Ambivalence over emotional expression was positively correlated with NSSI. After controlling for gender and baseline NSSI, anxiety symptoms fully mediated the association between ambivalence over emotional expression and NSSI. In addition, the relationship between ambivalence over emotional expression and NSSI was moderated by NSSI refusal self-efficacy.

CONCLUSIONS

These findings imply that to decrease ambivalence over emotional expression, to reduce anxiety symptoms, and to promote NSSI refusal self-efficacy may be useful for interventions and preventions of NSSI.HIGHLIGHTSTested the relationship between ambivalence over emotional expression and NSSI in adolescents.Examined a moderated-mediation model over six months.Found the mediated effect of anxiety symptoms and moderated effect of NSSI refusal self-efficacy in the relationship between ambivalence over emotional expression and NSSI.

Translation and validation of the simplified Chinese version of the Chronic Pain Coping Inventory-42

BACKGROUND

The Chronic Pain Coping Inventory-42(CPCI-42) is mainly used for chronic pain management project, its original version is written in English and has been widely used in western countries. Therefore, the purpose of our study is to apply the CPCI-42 to Chinese patients and evaluate its responsiveness, reliability, and validity for Chinese patients with lumbar disc herniation (LDH).

METHODS

Translation and adaptation were carried out in accordance with the guidelines of the American Academy of Orthopedic Surgeons Outcome Committee. A total of 133 patients who were diagnosed with LDH were included in this study. Psychometric evaluations were then performed and included score distribution, internal consistency, test-retest reliability, construct validity, and responsiveness.

RESULTS

CPCI-42 is well adapted to the assessment of the cognitive and behavioral strategies of patients with LDH, and the scores of score distribution, internal consistency, test-retest reliability, construct validity, and responsiveness are excellent. Forward and reverse translation of the CPCI-42 to English from Chinese worked smoothly.

CONCLUSION

It is applicable to the assessment of quality of life of the cognitive and behavioral strategies of patients with LDH, and the scores of all indicators are excellent.

Translation and Validation of a Simplified Chinese Version of the Anterior Cruciate Ligament-Quality of Life Questionnaire

Background

The Anterior Cruciate Ligament-Quality of Life (ACL-QOL) questionnaire is a widely used and effective scale for quality of life in patients with chronic anterior cruciate ligament (ACL) injury.

Purpose

To translate and adapt the ACL-QOL questionnaire for Chinese patients and evaluate its reliability, validity, and responsiveness in this population.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

Translation and adaptation were conducted in accordance with the guidelines of the A merican Academy of Orthopaedic Surgeons Outcome Committee. Included were 121 patients who were diagnosed with a chronic ACL injury and underwent ACL reconstruction between January 2020 and June 2021. Preoperatively, patients completed the simplified Chinese version of the ACL-QOL (ACL-QOL-C), the Knee injury and Osteoarthritis Outcome Score, and the 12-Item Short Form Health Survey. The ACL-QOL-C was also completed at 12- and 24-week follow-ups. Psychometric evaluations were then performed and included score distribution, internal consistency, test-retest reliability, construct validity, and responsiveness.

Results

The Cronbach alpha ranged from .905 to .975, indicating excellent internal consistency, and the intraclass correlation coefficient ranged from 0.864 to 0.985, indicating excellent test-retest reliability. The consistency between the above results and our a priori hypotheses was more than 70% (35/42), indicating good construct validity. The standard error of measurement and effect size of the total score and each item of the ACL-QOL-C were >0.8 at the final follow-up, indicating good responsiveness.

Conclusion

The English version of the ACL-QOL has been successfully translated into Chinese, and it has been shown to be applicable for the assessment of the quality of life in Chinese patients with chronic ACL injury.

Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China

BACKGROUND

To explore whether emotional expressivity and the patterns of language use could predict benefits from expressive writing (EW) of breast cancer (BC) patients in a culture that strongly discourages emotional disclosure.

METHODS

Data were obtained from a recent trial in which we compared the health outcomes between a prolonged EW group (12 sessions) and a standard EW group (four sessions) (n = 56 per group) of BC patients receiving chemotherapy. The Chinese texts were tokenized using the THU Lexical Analyser for Chinese. Then, LIWC2015 was used to quantify positive and negative affect word use.

