Factors Associated with Psychological Distress among Women of African Descent at High Risk for BRCA Mutations

Little is known about psychological distress among women of African descent who are at high risk for a BRCA mutation. This is a group for whom breast cancer risk reduction is critical due to the group’s high rates of breast cancer mortality. Distress is important to consider as it may reduce the potential benefit of genetic counseling and negatively affect decision making related to risk reduction. The goals of the current study were to examine breast cancer-specific distress and depressive symptoms in women of African descent at who are at high risk for a BRCA mutation and to identify background factors associated with these outcomes. Participants were 148 high-risk African American and Caribbean women who were part of a larger study that offered participants BRCA counseling at no cost. Participants completed the Impact of Events Scale, which assessed breast cancer-specific distress, and the Center of Epidemiological Studies-Depression Scale, which assessed depressive symptoms. Results of analyses revealed that almost half of the sample achieved scores indicating high and clinically significant breast cancer-specific distress, while almost one-third had clinically significant depression scores. Results further showed that low income was significantly associated with cancer-specific distress, while having a cancer diagnosis was significantly associated with depressive symptoms. These results underscore the need for targeted psychological support throughout the genetic risk assessment process for this particular high-risk group.     

Psychological distress and well-being in advanced cancer: The effects of optimism and coping

This study examined the relations among optimism, coping, functional status, and psychological adjustment in 75 adults diagnosed with cancer. Both the positive and the negative aspects of psychological adjustment were assessed. All participants had been diagnosed with advanced stages of cancer (i.e., Stages II, III, and IV). Participants completed three assessments across a 4-month time period. Both optimism and coping were associated with psychological adjustment, even after controlling for functional status and prior adjustment. Additionally, optimism and coping were differentially related to distress and well-being. Optimism was strongly and positively associated with well-being and inversely related to distress. Escape-Avoidance coping was positively associated with distress and Accepting Responsibility coping was negatively associated with well-being. Comparisons between the current and prior studies indicated that individuals who are diagnosed with more advanced stages of cancer or who have survived bone marrow transplantation exhibit higher levels of optimism than do healthy individuals and individuals with early-stage disease.     

Illness representations and distress in women undergoing screening for familial ovarian cancer

Women with a familial or genetic predisposition to ovarian cancer are at significantly increased risk of developing the disease, and this warrants effective risk management strategies. A clinical trial of ovarian cancer screening (OCS) is being conducted to establish the effectiveness of this risk management strategy. This article reports data from its psychological partner study which aims to evaluate the psychological effects of OCS. Leventhal's Self-Regulatory Model provided the theoretical framework for understanding emotional responses to OCS. The revised Illness Perceptions Questionnaire (IPQ-R) is based on this model and the IPQ-R, adapted to the risk of ovarian cancer, was completed by women (N?=?1999) prior to screening. The original IPQ-R factor structure was not replicated but IPQ-R variables explained 14.70% of the variance in women's ovarian cancer-specific distress after controlling for age, general anxiety and depression. Negative emotional representations of ovarian cancer risk and general anxiety were moderately associated with greater ovarian cancer-specific distress whereas cognitive illness representations were weakly related to ovarian cancer-specific distress. Further analyses of data from the ongoing psychological evaluation are needed to determine the predictive utility of IPQ-R variables in explaining distress during OCS.     

Illness representations and distress in women undergoing screening for familial ovarian cancer

Women with a familial or genetic predisposition to ovarian cancer are at significantly increased risk of developing the disease, and this warrants effective risk management strategies. A clinical trial of ovarian cancer screening (OCS) is being conducted to establish the effectiveness of this risk management strategy. This article reports data from its psychological partner study which aims to evaluate the psychological effects of OCS. Leventhal's Self-Regulatory Model provided the theoretical framework for understanding emotional responses to OCS. The revised Illness Perceptions Questionnaire (IPQ-R) is based on this model and the IPQ-R, adapted to the risk of ovarian cancer, was completed by women (N?=?1999) prior to screening. The original IPQ-R factor structure was not replicated but IPQ-R variables explained 14.70% of the variance in women's ovarian cancer-specific distress after controlling for age, general anxiety and depression. Negative emotional representations of ovarian cancer risk and general anxiety were moderately associated with greater ovarian cancer-specific distress whereas cognitive illness representations were weakly related to ovarian cancer-specific distress. Further analyses of data from the ongoing psychological evaluation are needed to determine the predictive utility of IPQ-R variables in explaining distress during OCS.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

