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


Previous studies have found that most breast cancer patients report psychological distress and may be in need of emotional help,[33] especially during the first 24 months after diagnosis.[34] In current study, the incidence rates of clinical depressive symptoms and severe depressive symptoms in women newly diagnosed with breast cancer were 36.4 and 36.0 % respectively. These rates are higher than findings from previous studies using the same instrument for assessing the depressive symptoms in patients under later-stages treatment for breast cancer.[15,35] Our findings suggest that patients who are newly diagnosed with breast cancer are at higher risk of developing depressive symptoms. Nevertheless, methodologically more rigorous assessments (e.g., clinical interview) should be conducted to determine if these patients meet the criteria for clinically significant depression.

Some researchers have argued that emotional suppression may be an important risk factor for cancer. Individuals who adopt a style of emotion suppression in response to negative emotions throughout adult life are more likely to be diagnosed with breast cancer.[36] Similar findings have been found in other diseases.[37] The current study showed that women with breast cancer in Mainland China used higher level of emotional suppression than healthy women. Our findings suggest that a relative high level of emotional suppression is not conducive to women's health, even though forbearance, the mastering of maintaining harmonious relations with others, is generally considered a valuable character trait in women according to traditional Chinese culture.[23] Supportive–expressive therapy for those diagnosed with cancer in previous study may also be helpful for breast cancer prevention in mainland China, and future research should focus on this field.

Consistent with previous research,[21] examination of the correlations between the emotional suppression and depressive symptoms revealed that participants with controlled emotional coping style have higher level of depressive symptoms. Findings from regression analyses implicated emotional suppression had a significant effect on the depressive symptoms; higher scores on anger suppression predicted higher level of depressive symptoms after controlling for the effects of group membership and levels of anxiety symptoms. Depression suppression and anxiety suppression had no significant effect on depressive symptoms, though both subscale scores were significantly correlated with CES-D scores. These results, which were similar to findings of Iwamitsu's study,[38] implied that suppression of different negative emotion had different psychological outcomes. Therefore, it is important to encourage suppressive patients to express negative emotion correctly and appropriately.

Anger suppression has been found to be linked with increased risk of adverse cardiac events, greater pain, and poor immune function.[39] In current study, when considering the three emotional suppression tendencies concurrently, anger suppression showed a unique role in predicting depressive symptoms in Chinese women with breast cancer. However, Ando et al.[40] found that only anxiety suppression could significantly predict the level of psychological stress of breast cancer patients before the diagnosis. The possible reason for this inconsistency may be that anger expression is more socially undesirable for Chinese women and they seem to have more difficulty in expressing anger than anxiety and depression. As mentioned by Ho et al., Hong Kong Chinese cancer survivors had higher levels of anger suppression compared to British counterparts.[24] What is more, patients are considered to be angry when realizing the authenticity and immutability of a diagnosis of life-threatening disease. As a result, psychosocial intervention in breast cancer patients targeting anger expression may be effective for alleviating symptoms of depression. Further studies are required to confirm the effect of anger expression on psychological distress.

Strength and Limitation

A key strength of the present study was that we recruited a matched control group for comparison, a methodological improvement from previous studies. High rates of participation (98.9 and 95.0 % of patients and controls, respectively) and complete response on all of the questionnaires significantly helped to reduce errors caused by missing data. Finally, our study was the first to illustrate the importance of assessing emotional suppression tendencies in Chinese women newly diagnosed with breast cancer.

There were several limitations worth noting of the current study. Firstly, because of the self-report nature of the CES-D, it was difficult to draw conclusions about clinically diagnosed depression, which should be included in the future study. Secondly, measures of depressive symptoms were only taken at one time point. Future studies with multiple time points would help to explore the relationships between emotional suppression tendencies and changes in depressive symptoms over time in breast cancer patients.