"Shame on Me": Exploring the Role of Self-Stigma in Psychological Outcomes Among Type 2 Diabetes Patients in Hong Kong.

BACKGROUND: Studies have suggested that type 2 diabetes mellitus (T2DM) are at risk of self-stigmatization (i.e., internalized sense of shame about having diabetes). Self-stigma has been found to be associated with poorer psychological outcomes among chronic disease patients; relevant studies examining such an association and its psychosocial mechanisms are scarce among Chinese T2DM patients. This study aimed to examine the association between self-stigma and psychological outcomes among T2DM patients in Hong Kong. Self-stigma was hypothesized to be associated with higher psychological distress and lower quality of life (QoL). Such associations were also hypothesized to be mediated by lower perceived social support, lower self-care self-efficacy, plus higher self-perceived burden to significant others. METHODS: T2DM patients (N = 206) recruited from hospitals and clinics in Hong Kong were invited to complete a cross-sectional survey measuring the aforementioned variables. RESULTS: After controlling for covariates, multiple mediation analysis results indicated the indirect effects from self-stigma to psychological distress via increased self-perceived burden (ß = 0.07; 95% CI = 0.02, 0.15) and decreased self-care self-efficacy (ß = 0.05; 95% CI = 0.01, 0.11) were significant. Moreover, the indirect effect from self-stigma to QoL via decreased self-care self-efficacy was also significant (ß = -0.07; 95% CI = -0.14, -0.02). After considering the mediators, the direct effects from self-stigma to higher psychological distress and lower QoL remained significant (ßs = 0.15 and -0.15 respectively, ps < .05). CONCLUSIONS: Self-stigma could be linked to poorer psychological outcomes through increased self-perceived burden and decreased self-care self-efficacy among T2DM patients. Targeting those variables when designing interventions might facilitate those patients' psychological adjustments.

Positive Psychology Interventions for Improving Self-management Behaviors in Patients with Type 1 and Type 2 Diabetes: a Narrative Review of Current Evidence.

PURPOSE OF REVIEW: Interests have been emerging in using positive psychology interventions (PPIs) to improve diabetes self-management (DSM) behaviors (e.g., blood glucose monitoring, physical activity). To explore the impact of those interventions on DSM behaviors, we summarized the evidence of PPIs on self-management behaviors among both type 1 diabetes (T1D) and type 2 diabetes (T2D) patients between 2012 and 2022. RECENT FINDINGS: Among the eight studies identified, different study designs and types of PPIs were apparent. Typical PPIs (e.g., activities enhancing positive affect/gratitude/self-affirmation/optimism) were usually applied to T1D patients (N = 5); PPIs were usually combined with motivational interviewing for T2D patients (N = 3). Contrary to expectations, PPIs did not consistently demonstrate positive effects on self-management behaviors' change regardless of the types of diabetes patients, compared to the control groups. Improvements in diabetes patients' self-management behaviors from PPIs are still unclear. Future studies should more rigorously evaluate and identify the active ingredients of PPIs for behavioral changes among diabetes patients.

"My Cross-Border PhD Journey": A Qualitative Study on the Educational and Life Challenges of Mainland Chinese PhD Students in Hong Kong.

PhD students' poor mental health has been increasingly concerning. However, challenges among PhD students studying aboard are understudied. The Educational and Life Transitions (ELT) model postulates that international PhD students are subject to both academic and acculturative stressors; however, relevant research is limited in the Chinese context. We examined mainland Chinese PhD students' study and living experiences in Hong Kong using a qualitative approach. Through purposive sampling, 37 mainland Chinese PhD students in different disciplines from public-funded universities in Hong Kong were recruited to participate in online focus group interviews (December 2020-February 2021). The interviews were analyzed using the framework analysis method. Ten themes of academic/acculturative stressors were identified. The academic stressors included: (1) high expectations from the supervisors; (2) emphasis on self-discipline as PhD students; (3) peer comparison in academia; (4) difficulties shifting research directions/academic disciplines; (5) uncertainties about future career. The acculturative stressors included: (1) differences in the political environment; (2) language barriers; (3) difficulties living in Hong Kong; (4) limited social interaction with others; (5) local people's discriminatory behaviors. This study sheds light on the stressors experienced by mainland Chinese PhD students in Hong Kong. To better address those students' academic and acculturative stressors, cross-cultural training and additional support from supervisors/the university could be provided.

