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Perceived stress as a mediator between social constraints and sleep quality among Chinese American breast cancer survivors

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Abstract

Purpose

Previous studies primarily focused on how disease- and treatment-related variables affect cancer survivors’ sleep quality. Little is known about the impact of the psychosocial factors on their sleep quality. Social constraints are perceived negative social interactions inhibiting one’s disclosure. This study examined the association between social constraints and Chinese American breast cancer survivors’ (BCS) sleep quality and tested perceived stress as a mediator explaining the association.

Methods

Chinese American BCS (n = 94) were recruited from Southern California. Participants’ social constraints, perceived stress, and sleep quality were measured in a questionnaire package.

Results

Social constraints were associated with higher perceived stress (r = 0.32, p = .002) and poorer sleep quality (r = 0.33, p < .001). Perceived stress was associated with poorer sleep quality (r = 0.47, p < .001). Results from structural equation modeling supported the proposed mediation model, with satisfactory model fit indices (χ 2 (23) = 33.28, p = .08, comparative fit index = 0.98, Tucker–Lewis index = 0.97, root-mean-square error of approximation = 0.07). The indirect effect from social constraints to poor sleep quality (indicated by the Pittsburgh Sleep Quality Index; PSQI) via perceived stress was significant (β = 0.20; 95% confidence intervals (CI) = 0.06, 0.40). The path coefficient for direct effect from social constraints to PSQI significantly dropped from β = 0.32 (95% CI = 0.11, 0.51) to β = 0.13 (95% CI = −0.12, 0.35) after considering perceived stress as a mediator, suggesting a mediation effect.

Conclusions

This study implied that social constraints may worsen sleep quality among Chinese American BCS through increasing perceived stress. Interventions to reduce social constraints and perceived stress may improve sleep quality.

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References

  1. American Cancer Society (2016) Cancer facts & figures 2016. American Cancer Society, Atlanta

    Google Scholar 

  2. Savard J, Simard S, Blanchet J, Ivers H, Morin CM (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24:583–590

    Article  CAS  PubMed  Google Scholar 

  3. Beck SL, Berger AM, Barsevick AM, Wong B, Stewart KA, Dudley WN (2010) Sleep quality after initial chemotherapy for breast cancer. Support Care Cancer 18:679–689

    Article  PubMed  Google Scholar 

  4. Bower JE, Ganz PA, Irwin MR, Kwan L, Breen EC, Cole SW (2011) Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism? J Clin Oncol 29:3517–3522

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fortner BV, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH (2002) Sleep and quality of life in breast cancer patients. J Pain Symptom Manag 24:471–480

    Article  Google Scholar 

  6. Davidson JR, MacLean AW, Brundage MD, Schulze K (2002) Sleep disturbance in cancer patients. Soc Sci Med 54:1309–1321

    Article  PubMed  Google Scholar 

  7. Vargas S, Wohlgemuth WK, Antoni MH, Lechner SC, Holley HA, Carver CS (2010) Sleep dysfunction and psychosocial adaptation among women undergoing treatment for non-metastatic breast cancer. Psycho-Oncology 19:669–673

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lepore SJ, Revenson TA (2007) Social constraints on disclosure and adjustment to cancer. Soc Personal Psychol Compass 1:313–333

    Article  Google Scholar 

  9. Creamer M, Burgess P, Pattison P (1992) Reaction to trauma: a cognitive processing model. J Abnorm Psychol 101:452–459

    Article  CAS  PubMed  Google Scholar 

  10. Nenova M, DuHamel K, Zemon V, Rini C, Redd WH (2013) Posttraumatic growth, social support and social constraint in hematopoietic stem cell transplant survivors. Psycho-Oncology 22:195–202

    Article  PubMed  Google Scholar 

  11. Lepore SJ, Helgeson VS (1998) Social constraints, intrusive thoughts, and mental health after prostate cancer. J Soc Clin Psychol 17:89–106

    Article  Google Scholar 

  12. Zakowski SG, Harris C, Krueger N, Laubmeier KK, Garrett S, Flanigan R, Johnson P (2003) Social barriers to emotional expression and their relations to distress in male and female cancer patients. Br J Health Psychol 8:271–286

    Article  PubMed  Google Scholar 

  13. You J, Lu Q (2014) Social constraints and quality of life among Chinese-speaking breast cancer survivors: a mediation model. Qual Life Res 23:2577–2584

    Article  PubMed  Google Scholar 

  14. Adams RN, Mosher CE, Cohee AA, Stump TE, Monahan PO, Sledge GW Jr, Cella D, Champion VL (2016) Avoidant coping and self-efficacy mediate the relationship between perceived social constraints and symptoms among long-term breast cancer survivors. Psycho-Oncology

  15. Liu J, Mok E, Wong T (2005) Perceptions of supportive communication in Chinese patients with cancer: experiences and expectations. J Adv Nurs 52:262–270

    Article  PubMed  Google Scholar 

  16. Lee J, Bell K (2011) The impact of cancer on family relationships among Chinese patients. J Transcult Nurs 22:225–234

    Article  PubMed  Google Scholar 

  17. Juth V, Smyth JM, Carey MP, Lepore SJ (2015) Social constraints are associated with negative psychological and physical adjustment in bereavement. Applied Psychology: Health and Well-Being 7:129–148

    Google Scholar 

  18. Harvey A (2002) A cognitive model of insomnia. Behavior Research and Therapy 40:869–893

    Article  CAS  Google Scholar 

  19. Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL (2010) Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manag 39:535–547

