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

Disclosures

BMC Womens Health. 2015;15(91) 

In This Article

Methods

Sample and Design

Patient Group. Between September 2011 and June 2012, patients were recruited from Xiangya Hospital and Second Xiangya Hospital, Central South University. Eligible patients met the following criteria: (1) women newly diagnosed with breast cancer stage I or stage II by biopsy, (2) informed of the diagnosis by their relatives or doctors, and (3) ability to speak Chinese. Patients with the following conditions were excluded: (1) breast cancer recurrence, (2) known untreated or unstable major medical conditions other than breast cancer, (3) known major psychiatric or neurological disorders that would interfere with completion of the measures, and (4) history of substance abuse.

Two hundred and fifty-five women met the first three inclusion criteria and were invited to the study. Eight of them were excluded from the study according to the exclusion criteria. Thus, the final patient sample consisted of 247 women, all of whom agreed to participate after being informed of the aim and procedure of the study. Participants aged from 26 to 70 years, with a mean (SD) = 47.45(7.43) years. About 40.5 % of the patients were from urban areas and 59.5 % were from rural areas. Most (89.5 %) of the patients were married, 7.3 % were divorced, and 3.2 % were widowed. They had received a mean (SD) of 9.77(3.42) years of schooling. The employment status of the patients reported were: employed (77.3 %), housewife (15.4 %), and retired (7.3 %).

Healthy Comparison Group. We recruited the healthy women from Changsha and the surrounding area for comparison. Eligible women had self-reported good physical health and spoke Chinese. Women with the following conditions were excluded: (1) history of any type of cancer, (2) known untreated or unstable major medical conditions, (3) known major psychiatric or neurological disorders that would interfere with completion of the measures, and (4) history of substance abuse.

Three hundred and eighty-one women volunteered to participate. Nineteen of them were excluded from the study, leaving 362 women as health controls. The ages of participants ranged from 25 to 68 years, with a mean (SD) = 46.59 (7.57) years. Among the 362 women, 39.2 % were from urban areas and 60.8 % were from rural areas. The majority (93.1 %) of the healthy women were married, 4.4 % were divorced, and 2.5 % were widowed. They had received a mean (SD) of 9.53 (3.43) years of schooling. The employment status reported were: employed (74.3 %), housewife (10.8 %), and retired (14.9 %).

Procedure

The research procedure of the current study was approved by the Ethics Committee of the Second Xiangya Hospital, Central South University. After participants provided written informed consent, trained psychology students administered structured questionnaires in face-to-face interviews to collect information on demographic, emotional control, anxiety and depressive symptoms.

Measures

Demographics Form. Demographic data including: age, years of schooling, long-term residence, marital status and employment status.

Center for Epidemiological Studies Depression Scale (CES-D). The CES-D is a 20-item self-report questionnaire that assesses depressive symptoms in general population. For each item, individuals are asked to describe how often they have experienced a given symptom over the last week, and respond on a 4-point scale ranging from 0 (not at all) to 3 (a lot). Higher scores indicate higher levels of such symptoms. The CES-D possesses strong reliability and validity in clinical and nonclinical adults.[25,26] The cronbach's α coefficient of CES-D in current study was 0.88.

The Beck Anxiety Inventory (BAI). The BAI is a 21-item self-report inventory that measures the severity of anxiety symptoms in the last week. Items are rated on a 4-point scale ranging from 0 (not at all) to 3 (severely, I could barely stand it), with higher scores indicating higher levels of anxiety symptoms.[27] Good psychometric properties have been demonstrated in a variety of clinical populations, including breast cancer patients.[28] The cronbach's α coefficient of BAI in current study was 0.87.

The Chinese Version of Courtauld Emotional Control Scale (CECS). The original CECS was developed to assess the extent of emotional control when a particular negative emotion is experienced. It contains 21 items separated into three subscales for the report of the suppression or the expression of feelings towards anger, anxiety, and unhappiness (depressed mood). Individuals are asked to response to the phrases such as "When I feel angry, I bottle it up" on a 4-point scale ranging from 1 (almost never) to 4 (almost always). The total emotional suppression scores are summed by three subscale scores, with higher scores indicating higher levels of emotional suppression. In previous research, the CECS has shown good reliability.[29]

The Chinese version of CECS was developed through the procedures of translation and back translation, as well as reference to the version developed by Ho et al.[24] to ensure the meaning of each statement corresponded accurately to the meaning of the original one. In our previous research, the Chinese version of CECS was proved to be applicable for Chinese women with breast cancer.[30] In the current sample, CECS and its subscales exhibited strong internal consistency: 0.96 (CECS), 0.89 (anger), 0.91 (anxiety), and 0.92 (depressed mood).

Analyses

Descriptive analyses, analysis of variance, and hierarchical regression analyses were performed by SPSS 17.0 software with a 5 % level of significance. The incidence rates of depressive symptoms were calculated according to the cutoff CES-D score of 16 established by Radolff: the CES-D score of 16 to 26 indicating clinical depressive symptoms, and CES-D score ≥27 indicating severe depressive symptoms.[31] Analyses of variance were conducted to investigate differences on depressive symptoms and emotional suppression tendencies between two groups. Bivariate correlations between age, years of schooling, emotional suppression, anxiety symptoms and depressive symptoms for all participants were analyzed using Pearson correlations or Spearman correlations depending on the distribution of variables. Hierarchical regression analyses were performed to examine the effect of the three emotional suppression tendencies on depressive symptoms in participants. As anxiety may be closely related to depressive symptoms, we controlled levels of anxiety in our regression analyses. Collinearity between independent variables was tested based on variance inflation factors and tolerances.[32]

Comments

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