Acculturation and quality of life among Chinese American breast cancer survivors: The mediating role of self‐stigma, ambivalence over emotion expression, and intrusive thoughts

Abstract

Objectives: Highly acculturated Chinese American breast cancer survivors have greater access to health care providers, are English language proficient, and have more knowledge about the health care system. However, less is known about the potential psychosocial factors that may account for the health benefits of acculturation. As such, the current study seeks to understand how mainstream acculturation is associated with higher quality of life by investigating self-stigma, ambivalence over emotion expression (AEE), and intrusive thoughts, as serial mediators among Chinese breast cancer survivors.Methods: One hundred twelve Chinese American breast cancer survivors completed a self-reported questionnaire with these trait variables.Results: We found support for a serial multiple mediation hypothesis in which mainstream acculturation was indirectly associated with quality of life through selfstigma, AEE, and intrusive thoughts. Specifically, mainstream acculturation was associated with lower self-stigma, which, in turn, was associated with lower AEE and intrusive thoughts and subsequently resulted in lower quality of life among Chinese American breast cancer survivors. Conclusions:The findings suggest that psychosocial factors are important mechanisms through which acculturation is associated with quality of life among Chinese American breast cancer survivors. As Chinese immigrants acculturate to mainstream American culture, they may benefit from the reduced public stigma toward breast cancer and incorporate new post-immigration knowledge about cancer that protects them from high levels of self-stigma. This, in turn, may lead Chinese American breast cancer survivors to experience lower AEE and intrusive thoughts and subsequently experience higher quality of life. KEYWORDS acculturation, ambivalence over emotional expression, cancer, Chinese, intrusive thoughts, oncology, quality of life, self-stigma

Effects of decisional conflict, decision regret and self‐stigma on quality of life for breast cancer survivors: A cross‐sectional, multisite study in China

“…In our study, the mean score of self‐stigma was 18.57 (SD = 4.83), which is higher than that of Chinese–American breast cancer survivors with a self‐stigma being 16.30 (SD = 7.18; Tsai et al, 2019). When Chinese immigrants adapted and adjusted to mainstream American culture, they received social support such as the Pink Ribbon campaign to protect them from self‐stigma (Tsai et al, 2019). We also found that women who chose mastectomy without reconstruction reported significantly higher levels of self‐stigma than those who chose breast conservative surgery.…”

“…Chinese immigrants adapted and adjusted to mainstream American culture, they received social support such as the Pink Ribbon campaign to protect them from self-stigma (Tsai et al, 2019). We also found that women who chose mastectomy without reconstruction reported significantly higher levels of self-stigma than those who chose breast conservative surgery.…”

Psychological distress among Chinese patients with breast cancer undergoing chemotherapy: Concordance between patient and family caregiver reports

“…Furthermore, they did not want to burden their family caregivers, and some patients felt psychological distress was untreatable. They felt they could not benefit from talking about their distressing problems with caregivers, or they were ashamed to disclose their negative emotions because of disease sigma (Tsai et al, 2019). Family caregivers need to perform caregiving tasks and balance obligations at work (Yeung et al, 2020).…”

Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients

“…Women with breast cancer described the burden of being expected to be positive despite the continued association of cancer with death and how they sometimes had to downplay their private suffering to present a positive front to others [ 72 ]. Amongst these women, being less educated and opting for breast conservation surgery [ 71 ], being on chemotherapy, having depressive symptoms with high levels of ambivalence over emotional expression and intrusive thoughts [ 74 ] were significantly associated with higher self-stigma. Furthermore, there was significant inverse relationship between annual household income [ 74 ] and time since diagnosis 100] with self-stigma in patients with breast cancer.…”

“…Amongst these women, being less educated and opting for breast conservation surgery [ 71 ], being on chemotherapy, having depressive symptoms with high levels of ambivalence over emotional expression and intrusive thoughts [ 74 ] were significantly associated with higher self-stigma. Furthermore, there was significant inverse relationship between annual household income [ 74 ] and time since diagnosis 100] with self-stigma in patients with breast cancer. Patients with breast and prostate cancers appeared less stigmatised [ 18 , 22 , 55 , 86 , 87 ].…”