    Article  Google Scholar 

  20. Morin CM, Rodrigue S, Ivers H (2003) Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med 65:259–267

    Article  PubMed  Google Scholar 

  21. Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ, Fang SC (2005) Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res 14:1943–1952

    Article  CAS  PubMed  Google Scholar 

  22. Leung DYP, Lam T, Chan SSC (2010) Three versions of perceived stress scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health 10:513–521

    Article  PubMed  PubMed Central  Google Scholar 

  23. Buysse DJ, Reynolds CFI, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  CAS  PubMed  Google Scholar 

  24. Hong JS, Tian J, Wu LH (2014) The influence of chemotherapy-induced neurotoxicity on psychological distress and sleep disturbance in cancer patients. Curr Oncol 21:174–180

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Grutsch JF, Wood PA, Du-Quiton J, Reynolds JL, Lis CG, Levin RD, Daehler MA, Gupta D, Quiton DFT, Hrushesky WJM (2011) Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer. J Circadian Rhythms 9:4

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lepore SJ, Ituarte PHG (1999) Optimism about cancer enhances mood by reducing negative social relations. Cancer Research, Therapy and Control 8:165–174

    Google Scholar 

  27. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

    Article  CAS  PubMed  Google Scholar 

  28. Little TD, Cunningham WA, Shahar G, Widaman KF (2002) To parcel or not to parcel: exploring the question, weighing the merits. Struct Equ Model 9:151–173

    Article  Google Scholar 

  29. Kline RB (2005) Principles and practice of structural equation modeling. Guilford Press, New York, NY

    Google Scholar 

  30. Kelloway EK (1998) Using LISREL for structural equation modeling a research guide. Sage Publications, Thousand Oaks California

    Google Scholar 

  31. Steiger JH (1990) Structural model evaluation and modification: an interval estimation approach. Multivar Behav Res 25:173–180

    Article  CAS  Google Scholar 

  32. Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55

    Article  Google Scholar 

  33. MacKinnon DP, Lockwood CM, Williams J (2004) Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivar Behav Res 39:99–128

    Article  Google Scholar 

  34. Bertero CM (2002) Affected self-respect and self-value—the impact of breast cancer treatment on self-esteem and QoL. Psycho-Oncology 11:356–364

    Article  PubMed  Google Scholar 

  35. Yeung NCY, Lu Q, Lin W (2014) Specificity may count: not every aspect of coping self-efficacy is beneficial to quality of life among Chinese cancer survivors in China. International Journal of Behavioral Medicine 21:629–637

    Article  PubMed  Google Scholar 

  36. Sadeh A, Keinan G, Daon K (2004) Effects of stress on sleep: the moderating role of coping style. Health Psychol 23:542–545

    Article  PubMed  Google Scholar 

  37. Simeit R, Deck R, Conta-Marx B (2004) Sleep management training for cancer patients with insomnia. Support Care Cancer 12:176–183

    Article  PubMed  Google Scholar 

  38. Yeung WF, Chung KF, Poon MMK, Ho FYY, Zhang SP, Zhang ZJ, Ziea ETC, Wong VT (2012) Chinese herbal medicine for insomnia: a systematic review of randomized controlled trials. Sleep Med Rev 16:497–507

    Article  PubMed  Google Scholar 

  39. Badr H, Taylor CL (2006) Social constraints and spousal communication in lung cancer. Psycho-Oncology 15:673–683

    Article  PubMed  Google Scholar 

  40. Pasipondodya EC, Parrish BP, Laurenceau J, Cohen LH, Siegel SD, Graber EC, Belcher AJ (2012) Social constraints on disclosure predict daily well-being in couples coping with early-stage breast cancer. J Fam Psychol 26:661–667

    Article  Google Scholar 

  41. Lu Q, Wong CC, Gallagher MW, Tou RY, Young L, Loh A (2017) Expressive writing among Chinese American breast cancer survivors: a randomized controlled trial. Health Psychol

  42. Carlson LE, Garland SN (2005) Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine 12:278–285

    Article  PubMed  Google Scholar 

  43. Uysal A, Lu Q (2011) Is self-concealment associated with acute and chronic pain? Health Psychol 30:606–614

    Article  PubMed  Google Scholar 

  44. Lu Q, Zeltzer L, Tsao J (2013) Multiethnic differences in responses to laboratory pain stimuli among children. Health Psychol 32:905–914

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. The Jockey Club School of Public Health and Primary Care, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

    Nelson C. Y. Yeung

  2. Department of Psychology, University of Houston, Room 126, Heyne Building, 3695 Cullen Boulevard, Houston, TX, 77204-5022, USA

    Jeffrey Ramirez & Qian Lu

Authors
  1. Nelson C. Y. Yeung
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  2. Jeffrey Ramirez
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  3. Qian Lu
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Corresponding authors

Correspondence to Nelson C. Y. Yeung or Qian Lu.

Ethics declarations

This study was granted approval from the relevant institutional review board.

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

This study was supported by the American Cancer Society MRSGT-10-011-01-CPPB (PI: Qian Lu) and National Cancer Institute R01CA180896-01A1 (PI: Qian Lu).

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Yeung, N.C.Y., Ramirez, J. & Lu, Q. Perceived stress as a mediator between social constraints and sleep quality among Chinese American breast cancer survivors. Support Care Cancer 25, 2249–2257 (2017). https://doi.org/10.1007/s00520-017-3632-9

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  • DOI: https://doi.org/10.1007/s00520-017-3632-9

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