"The light after the storm": Psychosocial correlates of adversarial growth among nurses in Hong Kong amid the fifth wave of the COVID-19 pandemic.

OBJECTIVE: Healthcare professionals are highly susceptible to adverse psychological outcomes amid the COVID-19 pandemic due to their job duties. As the largest part of the healthcare workforce, growing attention has been paid to nurses' adjustments to the pandemic. Despite the distress, recent studies found that nurses could still experience positive changes (i.e., adversarial growth, AG) during the pandemic. Research on the general populations has indicated that individuals' stress responses, coping resources, and coping strategies are associated with their AG during the pandemic. This study examined how sociodemographic characteristics, secondary traumatic and posttraumatic stress, coping resources, and coping strategies were associated with AG among nurses in Hong Kong amid the fifth wave (i.e., the most disastrous wave) of the COVID-19 pandemic. METHOD: Recruited through local nursing associations between May 24 and June 13, 2022, 209 nurses in Hong Kong completed an online questionnaire measuring the abovementioned variables. RESULTS: Hierarchical regression results found that those affiliating with a religion, having participated in mental health-related workshops, higher levels of secondary traumatic stress (STS), social support, job satisfaction, plus more frequent emotional processing were associated with higher AG (ßs ranging from 0.15 to 0.31, ps < .01). CONCLUSIONS: Nurses did report AG during the fifth wave of the COVID-19 pandemic in Hong Kong. To promote AG among those nurses, future interventions should enhance nurses' understanding about the potential impact of STS on their well-being, solicit their interpersonal and work-related coping resources, plus facilitate their use of effective coping strategies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial.

BACKGROUND: Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS). METHODS AND RESULTS: CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1-3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress. CONCLUSION: A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS' depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy. CLINICAL TRIAL REGISTRATION NUMBER: NCT02946619.

Physical Competence, Physical Well-Being, and Perceived Physical Literacy among Older Adults in Day Care Centers of Hong Kong.

In Hong Kong, where the aging problem is inevitable, it is increasingly common for older adults to be admitted to day care centers. However, there has been limited research exploring conceivable indicators of healthy aging among older adults in such settings. The present study investigated the associations among the three indicators (physical competence, physical well-being, and perceived physical literacy) among older adults in day care centers of Hong Kong. A total of 97 participants (aged 60 years old or above) participated in the study from April to July 2021 amid the COVID-19 pandemic. Data on participants' sociodemographic information, physical competence (PC), physical well-being (PWB), and perceived physical literacy (PPL) were collected. Our results showed that the level of PC reached a high level among the participants. Positive correlations were found between PC and PWB and between PPL and PWB (r = 0.22−0.23, p < 0.05). However, PC was not associated with PPL (r = 0.11, p > 0.05). In addition, as a component within PPL, "knowledge and understanding" (KU) was found to be correlated with PC (r = 0.21, p < 0.05) and had a positive and moderate correlation with PWB (r = 0.35, p < 0.01). The results suggest that older adults admitted to day care centers maintain and enhance their physical competence to improve their physical well-being. Greater knowledge and understanding of physical literacy and physical health should be delivered among day care centers considering future development.

Differential associations among social support, health promoting behaviors, health-related quality of life and subjective well-being in older and younger persons: a structural equation modelling approach.

BACKGROUND: Extensive studies have confirmed social support as a critical protective factor of people's health-related quality of life (HRQoL) and subjective well-being (SWB). However, health promoting behaviors as a potential mechanism and age differences in this mechanism has received fewer attention. This study aims to examine the associations among social support, health promoting behaviors, HRQoL and SWB in older and younger persons in Hong Kong. METHOD: A convenience sample of both younger (12-35 years old) and older persons (55 years old and above) were recruited from three non-government organizations to complete a survey. Structural Equation Model (SEM) was conducted to test both the measurement model and structural models to examine the relationship between social support, health promoting behaviors, HRQoL and SWB. Multi-group SEM was also performed and compared to test whether there were significant age differences in the pathways between the key variables. RESULTS: A final sample of 408 participants (older-persons: N = 200 (mean age: 71.63 (8.16); 180/200 female), younger-persons: N = 208 (mean age: 18.10 (5.04); 155/208 female) were included in the final analysis. Results showed that social support was positively associated with SWB directly and indirectly through health promoting behaviors for the whole sample (CFI = .95, IFI = .94, RMSEA = .07, SRMR = 0.056). Results suggested that the association between the variables differed across age samples. While social support showed a positive association with health promoting behaviors for both younger and older persons, how each of them associated with HRQoL and SWB was different. CONCLUSION: Findings suggest that the pathway which social support linked with HRQoL and SWB might differ across age groups. Age-specific strategies should be considered when promoting HRQoL and SWB among the younger and older population.

