Skip to main content

Advertisement

SpringerLink
Log in

Perceived Social Support Mediates the Longitudinal Relations between Ambivalence over Emotional Expression and Quality of Life among Chinese American Breast Cancer Survivors

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Purpose

The present study examined perceived social support as a mediator of the longitudinal link between ambivalence over emotional expression (AEE) and quality of life among a sample of Chinese breast cancer survivors.

Methods

Ninety-six Chinese breast cancer survivors recruited from Southern California completed four surveys in total: (1) a baseline survey (T1), 1-month follow-up (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), and the Medical Outcomes Study Social Support Scale (MOS-SSS).

Results

Higher T1 AEE was associated with lower T1 social support (B = −0.01, SE = 0.004, p < 0.01) which in turn was associated with lower quality of life at T2 (B = 2.98, SE = 0.64, p < 0.01), T3 (B = 2.14, SE = 0.54, p < 0.01), and T4 (B = 2.08, SE = 0.68, p < 0.01).

Conclusions

These results suggest that the harmful effect of AEE on quality of life is explained by reduced social support. Given the detrimental effects of AEE on social support and quality of life, future research on interventions that facilitate emotional disclosure is needed. Implications for the effects of Chinese culture on AEE are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Gomez SL, Von Behren J, McKinley M, Clarke CA, Shariff-Marco S, Cheng I et al. Breast cancer in Asian Americans in California, 1988–2013: increasing incidence trends and recent data on breast cancer subtypes. Breast Cancer Res Treat. 2017;164(1):139–47. https://doi.org/10.1007/s10549-017-4229-1.

  2. Gomez SL, Quach T, Horn-Ross PL, Pham JT, Cockburn M, Chang ET, et al. Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. Am J Public Health. 2010;100:25–31.

    Article  Google Scholar 

  3. Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;27(1):27–32. https://doi.org/10.1186/1756-9966-27-32.

  4. King LA, Emmons RA. Conflict over emotional expression: psychological and physical correlates. J Pers Soc Psychol. 1990;58(5):864–77. https://doi.org/10.1037/0022-3514.58.5.864.

    Article  PubMed  CAS  Google Scholar 

  5. King LA. Ambivalence over emotional expression and reading emotions in situations and faces. J Pers Soc Psychol. 1998;74(3):753–62. https://doi.org/10.1037/0022-3514.74.3.753.

    Article  PubMed  CAS  Google Scholar 

  6. King LA, Emmons RA. Psychological, physical, and interpersonal correlates of emotional expressiveness, conflict, and control. Eur J Personal. 1991;5(2):131–50. https://doi.org/10.1002/per.2410050206.

    Article  CAS  Google Scholar 

  7. Tucker JS, Winkelman DK, Katz JN, Bermas BL. Ambivalence over emotional expression and psychological Weil-being among rheumatoid arthritis patients and their spouses. J Appl Soc Psychol. 1999;29(2):271–90. https://doi.org/10.1111/j.1559-1816.1999.tb01386.x.

    Article  Google Scholar 

  8. Lu Q, Man J, You J, LeRoy AS. The link between ambivalence over emotional expression and depressive symptoms among Chinese breast cancer survivors. J Psychosom Res. 2015;79(2):153–8. https://doi.org/10.1016/j.jpsychores.2015.01.007.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lu Q, Yeung N, Man J, Gallagher MW, Chu Q, Deen SH. Ambivalence over emotional expression, intrusive thoughts, and posttraumatic stress symptoms among Chinese American breast cancer survivors. Support Care Cancer. 2017;25(10):1–7. https://doi.org/10.1007/s00520-017-3744-2.

  10. Chen SX, Cheung FM, Bond MH, Leung JP. Decomposing the construct of ambivalence over emotional expression in a Chinese cultural context. Eur J Pers. 2005;19(3):185–204. https://doi.org/10.1002/per.538.

    Article  Google Scholar 

  11. Markus HR, Kitayama S. Culture and the self: implications for cognition, emotion, and motivation. Psychol Rev. 1991;98(2):198–224. https://doi.org/10.1037/0033-295X.98.2.224.

  12. Lu Q, Stanton AL. How benefits of expressive writing vary as a function of writing instructions, ethnicity and ambivalence over emotional expression. Psychol Health. 2010;25(6):669–84. https://doi.org/10.1080/08870440902883196.

    Article  PubMed  Google Scholar 

  13. Biglia N, Bounous V, Malabaila A, Palmisano D, Torta D, d'Alonzo M, et al. Objective and self-reported cognitive dysfunction in breast cancer women treated with chemotherapy: a prospective study. Eur J Cancer Care. 2012;21(4):485–92. https://doi.org/10.1111/j.1365-2354.2011.01320.x.

    Article  CAS  Google Scholar 

  14. You J, Lu Q. Social constraints and quality of life among chinese-speaking breast cancer survivors: a mediation model. Qual Life Res. 2014;23(9):2577–84. https://doi.org/10.1007/s11136-014-0698-4.

    Article  PubMed  Google Scholar 

  15. Gottlieb BH, Bergen AE. Social support concepts and measures. J Psychosom Res. 2010;69(5):511–20. https://doi.org/10.1016/j.jpsychores.2009.10.001.