RESULTS

Our first hypothesis that BC patients with higher levels of emotional expressivity tended to use higher levels of positive and negative affect words in texts was not supported (r = 0.067, p = 0.549 and r = 0.065, p = 0.559, respectively). The level of emotional expressivity has a significant effect on the quality of life (QOL), and those who used more positive or fewer negative affective words in texts had a better QOL (all p < 0.05). However, no significant difference was identified in physical and psychological well-being (all p > 0.05). Furthermore, the patterns of affective word use during EW did not mediate the effects of emotional expressivity on health outcomes (all p > 0.05).

CONCLUSIONS

Our findings suggest that the level of emotional expressivity and the pattern of affective word use could be factors that may moderate the effects of EW on QOL, which may help clinicians identify the individuals most likely to benefit from such writing exercises in China.

The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial

BACKGROUND

Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS).

METHODS AND RESULTS

CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1-3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress.

CONCLUSION

A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS' depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02946619.

The Effect of Mindfulness-Based Stress Reduction (MBSR) on Emotional Flexibility and Ambivalence Over Emotional Expression in Divorced Women: A Pilot Randomized Controlled Trial

The present study was developed to evaluate the effects of mindfulness-based stress reduction (MBSR) on the level of emotional flexibility and ambivalence related to emotional expression of divorced women. A general community sample of 30 divorced women was recruited and randomly assigned to experimental and control groups. The experimental group received MBSR for 8 weeks, and the control group was placed on a waiting list. The Emotional Flexibility Questionnaire (EFQ) and the Ambivalence Over the Expression of Emotion Questionnaire (AEQ) were administered to both groups before (pre) and after (post) the treatment. Data were analyzed using two-way mixed repeated-measures analyses of variance. The results showed that women in the treatment group had a significant increase in the total score of the EFQ and its components. In addition, the MBSR group had a significant decrease in the total score of the AEQ and its components. MBSR intervention shows potential for use with divorced women to help with emotion regulation and subsequent better adjustment to separation.

A latent profile analysis of emotional expression among patients with unintentional injuries

BACKGROUND

Emotional expression has been suggested to affect the well-being of individuals with unintentional injuries. However, few studies have investigated it as a heterogeneous phenomenon. The purpose of this study was to characterize the patterns of emotional expression among patients with unintentional injuries using latent profile analysis, and to examine the relationship among these latent profiles and cognitive processing, posttraumatic growth, and posttraumatic stress disorder.

METHODS

A cross-sectional study was carried out at two general hospitals in Wenzhou, China. In total, 352 patients with unintentional injuries completed the socio-demographic questionnaire, Berkeley Expressivity Questionnaire, Ambivalence Over Emotional Expression Questionnaire, Event-Related Rumination Inventory, the Posttraumatic Growth Inventory, and PTSD Checklist-Civilian Version.  RESULTS: Three unique profiles were identified: high emotional expressivity (n = 238, 67.6%), moderate emotional expressivity (n = 45, 12.8%), and low emotional expressivity (n = 69, 19.6%). The ANOVA and chi-square tests demonstrated significant differences among the three groups concerning deliberate rumination and posttraumatic growth. Multinomial logistic regression analysis indicated that monthly income and time since injury significantly predicted profile membership.

CONCLUSIONS

Most patients showed high emotional expressivity after an unintentional injury. Emotional expression profiles were associated with deliberate rumination and posttraumatic growth. Emotional expression interventions tailored for different profiles are warranted after an unintentional injury.

Greater Post-Surgical Pain Predicts Long-Term Depressed Affect in Breast Cancer Patients

Abstract. Background: Depressed affect is observed during primary treatment for early-stage breast cancer and often persists into survivorship. Pain can influence the long-term emotions of women with breast cancer. Behavioral mechanisms explaining this relationship are less clear. Coping during primary treatment may play a role in the association between pain and depressed affect. Aims: Our observational study examined a longitudinal mediation model testing whether post-surgical pain intensity predicted depressed affect 5 years later via disengagement and/or engagement coping at the end of treatment. Method: Women ( N = 240) with stage 0–III breast cancer completed measures of pain, coping, and depressed affect 4–10 weeks post-surgery, and 12 months and 5 years later. Results: Structural modeling yielded measurement models of 12-month disengagement and engagement coping. Direct effects emerged between post-surgical pain intensity and 12-month disengagement (β = .37, p < .001) and engagement coping (β = .16, p < .05). Post-surgical pain intensity was also related to 5-year depressed affect (β = .25, p < .05). Disengagement and engagement coping were not associated with depressed affect at 5-year follow-up, and there was no evidence of mediation. Limitations: This is a secondary analysis of data from a trial conducted several years ago, and may not generalize due to a homogenous sample with attrition at long-term follow-up. Conclusions: Greater post-surgical pain intensity predicts more disengagement and engagement coping at the end of primary treatment, as well as depressed affect during survivorship. Managing post-surgical pain may influence the emotions of survivors of breast cancer up to 5 years later, possibly through coping or non-coping processes.