Finding the silver linings in the COVID-19 pandemic: Psychosocial correlates of adversarial growth among Filipina domestic helpers in Hong Kong.

OBJECTIVE: The coronavirus (COVID-19) pandemic has disrupted many people's life. Negative impacts of pandemic measures and economic hardship on psychological well-being are common among the global populations. In Hong Kong, the pandemic not only affects the local populations, but also the migrant Filipina domestic helpers (FDH). Despite the distress, evidence suggests that people still experience positive changes (aka adversarial growth) amid the COVID-19 pandemic. We expect the same applies to FDH in Hong Kong. Studies have shown that coping resources (e.g., resilience, social support, literacy of trauma-related information), cognitive appraisal, and coping strategies are associated with adversarial growth among individuals living with highly stressful events. Relevant studies for migrant populations in the COVID-19 context are limited. This study examined the psychosocial correlates of adversarial growth among FDH in Hong Kong. METHOD: By convenient sampling, FDH (N = 266) recruited from public gathering venues were asked to complete a cross-sectional survey. Their COVID-19-related distress, work-related stress, COVID-19 information literacy, emotional and material support, resilience, cognitive appraisals (harm, threat, challenge), and coping strategies (religious coping, positive reframing, acceptance) were measured. RESULTS: Controlled for covariates, hierarchical regression results showed that higher levels of resilience (ß = .21), emotional support (ß = .16), COVID-19-related information literacy (ß = .15), and religious coping (ß = .16) were associated with higher adversarial growth (ps < .05). CONCLUSIONS: FDH in Hong Kong reported positive changes amid the COVID-19 pandemic. Based on our findings, facilitating those FDH's resilience, emotional support, COVID-19 information literacy, and religious coping might be important strategies to enhance their adversarial growth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social constraints and fear of recurrence among Chinese American breast cancer survivors: An exploration of psychosocial mediators.

OBJECTIVE: Fear of cancer recurrence (FCR) is commonly experienced among Caucasian and Chinese American breast cancer survivors (BCS). Emerging studies have suggested that Caucasian BCS' communication with family members contributes to their FCR. However, whether such findings apply to Chinese American BCS has yet to be explored. This study examined the association between social constraints (i.e., perceived barriers from significant others inhibiting cancer-related disclosure) and FCR among 136 Chinese American BCS, plus proposed that self-stigma (i.e., internalized feelings of shame about having cancer), bodily pain, and ambivalence over emotional expression (AEE; conflict between the desire to express emotions and the fear of its consequences) would mediate the association. METHODS: Participants recruited through cancer associations in the USA were invited to complete a cross-sectional survey measuring their socio-demographic/cancer-related variables and the above-mentioned psychological variables. RESULTS: Higher levels of social constraints, AEE, self-stigma, and bodily pain were associated with higher FCR (rs ranged from 0.27 to 0.40, ps < 0.01). After controlling for covariates, path analysis results supported the proposed mediation model with satisfactory fit indices (χ2 (7) = 2.08, Comparative Fit index = 1.00, Tucker Lewis Index = 1.08, Root Mean Square Error of Approximation = 0.00). Specifically, social constraints were associated with higher FCR through increased self-stigma (ß = 0.10, 95% confidence interval [CI] = 0.02, 0.17), AEE (ß = 0.14, 95% CI = 0.01, 0.27), and bodily pain (ß = 0.09, 95% CI = 0.02, 0.17), indicating significant mediation effects. After considering the mediators, the direct effect from social constraints to FCR was no longer significant. CONCLUSIONS: The association between social constraints and higher FCR could be mediated by increased self-stigma, AEE, and bodily pain among Chinese American BCS. Interventions targeting to address those variables may reduce FCR among those BCS.

Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials.