    Article  PubMed  Google Scholar 

  16. Kim J, Han JY, Shaw B, McTavish F, Gustafson D. The roles of social support and coping strategies in predicting breast cancer patients’ emotional well-being: testing mediation and moderation models. J Health Psychol. 2010;15(4):543–52. https://doi.org/10.1177/1359105309355338.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wellisch D, Kagawa-Singer M, Reid SL, Lin YJ, Nishikawa-Lee S, Wellisch M. An exploratory study of social support: a cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients. Psycho-Oncology. 1999;8(3):207–19. https://doi.org/10.1002/(SICI)1099-1611(199905/06)8:3<207::AID-PON357>3.0.CO;2-B.

    Article  PubMed  CAS  Google Scholar 

  18. Wong CC, Lu Q. Match between culture and social support: acculturation moderates the relationship between social support and well-being of Chinese American breast cancer survivors. Qual Life Res. 2017;26(1):73–84. https://doi.org/10.1007/s11136-016-1362-y.

    Article  PubMed  Google Scholar 

  19. Yu Y, Sherman KA. Communication avoidance, coping and psychological distress of women with breast cancer. J Behav Med. 2015;38(3):565–77. https://doi.org/10.1007/s10865-015-9636-3.

    Article  PubMed  Google Scholar 

  20. Emmons RA, Colby PM. Emotional conflict and well-being: relation to perceived availability, daily utilization, and observer reports of social support. J Pers Soc Psychol. 1995;68(5):947–59. https://doi.org/10.1037/0022-3514.68.5.947.

    Article  PubMed  CAS  Google Scholar 

  21. Lu Q, Wong CCY, Gallagher MW, Tou RY, Young L, Loh A. Expressive writing among Chinese American breast cancer survivors: a randomized controlled trial. Health Psychol. 2017;36(4):370–9. https://doi.org/10.1037/hea0000449.

    Article  PubMed  Google Scholar 

  22. Brislin RW. Back-translation for cross-cultural research. J Cross-Cult Psychol. 1970;1(3):185–216. https://doi.org/10.1177/135910457000100301.

    Article  Google Scholar 

  23. Porter LS, Keefe FJ, Lipkus I, Hurwitz H. Ambivalence over emotional expression in patients with gastrointestinal cancer and their caregivers: associations with patient pain and quality of life. Pain. 2005;117(3):340–8. https://doi.org/10.1016/j.pain.2005.06.021.

    Article  PubMed  Google Scholar 

  24. Yu DS, Lee DT, Woo J. Psychometric testing of the Chinese version of the medical outcomes study social support survey (MOS-SSS-C). Res Nurs Health. 2004;27(2):135–43. https://doi.org/10.1002/nur.20008.

    Article  PubMed  Google Scholar 

  25. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14. https://doi.org/10.1016/0277-9536(91)90150-B.

    Article  PubMed  CAS  Google Scholar 

  26. Wan C, Zhang D, Yang Z, Tu X, Tang W, Feng C, et al. Validation of the simplified Chinese version of the FACT-B for measuring quality of life for patients with breast cancer. Breast Cancer Res Treat. 2007;106(3):413–8. https://doi.org/10.1007/s10549-007-9511-1.

    Article  PubMed  Google Scholar 

  27. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. JCO Clin Cancer. 1993;11:570–9.

    CAS  Google Scholar 

  28. Muthén BO, Muthén LK. Mplus: Statisitcal analysis with latent variables (version 5.1). Los Angeles: Muthén & Muthén Inc.; 2008.

  29. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6(1):1–55. https://doi.org/10.1080/10705519909540118.

    Article  Google Scholar 

  30. Tsai W, Lu Q. Acculturation matters in the relation between ambivalence over emotional expressions and well-being among Chinese American breast cancer survivors. Qual Life Res. 2017;26(10):2755–62. https://doi.org/10.1007/s11136-017-1618-1.

  31. Marroquín B, Tennen H, Stanton AL. Coping, emotion regulation, and well-being: intrapersonal and interpersonal processes. The happy mind: cognitive contributions to well-being. Springer; 2017. p. 253–274. https://doi.org/10.1007/978-3-319-58763-9_14.

  32. Spiegel D. Healing words: emotional expression and disease outcome. JAMA. 1999;281(14):1328–49. https://doi.org/10.1001/jama.281.14.1328.

    Article  PubMed  CAS  Google Scholar 

  33. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer. 2004;12(12):871–6. https://doi.org/10.1007/s00520-004-0682-6.

    Article  PubMed  Google Scholar 

  34. Okazaki S. Sources of ethnic differences between Asian American and white American college students on measures of depression and social anxiety. J Abnorm Psychol. 1997;106(1):52–60. https://doi.org/10.1037/0021-843X.106.1.52.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This research was supported by the American Cancer Society MRSGT-10-011-01-CPPB (PI: Qian Lu).

Funding

This study was funded by the American Cancer Society MRSGT-10-011-01-CPPB (PI: QL).

Author information

Authors and Affiliations

  1. Department of Psychology, California State University San Marcos, San Marcos, CA, USA

    William Tsai

  2. Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, USA

    Qian Lu

Authors
  1. William Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qian Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qian Lu.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsai, W., Lu, Q. Perceived Social Support Mediates the Longitudinal Relations between Ambivalence over Emotional Expression and Quality of Life among Chinese American Breast Cancer Survivors. Int.J. Behav. Med. 25, 368–373 (2018). https://doi.org/10.1007/s12529-017-9705-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-017-9705-9

Keywords

Search

Navigation