Effectiveness of mobile health-based self-management interventions in breast cancer patients: a meta-analysis

PURPOSE

To determine the effectiveness of mobile health-based self-management interventions on medical/behavioral, role, and emotional management in breast cancer patients.

METHODS

The Embase, MEDLINE, SINOMED, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, and Weipu (VIP) databases were extensively searched from inception to November 30, 2020, to identify eligible clinical trials. Outcomes included medical/behavioral management (self-management behavior, functional exercise compliance, self-efficacy, complications, and symptoms), role management (role functioning), and emotional management (anxiety and depression), social support, and health-related quality of life.

RESULTS

Twenty-four studies were included in this meta-analysis. The results of the meta-analysis indicated that mobile health-based self-management interventions could potentially improve breast cancer patients' self-management behavior, functional exercise compliance (WMD = 15.80, 95% CI = 10.53 to 21.08, P < 0.001), self-efficacy (SMD = 1.22, 95% CI = 0.57 to 1.87, P < 0.001), and health-related quality of life (SMD = 0.78, 95% CI = 0.44 to 1.12, P < 0.001); reduce the incidence of lymphedema (RR = 0.20, 95% CI = 0.15 to 0.26, P < 0.001); and relieve the level of anxiety (SMD =  - 0.67, 95% CI =  - 0.99 to - 0.35, P < 0.001). However, patients assigned to the mobile health group and the conventional care group did not differ significantly in symptom relief (including pain and fatigue), role functioning, depression, or social support (all P ≥ 0.05).

CONCLUSION

Mobile health-based self-management interventions can potentially facilitate the self-management and health-related quality of life of breast cancer patients.

Evaluating relationships between lung cancer stigma, anxiety, and depressive symptoms and the absence of empathic opportunities presented during routine clinical consultations

OBJECTIVE

Empathic communication in clinical consultations is mutually constructed, with patients first presenting empathic opportunities (statements communicating emotions, challenges, or progress) to which clinicians can respond. We hypothesized that lung cancer patients who did not present empathic opportunities during routine consultations would report higher stigma, anxiety, and depressive symptoms than patients who presented at least one.

METHODS

Audio-recorded consultations between lung cancer patients (N = 56) and clinicians were analyzed to identify empathic opportunities. Participants completed questionnaires measuring sociodemographic and psychosocial characteristics.

RESULTS

Twenty-one consultations (38 %) did not contain empathic opportunities. Unexpectedly, there was a significant interaction between presenting empathic opportunities and patients' race on disclosure-related stigma (i.e., discomfort discussing one's cancer; F = 4.49, p = .041) and anxiety (F = 8.03, p = .007). Among racial minority patients (self-identifying as Black/African-American, Asian/Pacific Islander, or other race), those who did not present empathic opportunities reported higher stigma than those who presented at least one (t=-5.47, p = .038), but this difference was not observed among white patients (t = 0.38, p = .789). Additional statistically significant findings emerged for anxiety.

CONCLUSION

Disclosure-related stigma and anxiety may explain why some patients present empathic opportunities whereas others do not.

PRACTICE IMPLICATIONS

Clinicians should intentionally elicit empathic opportunities and encourage open communication with patients (particularly from diverse racial backgrounds).

Systematic review of depressive, anxiety and post-traumatic stress symptoms among Asian American breast cancer survivors

OBJECTIVES

This paper aimed to review the experience of psychopathology symptoms (ie, depressive, anxiety and post-traumatic stress) and their social, cognitive and affective correlates among Asian American breast cancer survivors. Studies on psychosocial interventions for reducing psychopathology symptoms were also included in this review.

DESIGN

A systematic review was conducted.

METHODS

PubMed, PsycINFO and Web of Science were searched from database inception to November 2018. Empirical, peer-reviewed articles on adult women of Asian heritage residing in the USA with breast cancer diagnoses were included in this review. The methodological quality of the included articles was coded.