The mindfulness-based stress reduction program (MBSR) may reduce blood pressure (BP) in patients with hypertension or elevated BP. However, some important parameters (such as asleep BP) have not been investigated in previous reviews, and a well-conducted meta-analysis is lacking. This meta-analysis investigates the effect and acceptability of MBSR on patients with elevated BP or hypertension. Relevant articles were searched in multiple databases, including MEDLINE, EMBASE, and APA PsycInfo. Included studies were randomized controlled trials that involved patients with an elevated BP, had a control group, and investigated the effect of MBSR. The mean office and out-of-office (including 24-hour, daytime, and asleep) systolic BP and diastolic BP, psychological outcomes (depression/anxiety/stress), and dropout rate were compared between the MBSR arm and the control arm using a random-effects model. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Twelve studies were included, and only one was considered having low risk of bias. MBSR decreased the office systolic BP and diastolic BP by 6.64 and 2.47 mm Hg at postintervention, respectively; the reduction in diastolic BP was sustained until 3 to 6 months after the recruitment. Our meta-analyses did not find a significant reduction in out-of-office BP after MBSR. MBSR reduced depressive, anxiety, and stress symptoms. The dropout rate from MBSR arm was 15% and was similar to that of control arm. The current evidence is limited by lack of high-quality and adequately powered trials with long-term follow-up. Furthermore, out-of-office BP was only reported by few trials.

Difficulties in identifying and describing feelings, social constraints, affect, and functional well-being among Chinese breast cancer patients: A mediation model.

PURPOSE: Functional well-being (i.e., individuals' functioning in daily living activities and social roles; FWB) is often an understudied aspect of quality of life among breast cancer patients (BCP). Previous research has suggested that patients' emotional experience is associated with their FWB. However, little is known about how intrapersonal and interpersonal barriers of emotional processing and expression (i.e., social constraints, difficulties in identifying and expressing emotions) associated with FWB among Chinese BCP, plus how positive/negative affect might explain such associations. METHOD: Chinese BCP (N = 327) in Weifang, Shandong province, China completed a cross-sectional survey. The Functional Well-Being subscale from the Chinese version of the Functional Assessment of Cancer Therapy-Breast (FACT-B), the Social Constraints Scale, the Difficulty in Identifying Feelings (DIF; 7 items) and the Difficulty in Describing Feelings (DDF; 5 items) subscales from the Toronto Alexithymia Scale and the Positive Affect and Negative Affect Schedule were used as assessment scales. RESULTS: Path analyses results supported the proposed mediation model with satisfactory fit indices (χ2(5) = 5.12, p = .40, CFI = 1.00; IFI = 1.00; RMSEA = 0.01). Specifically, difficulty in describing emotions was associated with poorer functional well-being through increased negative affect (ß = -0.06, 95%CI = -0.10, -0.03); difficulty in identifying emotions was associated with poorer functional well-being through reduced positive affect (ß = -0.04, 95%CI = -0.09, -0.003). Social constraints were associated with poorer functional well-being through both increased negative affect and decreased positive affect (ß = -0.16, 95%CI = -0.22, -0.10). After considering the mediators, difficulties in describing emotions still contributed significantly to functional well-being (ß = -0.20, 95%CI = -0.31, -0.08). Our results indicated that positive/negative affect could mediate between barriers of emotional processing/expression and FWB. CONCLUSIONS: This study was unique in revealing how intrapersonal and interpersonal barriers of emotional processing and expression could be associated with Chinese BCPs' FWB through varied mechanisms. Practitioners should consider strategies to reduce those barriers through interventions.

Finding the silver linings: Psychosocial correlates of posttraumatic growth among husbands of Chinese breast cancer survivors.

OBJECTIVES: Caregiving does not have to be a totally negative experience for the husband caregivers of breast cancer survivors (BCS). There are growing interests in exploring the positive psychological changes (aka posttraumatic growth; PTG) among husbands of BCS. Western studies have shown that coping resources, cognitive appraisal, and coping strategies are associated with PTG among caregivers of BCS. Studies in the Chinese context are limited. This study examined the psychosocial correlates of PTG among husbands of Chinese BCS. METHODS: Husbands of Chinese BCS (N = 176) were recruited from two hospitals in Weifang, China to complete a cross-sectional survey. Their levels of caregiving burden, marital satisfaction, cognitive appraisals, coping strategies, and PTG were measured. RESULTS: After controlling for covariates, hierarchical regression results indicated that higher caregiving burden (ß = .29), marital satisfaction (ß = .27), challenge appraisal (ß = 016), and social support seeking (ß = .23) were associated with higher PTG (Ps < .05). Additionally, a significant interaction between caregiving burden and positive reframing emerged in explaining PTG (ß = .17, P < .05). Positive reframing was only associated with higher PTG among those with higher caregiving burden (ß = .25, P = .03), but not those with lower caregiving burden (ß = -.09, P > .05). CONCLUSIONS: Stress and coping variables significantly contributed to PTG among husbands of Chinese BCS. Our findings implied that addressing those husband caregivers' marital satisfaction, challenge appraisal toward the impact of breast cancer, and social support seeking could be intervention strategies to facilitate their PTG. Among husbands having higher caregiving burden, positive reframing may also facilitate their PTG.

