Can self-esteem, mastery and perceived stigma predict long-term adjustment in women carrying a BRCA1/2-mutation? Evidence from a multi-center study

Abstract

Little is known about protective and vulnerability factors of long-term adjustment with BRCA1/2 carrier status. Specifically, the role of personal resources and perceptions of stigmatization have not been studied in the context of adjustment with hereditary breast cancer. The present study, therefore, explored associations of personal resources and stigma with cancer-specific anxiety in female BRCA1/2-carriers within a cross-sectional multi-center study. Participants (n = 237) had received carrier notification between 4 months and 8 years before data collection and experienced a low level of cancer-related anxiety on average. Younger age was associated with both higher perceptions of stigma (P = .002) and cancer-specific anxiety (P = .034). Time since receiving test results, affected status, having undergone prophylactic mastectomy or prophylactic oophorectomy was not associated with demographic or psychological variables. Global self-esteem (P = .002) and mastery (P < .001) were associated with fewer intrusive and avoidant thoughts, whereas stigma was associated with more (P < .001). Time since test result receipt did not moderate relations of self-esteem, mastery or stigma and cancer-specific anxiety. Cancer-specific anxiety did not vary as a function of time since carrier notification. Hence cancer-specific distress may be explained by past and ongoing experiences of cancer in the family rather than by the time point of carrier notification. Psychological interventions may benefit from specifically addressing feelings of stigmatization, and promoting self-worth and personal control in order to affect cancer-specific anxiety.

Facilitators and Challenges in Psychosocial Adaptation to Being at Increased Familial Risk of Breast Cancer

“…The confidence expressed by women in this study appeared to stem from feeling in control (e.g. of managing risk, seeking information and coping with possible difficulties associated with being at increased risk) and was consistent with the construct mastery, which Bcenters around gaining control over the event and one's life^ (Taylor 1983(Taylor , p. 1161, the psychosocial benefits of which have been demonstrated previously (Vodermaier et al 2010). Taylor (1983) asserted that gaining a sense of mastery is one of three components of cognitive adaptation, thus corroborating our finding that confidence in coping with various aspects of being at risk was a key property of personal characteristics that facilitates psychosocial adaptation to being at increased risk.…”

Experiences of Women Who Underwent Predictive BRCA 1/2 Mutation Testing Before the Age of 30

“…Findings from the present small study support previous research demonstrating that having BRCA 1/2 testing is beneficial for many women and there was no evidence in the present, albeit small, study to suggest that younger women may be less satisfied with testing than older women. It has been suggested that young age is an indicator for increased levels of distress amongst women undergoing BRCA 1/2 testing (Cull et al 1999;Foster et al 2002;Pasacreta 2003;Vodermaier et al 2010) and whilst this study did not measure participant distress, no participants in this small sample described the testing process as particularly distressing.…”

“…Much research has focused on investigating the impact and perceived costs and benefits for women undergoing BRCA 1/2 testing (Bowen et al 2004;Hamilton et al 2009b;Meiser et al 2002;Pasacreta 2003) but many of these studies included women with a wide range of ages and do not focus on issues specific to young women. Young women have been identified as being potentially a more vulnerable group in regards to suffering from cancer related worry and distress (Foster et al 2002;Lodder et al 1999;Vodermaier et al 2010). Young women often misinterpret their lifetime cancer risk as their short term cancer risk and often foresee a cancer diagnosis in the near future (Werner-Lin et al 2012).…”

The relative contributions of disease label and disease prognosis to Alzheimer's stigma: A vignette-based experiment

“…Examining the forms of stigma that the Alzheimer's label fosters or protects against is 159 complicated by the fact that Alzheimer's impairments-deficits in cognition and in social and 160 functional abilities-appear to elicit a different type of stigma than traditional foci of stigma 161 research, stigma that is rooted less in fear of dangerousness or violence and more in harsh 162 judgment on the person with Alzheimer's unkempt appearance, or disgust at or pity for that 163 person (Werner et al, 2010;Werner et al, 2011). 164…”