Depression and sexual adjustment following breast cancer in low‐income Hispanic and non‐Hispanic White women

Objective: Hispanics are the largest and fastest growing ethnic minority group in the United States and breast cancer is the most commonly diagnosed cancer in Hispanic women. However, Hispanics are underrepresented in the psychosocial breast cancer literature. Methods: This study included 677 low‐income women (425 Hispanic, 252 non‐Hispanic White) enrolled in the Medi‐Cal Breast and Cervical Cancer Treatment Program. Data were gathered through phone interviews conducted in English or Spanish 6 and 18 months following breast cancer diagnosis. We focus on three variables that the literature indicates are salient for breast cancer survivors: sexual function, body image and depression. Results: Results of an ANCOVA indicated worse sexual function for Hispanic women, even after controlling for significant covariates. Hispanics reported significantly less sexual desire, greater difficulty relaxing and enjoying sex, and greater difficulty becoming sexually aroused and having orgasms than non‐Hispanic White women. Both Hispanic and non‐Hispanic White women endorsed a lack of sexual desire more frequently than problems with sexual function. Body image did not differ between Hispanic and non‐Hispanic White women. In all, 38% of Hispanic and 48% of non‐Hispanic White women scored above cut‐off scores for depressive symptoms. While there was no ethnic difference in depressive symptoms, single women reported more depressive symptoms than partnered women. Conclusions: Findings suggest that low‐income breast cancer survivors may experience symptoms of depression more than a year following diagnosis, and that sexual dysfunction may be particularly salient for low‐income Hispanic women. Copyright © 2009 John Wiley & Sons, Ltd.     

'How I was then and how I am now': current and retrospective self-reports of anxiety and depression in Australian women with breast cancer

In an attempt to overcome the potential invalidity of response shift present in pre-test versus post-test designs, 197 breast cancer patients completed self-reports about their current anxiety and depression states about 2 years after diagnosis, and also for how they felt at the time of their diagnosis. Current and previous states of anxiety and depression, item analyses and factor analyses of these results, plus MANOVA across all items to test for changes over time (termed 'actual change' in the literature) were conducted. In addition, the combined anxiety and depression scores were analysed as a single unit to determine overlap of symptomatology and suggest possible treatments. As well as showing decreases in the proportion of participants who were experiencing clinically significant anxiety and depression from the time of diagnosis to the time of the survey, results indicated changes in the underlying anxiety symptomatology experienced by participants, moving from somatic complaints of fatigue to feelings of loss of control and inability to cope. The predominant symptomatology of depression remained consistently related to an inability to cope or make decisions, feelings of helplessness and loss. Suggestions for helping clinicians to deal with patients' symptomatology are discussed.     

The effects of journaling for women with newly diagnosed breast cancer

Forty-three women newly diagnosed with breast cancer participated in this study, which examined the role of expressive journal writing characteristics on mood over the course of a 12-week support group. Writing was analyzed using the linguistic inquiry and word count program. Writing characteristics that were examined included: average word count, number of journal entries, positive and negative emotion words, the ratio of positive to negative words, and the use of cognitive mechanism words (i.e. insight and causal words). Regression analyses revealed that increased levels of anxiety and depression, post-intervention, were predicted by the prevalence of negative emotion in writing. Unique variance in mood (anxiety and depression) was accounted for by expression of negative emotion (7 and 6%, respectively). These relationships were significant (p<0.05) and remained significant even after accounting for pre-intervention levels of distress, and for the quantity and frequency of writing. These findings suggest the need for additional research into the naturalistic application of journaling so that appropriate recommendations for writing (e.g. focus, timing, amount) can be offered to patients who might choose to utilize this approach for coping with the stresses of cancer diagnosis and treatment.     

The valence of attentional bias and cancer-related rumination in posttraumatic stress and posttraumatic growth among women with breast cancer

Objective: To examine the effects of self‐reported attentional bias on posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) through the potential mediator of cancer‐related rumination. Design: A cross‐sectional survey design was used and women with breast cancer (N=170) were recruited. Measures: Attentional biases, cancer‐related ruminations, PTSD symptoms, and PTG were assessed. Results: Negative attentional bias and negative cancer‐related rumination were positively related to PTSD symptoms following cancer diagnosis and treatments, but they were not related to PTG. Positive attentional bias and positive cancer‐related rumination were positively related to PTG, but positive attentional bias was not related to PTSD symptoms. Findings showed that negative cancer‐related rumination partially mediated the relationship between negative attentional bias and PTSD symptoms, while positive cancer‐related rumination partially mediated the relationship between positive attentional bias and PTG. Conclusion: Findings support that there are differential trajectories to PTSD symptoms and PTG with respect to different valence of habitual attentional style and cancer‐related rumination. They may serve as potential therapeutic leverages in the alleviation of PTSD symptoms and facilitation of PTG following cancer diagnosis and treatments. Copyright © 2010 John Wiley & Sons, Ltd.     

Examining the links between perceived impact of breast cancer and psychosocial adjustment: the buffering role of posttraumatic growth

Objectives: Finding positive changes in the aftermath of breast cancer (BC) may protect women against impaired adjustment. This study examines posttraumatic growth (PTG) in a sample of women receiving treatment for BC and explores the buffering role of PTG on the links between perceived impact of BC and emotional distress and quality of life (QoL). Methods: Seventy‐eight women receiving chemotherapy (n = 57) or radiotherapy (n = 21) completed the Portuguese versions of the Posttraumatic Growth Inventory, the Hospital Anxiety and Depression Scale, the World Health Organization for QoL‐Bref and Consequences sub‐scale of the Brief Illness Perception Questionnaire (assessing perceived impact of BC). Results: PTG was frequently reported and co‐existed with distress and dysfunction. A more negative perception of the impact of BC was significantly associated with higher emotional distress and impaired Physical and Psychological QoL, but was unrelated to PTG. Hierarchical regression analyses showed that PTG moderated these relationships, acting as a stress‐buffering mechanism. Among women who perceived BC as having a more negative impact on their lives, higher levels of PTG buffered this negative perceived impact on Psychological and Social QoL (p<0.01) and also on Depression (p<0.06). This effect was not found for Physical QoL and Anxiety. Conclusions: Results provide support for the stress‐buffering role of PTG. Finding positive changes in cancer experience seems to protect women from the effects of a negative perception of the impact of BC on adjustment. Psychosocial intervention programs should facilitate PTG in order to promote women's adjustment. Copyright © 2011 John Wiley & Sons, Ltd.