Benefits of a Psychosocial Intervention on Positive Affect and Posttraumatic Growth for Chinese American Breast Cancer Survivors: A Pilot Study.

Breast cancer survivors report persistent psychological and physical symptoms, which affect their quality of life and may challenge the recovery process. Due to social, cultural, and linguistic barriers, culturally sensitive care is largely unavailable for Chinese Americans, and their psychological needs are not often addressed. We aimed to investigate whether the Joy Luck Academy (JLA), a psychosocial intervention providing both information and peer support, was associated with positive adjustment among Chinese American breast cancer survivors. Thirty-nine Chinese American breast cancer survivors participated in a pilot psychosocial intervention. The educational materials and lectures were delivered in the participants' native language of Chinese. All of the educators and mentors shared the same linguistic and cultural background with the participants. The program utilized a community-based participatory research (CBPR) approach to further enhance the cultural sensitivity of the intervention. Participants' post-traumatic growth and positive affect were assessed before and after the intervention. The JLA showed an improvement in positive affect, and they had a greater appreciation for life. The intervention was found to be feasible, well-accepted, and beneficial for this population. Chinese American breast cancer survivors reported improved psychological health after attending the intervention. These findings encourage the development and implementation of psychosocial interventions for Chinese breast cancer survivors. Similar programs could be integrated into other ethnic or cultural communities.

Caregiving burden and self-efficacy mediate the association between individual characteristics and depressive symptoms among husbands of Chinese breast cancer patients.

PURPOSE: Perceptions of caregiving burden and self-efficacy are found to be associated with well-being among husbands of breast cancer patients (BCP). However, little is known about how individual characteristics associate with such caregiving-related perceptions and cancer caregivers' well-being. This study examined the associations between two individual characteristics (male gender role norms and ambivalence over emotional expression (AEE)) and depressive symptoms among husbands of Chinese BCP, and the potential mediating roles of caregiving burden and self-efficacy in such associations. METHODS: Participants (n = 176) were recruited in two hospitals in Weifang, China. Their endorsement of male gender role norms (e.g., "men should not ask for help"), AEE, caregiving burden, and depressive symptoms were measured in a cross-sectional survey. RESULTS: Path analysis results supported the proposed mediation model with satisfactory fit indices (χ2(2) = 2.73, p = .26, CFI = 1.00; IFI = 1.00; RMSEA = 0.05). Specifically, male gender role norms and AEE were associated with higher caregiving burden and lower caregiving self-efficacy, which in turn were associated with more depressive symptoms. Bootstrapping results supported that both male gender role norms (ß = 0.16; 95%CI = 0.09, 0.25) and AEE had significant indirect effects on depressive symptoms (ß = 0.11; 95%CI = 0.04, 0.18) via caregiving burden and self-efficacy, indicating that caregiving-related perceptions could mediate between individual characteristics and depressive symptoms. CONCLUSIONS: Male gender role norms and AEE might affect depressive symptoms among husbands of Chinese BCP through caregiving-related perceptions. Future interventions that reduce those husbands' barriers to express emotions, appreciate their commitment to take good care of their spouses, enhance caregiving skills, and reduce caregiving burden may decrease their depressive symptoms.

Correlates of sexual quality of life among husbands of Chinese breast cancer survivors.

