Emotional Suppression and Depressive Symptoms in Women Newly Diagnosed With Early Breast Cancer

Lingyan Li; Yanjie Yang; Jincai He; Jinyao Yi; Yuping Wang; Jinqiang Zhang; Xiongzhao Zhu


BMC Womens Health. 2015;15(91) 

In This Article


Breast cancer has been the most common malignancy amongst women around the world.[1] In 2008, about 1.38 million women were diagnosed with breast cancer and approximately 0.46 million women died of the disease worldwide.[2] China used to be a low-incidence area of breast cancer, however, urban cancer registries have documented 20 to 30 % increases in the incident rates of breast cancer in the last decade.[3] Based on data of the sixth national population census and the recent national incidence of female breast cancer, it is estimated that more than 270,000 Chinese women face the risk of being diagnosed with breast cancer.

Being diagnosed with breast cancer is a catastrophic life event, which usually induces psychological distress. Extensive studies have shown that patients with breast cancer usually present varying levels of depressive symptoms.[4,5] For example, 5 to 15 % of post-surgery patients report depressive symptoms using structured interviews. These percentages rise to 15 to 30 % when using screening questionnaires.[6] Even years after diagnosis and treatment, some patients with breast cancer still suffer from significant clinical depression.[7,8] In addition to decreasing physiological and psychological function,[9–12] depressive symptoms may have other serious consequences, such as increasing mortality in patients with breast cancer.[13]

Various factors are related to depressive symptoms in patients with breast cancer, including demographics, disease-related factors, and individual psychosocial characteristics such as coping styles and personality traits.[14–17] Emotional suppression, one of these coping styles, is defined as an individual's ability to consciously control the expression of negative emotions, such as anxiety, sadness, and anger. It is a core component of the cancer personality trait, commonly referred to as type C behavioral pattern elaborated by Temoshok.[18] Empirical evidence has been accumulated to support the link between emotional suppression and psychosocial maladjustment such as depressive symptoms in patients with breast cancer.[19] For example, Schlatter et al.[20] found that anger suppression was associated with higher level of depression in breast cancer patients during chemotherapy. Classen et al.[21] found that emotional suppression as a whole was related to worse mood in women with advanced breast cancer. Conversely, attempts to express negative emotions could lead to better adjustment to cancer.[18,22] Emotional expression in a supportive group environment enhanced the management of disease-related emotion and reduced distress. These findings suggest that a controlled emotion coping style may hinder psychological adjustment to cancer. In other words, sufficient emotional expression is important for breast cancer patients.

However, research to date has focused on western women. Studies show that compared to European and American women, Chinese women are more likely to ascribe to norms of emotional control for ensuring smooth social interactions.[23] Thus, emotional control appears to have important implication for the psychological adjustment of Chinese patients with breast cancer. Despite its importance in the Chinese context, there was only one study conducted by Ho and colleagues[24] concerning Hong Kong Chinese women. Ho et al. reported that women with cancer showed a tendency to suppress emotion, and emotional suppression positively predicted stress level even after the effect of depressed mood was under control. But almost ten years has passed since then, no evidence has indicated the relationships between emotional suppression and depressive symptoms in women newly diagnosed with breast cancer in Mainland China. Figuring out the role of emotional suppression may help us to better understand the depressive symptoms in patients, and to adopt useful intervention strategies to improve their psychological adjustment. Thus the aims of the current study were: (1) to investigate the incidence of depressive symptoms in the women newly diagnosed with early breast cancer in mainland China, and (2) to examine the relationships between emotional suppression and depressive symptoms in these patients.