Mediating Effect of Social Constraints in the Association Between Stigma and Depressive Symptoms in Chinese Breast Cancer Patients

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2024 Dec 19

PMID 39696252

Authors

Chunying Cui

Lie Wang

Affiliations

Soon will be listed here.

Abstract

Purpose: The present study aimed to investigate the effect of stigma on depressive symptoms and explore the mediating role of social constraints between stigma and depressive symptoms in Chinese breast cancer (BC) patients.

Methods: A cross-sectional design was conducted in China from December 2020 to July 2021. Out of 256 participants, 222 BC patients completed the questionnaires composed of demographic and clinical information, Patient Health Questionnaire-9 (PHQ-9), Social Impact Scale (SIS), and 15-item Social Constraints Scale (SCS-15). The hierarchical regression analysis was adopted to explore the associations of stigma and social constraints with depressive symptoms and the mediating role of social constraints.

Results: Approximately 20% of participants reported having depressive symptoms in Chinese BC patients. The indirect effect of stigma on depressive symptoms through social constraints was significant (a*b = 0.24, 95%CI = 0.15-0.33). When the mediator was controlled for, the direct impact of stigma on depressive symptoms was also significant (c'=0.16, p < 0.01).

Conclusion: The current study suggested that stigma may contribute to developing depressive symptoms by increasing social constraints in Chinese BC patients. Interventions based on reducing stigma and social constraints should be conducted to improve mental health in BC patients.

References

Bu X, Li S, Cheng A, Ng P, Xu X, Xia Y . Breast Cancer Stigma Scale: A Reliable and Valid Stigma Measure for Patients With Breast Cancer. Front Psychol. 2022; 13:841280. PMC: 9226439. DOI: 10.3389/fpsyg.2022.841280. View

Preacher K, Hayes A . Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008; 40(3):879-91. DOI: 10.3758/brm.40.3.879. View

Warmoth K, Wong C, Chen L, Ivy S, Lu Q . The role of acculturation in the relationship between self-stigma and psychological distress among Chinese American breast cancer survivors. Psychol Health Med. 2020; 25(10):1278-1292. DOI: 10.1080/13548506.2020.1734638. View

Tang W, Yusuf A, Jia K, Iskandar Y, Mangantig E, Mo X . Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer. 2022; 31(1):55. DOI: 10.1007/s00520-022-07506-4. View

Boing L, Soares Pereira G, Araujo C, Sperandio F, Loch M, Bergmann A . Factors associated with depression symptoms in women after breast cancer. Rev Saude Publica. 2019; 53:30. PMC: 6474749. DOI: 10.11606/S1518-8787.2019053000786. View

Cohee A, Adams R, Fife B, Von Ah D, Monahan P, Zoppi K . Relationship Between Depressive Symptoms and Social Cognitive Processing in Partners of Long-Term Breast Cancer Survivors. Oncol Nurs Forum. 2016; 44(1):44-51. PMC: 5181790. DOI: 10.1188/17.ONF.44-51. View

Badr H, Taylor C . Social constraints and spousal communication in lung cancer. Psychooncology. 2005; 15(8):673-83. DOI: 10.1002/pon.996. View

Weaver K, Foraker R, Alfano C, Rowland J, Arora N, Bellizzi K . Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?. J Cancer Surviv. 2013; 7(2):253-61. PMC: 3756807. DOI: 10.1007/s11764-013-0267-9. View

Brunet J, Sabiston C, Burke S . Surviving breast cancer: women's experiences with their changed bodies. Body Image. 2013; 10(3):344-51. DOI: 10.1016/j.bodyim.2013.02.002. View

10.

Tang P, Mayer D, Chou F, Hsiao K . The Experience of Cancer Stigma in Taiwan: A Qualitative Study of Female Cancer Patients. Arch Psychiatr Nurs. 2016; 30(2):204-9. DOI: 10.1016/j.apnu.2015.08.015. View

11.

Cordova M, Cunningham L, Carlson C, Andrykowski M . Social constraints, cognitive processing, and adjustment to breast cancer. J Consult Clin Psychol. 2001; 69(4):706-11. View

12.

Casavilca-Zambrano S, Custodio N, Liendo-Picoaga R, Cancino-Maldonado K, Esenarro L, Montesinos R . Depression in women with a diagnosis of breast cancer. Prevalence of symptoms of depression in Peruvian women with early breast cancer and related sociodemographic factors. Semin Oncol. 2020; 47(5):293-301. DOI: 10.1053/j.seminoncol.2020.08.003. View

13.

Cataldo J, Slaughter R, Jahan T, Pongquan V, Hwang W . Measuring stigma in people with lung cancer: psychometric testing of the cataldo lung cancer stigma scale. Oncol Nurs Forum. 2010; 38(1):E46-54. PMC: 3182474. DOI: 10.1188/11.ONF.E46-E54. View

14.

Lu Q, Gallagher M, Loh A, Young L . Expressive Writing Intervention Improves Quality of Life Among Chinese-American Breast Cancer Survivors: A Randomized Controlled Trial. Ann Behav Med. 2018; 52(11):952-962. DOI: 10.1093/abm/kax067. View

15.

Dinapoli L, Colloca G, Di Capua B, Valentini V . Psychological Aspects to Consider in Breast Cancer Diagnosis and Treatment. Curr Oncol Rep. 2021; 23(3):38. PMC: 7952347. DOI: 10.1007/s11912-021-01049-3. View

16.

Bray F, Laversanne M, Sung H, Ferlay J, Siegel R, Soerjomataram I . Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024; 74(3):229-263. DOI: 10.3322/caac.21834. View

17.

Manne S . Intrusive thoughts and psychological distress among cancer patients: the role of spouse avoidance and criticism. J Consult Clin Psychol. 1999; 67(4):539-46. DOI: 10.1037//0022-006x.67.4.539. View

18.

Liu J, Mok E, Wong T . Perceptions of supportive communication in Chinese patients with cancer: experiences and expectations. J Adv Nurs. 2005; 52(3):262-70. DOI: 10.1111/j.1365-2648.2005.03583.x. View

19.

Wong-Kim E, Sun A, Merighi J, Chow E . Understanding quality-of-life issues in Chinese women with breast cancer: a qualitative investigation. Cancer Control. 2005; 12 Suppl 2:6-12. DOI: 10.1177/1073274805012004S02. View

20.

Manne S, Glassman M . Perceived control, coping efficacy, and avoidance coping as mediators between spouses' unsupportive behaviors and cancer patients' psychological distress. Health Psychol. 2000; 19(2):155-64. DOI: 10.1037//0278-6133.19.2.155. View