PURPOSE: Western studies found that sexual quality of life (QoL) among husbands of breast cancer survivors was associated with their stress and coping processes. However, little is known about how breast cancer caregiving might be associated with those husbands' sexual QoL in the Chinese cultural context. Guided by the Stress and Coping model, we examined the psychosocial correlates of sexual QoL among husbands of Chinese breast cancer survivors. METHOD: Husbands of Chinese breast cancer survivors (N = 176) recruited from two hospitals in Weifang, China completed a cross-sectional survey. Their individual characteristics, caregiving-related stressors, cognitive appraisals, coping resources and strategies, and sexual QoL were measured. RESULTS: After controlling for covariates, hierarchical regression results showed that lower caregiving burden (ß = -0.34, p < .001), higher marital satisfaction (ß = 0.20, p < .001), and lower harm/threat appraisals (ß from -0.22 to -0.20, p < .001) were associated with better sexual QoL. Moreover, ambivalence over emotional expression (AEE; inner conflict concerning the desire to express emotions yet failing to do so) was found to moderate between protective buffering and sexual QoL (ß = 0.20, p < .01), such that the negative association between protective buffering and sexual QoL was only significant among those with higher AEE (ß = -0.38, p < .003). CONCLUSIONS: Both the stress and coping variables and their interactions with individual characteristics could be important determinants of those husbands' sexual QoL. Our findings implied that reducing husbands' caregiving burden, increasing their marital satisfaction, helping them reevaluate the negative impact of breast cancer, and reducing barriers for expressing emotions and concerns may increase their sexual well-being.

Self-stigma predicts lower quality of life in Chinese American breast cancer survivors: exploring the mediating role of intrusive thoughts and posttraumatic growth.

BACKGROUND: It is common for Chinese American breast cancer survivors to believe that having cancer is a stigmatizing condition. Little research exists on how this might affect their quality of life (QoL) and through which psychological processes. OBJECTIVE: In the present study, we examined the association between self-stigma and QoL in a sample of Chinese American breast cancer survivors and tested the potential mediating roles of intrusive thoughts and posttraumatic growth in this relationship. METHODS: One hundred and thirty-six Chinese American breast cancer survivors completed a questionnaire packet assessing their levels of self-stigma, intrusive thoughts, posttraumatic growth, and QoL. RESULTS: As hypothesized, findings indicated a significant negative correlation between self-stigma and QoL. Findings from a path analysis indicated significant indirect effects of self-stigma on QoL through intrusive thoughts and posttraumatic growth-the negative correlation between self-stigma and QoL was completely mediated by more intrusive thoughts and less posttraumatic growth. CONCLUSIONS: Our findings suggest that self-stigma may harm QoL among Chinese American breast cancer survivors by leading to more intrusive thoughts and not focusing on posttraumatic growth. To attenuate the negative impact of self-stigma on QoL among Chinese American breast cancer survivors, cognition-focused interventions should be utilized to reduce intrusive thoughts and foster posttraumatic growth.

Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors.

PURPOSE: Cancer-related self-stigma (the internalized sense of shame about having cancer) has been found to associate with poorer quality of life (QoL) among cancer survivors. However, culturally salient illness beliefs (e.g., cancer is contagious; cancer is a result of karma; and cancer brings shame to the family) may make Chinese cancer survivors vulnerable to self-stigmatization. This study examined the association between self-stigma and QoL among Chinese American breast cancer survivors (BCS). To understand the potential mechanism, the mediating role of self-perceived burden to caregivers between self-stigma and QoL was also examined. METHODS: Chinese American BCS (n = 136) were recruited through community-based cancer associations. Participants' self-stigma, self-perceived burden, and QoL were measured in a questionnaire package. RESULTS: Structural equation modeling results supported the proposed mediation model in predicting physical QoL (χ2(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ2(84) = 137.277, CFI = 0.958, TLI = 0.940, RMSEA = 0.069), with satisfactory model fit indices. Both the indirect effects from self-stigma to QoL via self-perceived burden (physical: ß = - 0.13; 95% CI = - 0.22, - 0.07 and emotional: ß = - 0.11; 95% CI = - 0.22, - 0.04) and the direct effects from self-stigma to poorer QoL were significant (physical: ß = - 0.22; 95% CI = -0.34, -0.10 and emotional: ß = - 0.39; 95% CI = - 0.54, - 0.23), suggesting a partial mediation effect of self-perceived burden between self-stigma and QoL. CONCLUSIONS: Self-stigma could reduce physical and emotional QoL through increasing self-perceived burden. Interventions aiming to reduce Chinese American BCS' self-stigma and perceptions of burdensomeness may facilitate improvement in QoL, which in turn promotes better cancer survivorship.