The Influence of Attentional Style and Risk Perceptions on Intentions to Undergo Prophylactic Oophorectomy Among First-Degree Relatives

This study examined the predictors of women's intentions to undergo prophylactic oophorectomy. Eighty female first-degree relatives (FDRs) of ovarian cancer patients completed a measure of attentional style upon enrollment into a Family Risk Assessment Program. Following participation, measures of cancer risk perceptions, perceived benefits and costs of surgery, and intentions to undergo preventive surgery were obtained. Hierarchical regression analyses indicated that a high monitoring attentional style, as well as greater perceived risk of ovarian cancer and greater perceived benefits of the procedure, was associated with greater intentions to undergo prophylactic oophorectomy. In addition, a significant interaction between attentional style and perceived risk revealed that high monitors who felt at increased risk for ovarian cancer were less inclined to undergo surgery, whereas low monitors who perceived themselves to be at increased risk were more inclined to undergo surgery. The implications of the results for the design of counseling interventions are discussed.     

Effects of coping style and BRCA1 and BRCA2 test results on anxiety among women participating in genetic counseling and testing for breast and ovarian cancer risk.

Using the monitoring process model (MPM), the authors examined the immediate effects of coping style and test results on the psychological distress of women at increased risk for breast and/or ovarian cancers. Cases selected for analysis were 107 probands and relatives of positive probands participating in genetic counseling and testing for heritable cancer risk. Specifically, the authors explored the relationships among coping style (high and low monitoring), test results (BRCA1 and BRCA2 mutation carrier and noncarrier status), and psychological distress (state anxiety). Consistent with the MPM, higher monitoring was associated with greater psychological distress while anticipating genetic test results. After test results were disclosed, greater distress was associated with testing positive for a mutation. The implications of the findings for breast and ovarian cancer patients are discussed.     

Biased cognitive processing of cancer-related information among women with family histories of breast cancer: evidence from a cancer stroop task.

Stimuli associated with sources of stress have been shown to interfere with cognition. The authors hypothesized that women with the stress of having a family history of breast cancer (FH+) would exhibit greater interference on a task with cancer-related stimuli than women without cancer in the family (FH-). The authors developed a modified Stroop color-naming task to test this hypothesis in a sample of FH+ (n = 72) and FH- (n = 96) women. Consistent with the hypotheses, FH+ women had longer color-naming times and more errors (ps < .01) on a cancer word list relative to noncancer lists. This biased processing was not mediated by the significantly higher perceived risk, general distress, or cancer-specific distress in FH+ women. Maladaptive alterations in processing cancer stimuli may have important clinical implications, as these women must process complex cancer-related information critical to their health (e.g., options for chemoprevention, screening).     

Optimism, pessimism, and change of psychological well-being in cancer patients

Whereas most previous studies have assessed optimism/pessimism as a unidimensional construct, there is increasing awareness that optimism and pessimism may represent two partially independent dimensions. In this study, the role of optimism and pessimism for the maintenance of psychological well-being was assessed in 161 newly diagnosed cancer patients. Before the start of chemotherapy, more positive affect balance was associated with higher optimism and lower pessimism. Over the course of 9 months following diagnosis, pessimism predicted negative change in affect balance, whereas no effect of optimism appeared. Higher levels of perceived side-effects of chemotherapy were associated with negative change in affect balance. However, an interaction effect of perceived side-effects with pessimism indicated that this was only the case in patients with above-median levels of pessimism. The conclusion is drawn that it may be more important to be less pessimistic than to be optimistic when diagnosed with cancer.     