RESULTS

The search yielded 16 empirical articles, which were all deemed to be of high methodological quality. Eleven studies utilised a quantitative design, two studies utilised a qualitative design and three studies utilised a mixed-methods design. Thirteen were cross-sectional and three were longitudinal in design. Only two intervention studies were identified. Studies showed that Asian American breast cancer survivors endorsed moderate to high levels of depressive symptoms, anxiety and post-traumatic stress symptoms; those who are more acculturated demonstrated lower levels of depressive and anxiety symptoms. Asian American breast cancer survivors with social constraints were more likely to have intrusive thoughts and, in turn, have high levels of psychopathology symptoms. Intervention studies were limited, but the use of community-based participatory research approaches and cultural adaptations were noted strengths of the studies.

DISCUSSION

In addition to discussing clinical implications, we highlight limitations of the literature, including a lack of longitudinal studies and the limited use of standardised diagnostic instruments for assessing psychopathology symptoms among this population. Clarifying the prospective relationships between psychopathology symptoms and their social, cognitive and affective correlates will help inform the development of culturally sensitive psychosocial interventions among Asian American breast cancer survivors.

Talking about cancer: Explaining differences in social support among Chinese American and European American breast cancer survivors

Cultural models of emotional disclosure and its impact on seeking support are understudied in the context of cancer diagnosis. We argue that two different cultural norms must be considered: (1) the importance of emotional disclosure and (2) attitudes toward seeking support from loved ones. Our interviews with 37 foreign-born Chinese American and 23 European American breast cancer survivors revealed differences in disclosure of cancer diagnosis and perception of social support. Both Chinese American and European American survivors receive and provide emotional and social support with loved ones, but their manifestations of disclosure and help-seeking behaviors are culturally specific.

Post-traumatic stress symptoms and social constraints in the communication with family caregivers among Chinese-speaking breast cancer survivors

PURPOSE

The consequences of breast cancer on physical and psychological well-being have been extensively studied. One of the long-term effects of the disease is Post-Traumatic Stress Symptoms (PTSS). However, only a small number of studies examined PTSS among Chinese-speaking breast cancer survivors. This study investigated interpersonal and physical health predictors of PTSS and explored sociodemographic and clinical factors linked to PTSS in this group. We hypothesized that higher levels of social constraints and lower levels of social support, relationship closeness, and physical health would be associated with higher levels of PTSS.

METHODS

A sample of 96 Chinese-speaking breast cancer survivors completed measures of PTSS, social constraints, social support, closeness, health-related quality of life, and acculturation. Bivariate correlation examined association between variables of interest. Then, a hierarchical multiple regression analysis was conducted to examine predictors of PTSS.

RESULTS

Participants reported an average score of 14.7 (SD = 10.46, range 0-44) on the severity of PTSS, with 54.2% (N = 52) meeting the criteria for likelihood of PTSD. PTSS were positively associated with social constraints and negatively associated with social support, closeness, and physical health. More medication usage was linked to worse PTSS. Only social constraints in the ability to communicate cancer-related concerns to the caregiver predicted worse PTSS severity.

CONCLUSIONS

The study unveils the role of interpersonal factors in mental health outcomes of Chinese-speaking breast cancer survivors. Future research should be conducted on larger samples and culturally relevant psychosocial interventions should be developed.

Emotions and Coping Strategies During Breast Cancer in Latina Women: A Focus Group Study

We conducted three focus groups among Latina breast cancer (BC) survivors (N = 23). The aim was to qualitatively identify how Latina women cope with BC treatment, what emotions arose during their treatment, and if they experienced any medical barriers during their journey. Women were also asked about a potential online resource. Specific emotions of anger and fear were commonly identified but related to different contexts. Family support and spirituality were frequently cited as two positive coping resources during BC and its treatment. Additionally, women expressed what they believe would be essential in an online community that would provide aid with BC support. Given the importance of reaching this vulnerable minority group, we recommend that future studies contextualize Latina women's emotional experiences and coping skills associated with BC as indicators of well-being. Along with previous studies, this study highlights the importance of developing culturally appropriate interventions. Additionally, we address alternative forms of resources that may be more accessible.