Guilt among husband caregivers of Chinese women with breast cancer: The roles of male gender-role norm, caregiving burden and coping processes.

Caregiver guilt (i.e., feeling of inadequacy in providing care to patients) is commonly experienced and studied among husbands of breast cancer survivors in Western countries. However, little is known about the psychosocial correlates of caregiver guilt in their Chinese counterparts. A total of 176 husbands of Chinese breast cancer survivors completed a cross-sectional survey in Weifang, Shandong province, China. As expected, hierarchical regression results showed that higher caregiving burden was associated with higher levels of caregiver guilt. However, for those who had stronger endorsement of the "Masculinity strength" gender-role norm, higher seeking social support from spouse was associated with higher guilt; for those with higher levels of marital satisfaction, higher protective buffering (i.e., hiding of concerns and negative emotions to protect others) was associated with lower caregiver guilt. Western assumptions on the harm of protective buffering and the benefits of support seeking as well as related supportive evidence among Western populations do not directly apply to the Chinese culture, which should be brought awareness to research and practice. Practitioners should consider the cultural background of the caregivers and should not simply encourage support seeking and discourage protective buffering.

Media exposure related to the 2008 Sichuan Earthquake predicted probable PTSD among Chinese adolescents in Kunming, China: A longitudinal study.

OBJECTIVE: This study examined the prevalence and the psychosocial predictors of probable PTSD among Chinese adolescents in Kunming (approximately 444 miles from the epicenter), China, who were indirectly exposed to the Sichuan Earthquake in 2008. METHOD: Using a longitudinal study design, primary and secondary school students (N = 3577) in Kunming completed questionnaires at baseline (June 2008) and 6 months afterward (December 2008) in classroom settings. Participants' exposure to earthquake-related imagery and content, perceptions and emotional reactions related to the earthquake, and posttraumatic stress symptoms were measured. Univariate and forward stepwise multivariable logistic regression models were fit to identify significant predictors of probable PTSD at the 6-month follow-up. RESULTS: Prevalences of probable PTSD (with a Children's Revised Impact of Event Scale score ≥30) among the participants at baseline and 6-month follow-up were 16.9% and 11.1% respectively. In the multivariable analysis, those who were frequently exposed to distressful imagery had experienced at least two types of negative life events, perceived that teachers were distressed due to the earthquake, believed that the earthquake resulted from damages to the ecosystem, and felt apprehensive and emotionally disturbed due to the earthquake reported a higher risk of probable PTSD at 6-month follow-up (all ps < .05). CONCLUSION: Exposure to distressful media images, emotional responses, and disaster-related perceptions at baseline were found to be predictive of probable PTSD several months after indirect exposure to the event. Parents, teachers, and the mass media should be aware of the negative impacts of disaster-related media exposure on adolescents' psychological health. (PsycINFO Database Record

Perceived Stress as a Mediator Between Social Support and Posttraumatic Growth Among Chinese American Breast Cancer Survivors.

BACKGROUND: Studies have shown that social support is positively associated with posttraumatic growth (PTG) among white cancer survivors. Whether the same relationship holds among Asian American cancer survivors and through what mechanism social support may influence PTG is unclear. OBJECTIVE: This study examined the association between social support and PTG among Chinese American breast cancer survivors and proposed perceived stress as a mediator. METHODS: Chinese American breast cancer survivors (n = 118) were recruited from Southern California. Participants' social support, perceived stress, and PTG were measured in a questionnaire package. RESULTS: Social support was associated with lower perceived stress (r= -0.34, P<.001) and higher PTG (r=0.44, P<.001). Perceived stress was negatively associated with PTG (r=-0.36, P< .001). Results from structural equation modeling supported the mediation model, with satisfactory model fit indices (χ37= 65.55, comparative fit index= 0.98, Tucker-Lewis Index = 0.97, root-mean-square error of approximation = 0.08). Both the indirect effect from social support to PTG via perceived stress (ß = .07, P< .05) and the direct effect from social support and PTG (ß= .40, P< .001) were statistically significant, suggesting a partial mediation effect of perceived stress between social support and PTG. CONCLUSIONS: The positive association between social support and Chinese American breast cancer survivors' PTG was supported. Our findings also suggested that social support may facilitate PTG through reduction of perceived stress. IMPLICATIONS FOR PRACTICE: Interventions that help to enhance Chinese American breast cancer survivors' social support may also facilitate their PTG.