乐观、悲观倾向与抑郁的关系及压力、性别的调节作用

采用问卷法,考察了334名大学生的乐观、悲观两种一般结果期待倾向与其抑郁感受的关系,以及压力水平和性别的可能调节作用。研究结果表明：（1）乐观倾向、悲观倾向既显著相关又存在相对独立性,二者对于抑郁的作用在强度上有所不同。其中,悲观倾向对于抑郁变异的独立贡献率较高。（2）压力水平是认知倾向与抑郁关系的显著调节因素,主要作用表现为随着压力水平的增高,乐观倾向的保护意义具有增强的趋势。（3）性别也具有一定的调节作用,主要表现在悲观倾向对于男性大学生抑郁的影响作用更强。特别是在控制压力水平的情况下,性别对于悲观倾向和抑郁关系的调节作用更为明显     

Response to an abnormal ovarian cancer-screening test result: Test of the social cognitive processing and cognitive social health information processing models

All cancer screening tests produce a proportion of abnormal results requiring follow up. Consequently, the cancer-screening setting is a natural laboratory for examining psychological and behavioural response to a threatening health-related event. This study tested hypotheses derived from the social cognitive processing and cognitive–social health information processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n = 278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), social environment (social support and constraint), emotional processing, distress, and benefit finding were obtained. Regression analyses indicated greater distress was associated with greater social constraint and emotional processing and a monitoring coping style in women with a family history of OC. Distress was unrelated to social support. Greater benefit finding was associated with both greater social constraint and support and greater distress. The primacy of social constraint in accounting for both benefit finding and distress was noteworthy and warrants further research on the role of social constraint in adaptation to stressful events.     

合作学习中一般自我效能感与自我监控的表现

该研究运用情境实验和问卷测量的方法,初探了一般自我效能感与自我监控不同的学生在合作学习的小组活动自评中的差异。结果表明,一般自我效能感高的被试对小组话动的价值评价比一般自我效能感低的被试更积极;但在对组织者的评价和对合作学习的喜爱程度上不如一般自我效能感低的学生。自我监控高的学生比自我监控低的学生对组织者有更积极的评价,但在对合作学习的喜爱程度上却比不上自我监控低的同学。     

Optimism, perceived risk of breast cancer, and cancer worry among a community-based sample of women.

Optimism is frequently inversely associated with distress; however, less is known about the mechanisms underlying this relationship. Optimism can be defined as having a generalized positive expectancy about the future. The authors hypothesized that a specific expectancy might mediate the relationship between optimism and distress. That model was tested using perceived risk of breast cancer as a specific measure of expectancy and cancer worry as a measure of distress in a community-based sample of 1,366 women. It was hypothesized that optimism would be inversely associated with cancer worry and that perceived risk of breast cancer would mediate the relationship between optimism and cancer worry. Multiple regression analyses revealed that perceived risk partially mediated the relationship between optimism and cancer worry.     

Personality and risk of cognitive impairment 25 years later

The authors examined the relationship between personality and cognitive impairment in 4,039 members of the Swedish Twin Registry. Neuroticism and extraversion scores were collected in 1973 at midlife, and cognitive impairment was assessed in the same group 25 years later. Data were analyzed with case-control and co-twin control designs. Greater neuroticism was associated with higher risk of cognitive impairment in the results from case-control, but not from co-twin, analyses. Compared with both extraversion and introversion, moderate extraversion was associated with lower risk of cognitive impairment in both case-control and co-twin designs, as was the combination of high neuroticism and low extraversion. Findings are discussed in the context of theories related to personality, psychological distress, arousal, and cognitive function.     

Optimism and Prostate Cancer-Specific Expectations Predict Better Quality of Life after Robotic Prostatectomy

We examined the relations among generalized positive expectations (optimism), prostate-cancer specific expectations, and prostate cancer-related quality of life in a prospective sample of 83 men who underwent robotic assisted laparoscopic prostatectomy (RALP) for prostate cancer. Optimism was significantly associated with higher prostate cancer-specific expectations, β = .36, p < .001. In addition, optimism and prostate cancer-specific expectations were independent prospective predictors of better scores on the following prostate cancer-related quality of life scales: Sexual Intimacy and Sexual Confidence; Masculine Self-Esteem (specific expectations only), Health Worry, Cancer Control, and Informed Decision Making (βs > .21, ps < .05). When considered simultaneously, both optimism and specific expectations contributed uniquely to better Health Worry and Cancer Control scores, optimism was a unique predictor of better Sexual Intimacy and Sexual Confidence scores, and specific expectations uniquely predicted higher scores on Informed Decision Making. Although optimism and prostate-cancer specific expectations are related, they contribute uniquely to several prostate cancer-related quality of life outcomes following RALP and may be important targets for quality of life research with this population.     