Effects of Nurse-Led Support Via WeChat, a Smartphone Application, for Breast Cancer Patients After Surgery: A Quasi-Experimental Study

Background: Women with breast cancer (BC) commonly experience physical and psychosocial symptoms after surgery. Web- and smartphone-based support can significantly improve women's symptoms and quality of life. Social care applications (apps) are widely used in China, but there are few studies on their effectiveness BC support. This study aimed to examine the effects of nurse-led support on the social care app WeChat^® (Tencent Holdings Limited, Shenzhen, China) in BC patients after surgery. Methods: A quasi-experimental study was conducted between June 2015 and August 2015. Sixty patients with BC (30 in the intervention group, 30 in the control group) were enrolled. Subjects in the intervention group participated in a WeChat-based support program (WSP) led by nurses, while subjects in the control group received a follow-up by telephone. Subjects in both groups were evaluated at the time of discharge and at 1, 3, and 6 months of follow-up. Physical well-being status, psychology status, and social support were evaluated. Results: There were no differences between intervention and control patients at baseline. Physical well-being (p < 0.001), anxiety (p < 0.001), depression (p < 0.001), and support from outside of family (p  = 0.037) were significantly better in the intervention group than in the control group after 6 months. The intervention group showed that physical well-being (p  = 0.036), anxiety (p < 0.001), and depression (p < 0.001) were significantly different from baseline to 6 months of follow-up. Conclusion: WSP assisted with nurse-led support and had physical, psychological, and social benefits for patients after surgery for BC.

A randomized controlled trial of a guided self-disclosure intervention to facilitate benefit finding in Chinese breast cancer patients: Study protocol

AIM

To describe a protocol that examines the feasibility and effectiveness of a face-to-face guided self-disclosure intervention for facilitating benefit finding and other related psychological outcomes for breast cancer patients.

BACKGROUND

Benefit finding can promote a positive attitude among patients facing disease. However, limited studies have focused on improving benefit finding among breast cancer patients. Previous research has been based on group interventions, which may not suit all patients. Self-disclosure was recognized as a strong predictor of benefit finding. This protocol is based on a brief face-to-face disclosure intervention to improve benefit finding for breast cancer patients.

DESIGN

A non-blinded randomized controlled trial.

METHODS

A total of 154 patients with breast cancer who have undergone radical mastectomy will be randomly assigned to either the experimental group, which will participate in a six-session face-to-face individual intervention, or the control group at a ratio of 1:1. Baseline assessments will take place after the breast cancer diagnosis, with follow-up assessments at 3, 6 and 9 months after baseline. The primary outcome is benefit finding; other outcomes are self-disclosure, cognitive reappraisal, social support, optimism and medical coping modes.

DISCUSSION

This study is to design a protocol for guided self-disclosure interventions to promote benefit finding in Chinese breast cancer patients. If this intervention is feasible and effective, it could be implemented in clinical practice.

IMPACT

This study will provide useful advice for health professionals to guide breast cancer patients in benefit finding during stressful events. If it is effective, it will be implemented broadly in clinical practice.

Successful Strategies for Engaging Chinese Breast Cancer Survivors in a Randomized Controlled Trial

Chinese immigrant breast cancer survivors face various challenges due to cultural and socioecological factors. Research efforts to develop culturally sensitive interventions have been limited by lack of knowledge regarding successful recruitment and implementation practices among Chinese immigrant populations. This paper documents strategies utilized during the development and implementation of a randomized controlled trial of a culturally sensitive psychosocial intervention for Chinese immigrant breast cancer survivors. In partnership with a community agency, we developed culturally and linguistically appropriate research materials, recruited participants from community channels, and conducted longitudinal data collection. Key strategies include building equitable research partnerships with community agencies to engage participants; being responsive to the needs of community agencies and participants; considering within-group diversity of the research population; utilizing recruitment as an opportunity for relationship-building with participants; and developing key strategies to promote retention. Successful participant engagement in cancer intervention research is the result of collaboration among breast cancer survivors, community leaders and agencies, and academic researchers. The engagement process for this study is novel because we have emphasized cultural factors in the process and taken a relational approach to recruitment and retention.

Perceived Social Support Mediates the Longitudinal Relations between Ambivalence over Emotional Expression and Quality of Life among Chinese American Breast Cancer Survivors

PURPOSE

The present study examined perceived social support as a mediator of the longitudinal link between ambivalence over emotional expression (AEE) and quality of life among a sample of Chinese breast cancer survivors.

METHODS

Ninety-six Chinese breast cancer survivors recruited from Southern California completed four surveys in total: (1) a baseline survey (T1), 1-month follow-up (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), and the Medical Outcomes Study Social Support Scale (MOS-SSS).

RESULTS

Higher T1 AEE was associated with lower T1 social support (B = -0.01, SE = 0.004, p < 0.01) which in turn was associated with lower quality of life at T2 (B = 2.98, SE = 0.64, p < 0.01), T3 (B = 2.14, SE = 0.54, p < 0.01), and T4 (B = 2.08, SE = 0.68, p < 0.01).

CONCLUSIONS

These results suggest that the harmful effect of AEE on quality of life is explained by reduced social support. Given the detrimental effects of AEE on social support and quality of life, future research on interventions that facilitate emotional disclosure is needed. Implications for the effects of Chinese culture on AEE are discussed.

Ambivalence over emotional expression and intrusive thoughts as moderators of the link between self-stigma and depressive symptoms among Chinese American breast cancer survivors

Due to successful public health campaigns, breast cancer has successfully transformed from a highly stigmatized illness to a philanthropically supported disease in the United States. However, Chinese American breast cancer survivors continue to experience high levels of self-stigma and associated negative mental health outcomes. In the present study, we examined the relations between self-stigma and depressive symptoms, and further tested individual difference variables such as ambivalence over emotional expression and intrusive thoughts that may exacerbate the harmful effects of self-stigma among this population. One hundred and twelve foreign-born Chinese breast cancer survivors living in the United States completed questionnaires measuring self-stigma, depressive symptoms, AEE, and intrusive thoughts. We found significant AEE × self-stigma and intrusive-thought × self-stigma interaction effects in predicting depressive symptoms. Specifically, the relationships between self-stigma and depressive symptoms were exacerbated among individuals with high levels of AEE and intrusive thoughts. Self-stigma represents a significant predictor of depressive symptoms among Chinese breast cancer survivors, and particularly so for individuals with higher levels of AEE and intrusive thoughts. The findings suggest that for interventions designed to reduce the negative mental health outcomes associated with self-stigma, targeting risk factors such as AEE and intrusive thoughts might be promising.

Is expressive suppression harmful for Chinese American breast cancer survivors?

Emotion regulation strategies are important for cancer survivors' adjustment. Expressive suppression, defined as the active effort of inhibiting the expressive component of an emotional response, has been found to be a maladaptive emotion regulation strategy. These studies, however, have been limited to cross-sectional designs and primarily European American samples. Chinese culture encourages emotion suppression to preserve interpersonal harmony and therefore it may be important to test these emotion regulation processes with this population. This study aimed to examine the longitudinal effects of expressive suppression, ambivalence over emotional expression (i.e., inner conflict over emotional expression), and cognitive reappraisal on quality of life among Chinese American breast cancer survivors. 103 participants completed a questionnaire assessing expressive suppression, ambivalence over emotional expression, cognitive reappraisal, and quality of life at baseline and a questionnaire assessing quality of life eight weeks later. Consistent with our hypotheses, baseline ambivalence over emotional expression was associated with lower follow-up quality of life above and beyond the effect of expressive suppression. Furthermore, cognitive reappraisal moderated the relations between expressive suppression and follow-up quality of life, such that expressive suppression may be less detrimental for Chinese American breast cancer survivors who are able to regulate their emotions using cognitive reappraisal. Implications for informing interventions for Chinese American breast cancer survivors are discussed.

Exploring Coping Strategies Among Young Asian American Women Breast Cancer Survivors

In recent years, breast cancer rates among young Asian American women have been increasing. Despite increases in breast cancer among young Asian American women, little is known about how this population copes throughout diagnosis, treatment, and survivorship. This study was a qualitative exploration of how young Asian American women cope with breast cancer diagnosis, treatment, and survivorship. In-depth interviews with 22 young (under the age of 50) Asian American women diagnosed with early stage breast cancer were conducted. Through qualitative data analysis, three major themes emerged including moving from managing the emotions of others to expressing emotional vulnerability, moving from work and productivity to work-life balance, and moving beyond the family and reaching out to breast cancer survivors. At diagnosis, participants worked to maintain normalcy including caring for others and working during treatment. Once treatment was over, women worked to find ways to use their experience as a transformative one and also to develop more positive coping skills including expressing emotional vulnerability and reaching out to others. Further studies are needed to create and test culturally tailored supportive interventions that enhance positive coping tools among young Asian American women diagnosed by breast cancer.