Monitoring,blunting, and the ability to achieve cognitive structure

It has often been suggested that vigilant information-seeking helps reduce uncertainty and coping with stress. The present paper argues that additional information can resolve uncertainty only to the extent that it is adequately structured or categorized. However, people may differ in their ability to achieve cognitive structure (AACS) and therefore in their ability to achieve certainty. This postulate may shed new light on Miller's (1987) findings that high monitors suffer from greater distress than low monitors. It is suggested that when high monitors have high AACS they will suffer from less psychological distress than low monitors. This interaction will not be found when blunting is involved. To examine these hypotheses, both AACS and information-seeking behavior of 77 rheumatoid arthritis patients were assessed. The two hypotheses were confirmed even after discounting the effect of subjective health perception and number of years subjects suffered from the disease.     

The effects of self-beliefs and relationship beliefs on adjustment to a relationship stressor

A longitudinal study of college students involved in long-distance romantic relationships was conducted to examine the associations of positive self-beliefs and positive relationship beliefs to general distress, relationship status at the end of the semester (together vs. broken up), adjustment to a relationship stressor (physical separation), and adjustment to breakup. It was expected that positive self-beliefs (self-esteem, perceived control mastery, optimism) would predict the general psychological health outcome and that positive relationship beliefs (e.g., optimism about the future of the relationship) would predict the three relationship outcomes. Results confirmed predictions. Despite the positive correlation between self-beliefs and relationship beliefs, positive self-beliefs were associated with less psychological distress but were not associated with the three relationship outcomes. Relationship beliefs were associated with all three of the relationship outcomes. Positive relationship beliefs were adaptive in terms of relationship status, but were related to worse adjustment to the separation and worse adjustment to the breakup.     

Dispositional optimism as a predictor of men's decision-related distress after localized prostate cancer.

This study investigated prospectively the relationship between optimism, threat appraisal, seeking support and information, cognitive avoidance, physical treatment side effects, and decision-related distress in 111 men with localized prostate cancer. Men were assessed at diagnosis and 2 and 12 months after treatment. Baseline decision-related distress predicted distress 2 and 12 months after treatment. Optimism was a significant prospective and concurrent predictor of decision-related distress, with the effect mediated by proximal cancer threat appraisal. Seeking support and information and cognitive avoidance were not associated with decision-related distress at any time point. For physical treatment side effects, concurrent urinary symptoms were predictive of decision-related distress 2 months after treatment. Results suggest that decision-related distress is generated by similar processes to that of the psychological distress that follows a cancer diagnosis. Screening for men with high decision-related distress for referral to in-depth decision support is suggested. Outcome expectations may present as a therapy target to increase the effectiveness of decisional support that is utility based.     

Psychological adjustment among African American breast cancer patients: one-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention.     

Psychosocial Conditions of Women Awaiting Genetic Counseling: A Population-based Study

The decision whether to undergo genetic counseling for hereditary breast and ovarian cancer is complex. Knowledge about the psychosocial conditions of women who are awaiting counseling is sparse. We aimed to compare the psychosocial conditions of women awaiting genetic counseling with those of women in two reference groups. We included 567 women referred to genetic counseling for hereditary risk of breast or ovarian cancer (Genetic Group), 689 women referred to mammography (Mammography Group) and a random sample of 2,000 women from the general population (Population Group). One to 4 weeks before the first counseling session or mammography, data were collected by questionnaires. Both women affected with cancer and unaffected women in the Genetic Group appeared to have a somewhat higher prevalence of cancer-specific-distress than the corresponding reference groups. Further research on the effect of pre- counseling interventions appear warranted in addition with exploring a potential association between waiting time and cancer-specific distress.