The Mediating Effects of Self-Esteem and Optimism on the Relationship between Quality of Life and Depressive Symptoms of Breast Cancer Patients

Eun Hye Ha, Young Kyung Cho, Eun Hye Ha, Young Kyung Cho

Abstract

Objective: This study investigated the mediating effects of the internal psychological factors of self-esteem and optimism on the relationship between breast cancer patients' quality of life in terms of symptoms and functioning and depressive symptoms.

Methods: The study centered on 384 breast cancer patients who had within a 24-month period received diagnosis of 0-4 stage cancer and had medical treatment. To achieve the study's purpose, the study made use of EORTC QLQ BR23, CES-D, and the Self-Esteem and Optimism Scales.

Results: Findings revealed that breast cancer patients' quality of life was negatively impacted by self-esteem and optimism, and that self-esteem and optimism impacted negatively on depressive symptoms. Analyses showed that when breast cancer patients' quality of life affects depressive symptoms, the full mediation effect of self-esteem was statistically significant. Also, findings revealed there to be a significant partial mediation effect due to optimism.

Conclusion: Study findings demonstrated that enhancing self-esteem is crucial in the psychological intervention of depressive symptoms because self-esteem functioned as the main causal factor accounting for all variation when breast cancer patients' quality of life affected depressive symptoms. In addition, results suggested that optimism is also vital to psychological intervention because it functioned as partial cause of heightened depressive symptoms when breast cancer patients' quality of life affected depressive symptoms.

Keywords: Breast neoplasms; Depression; Optimism; Quality of life; Self-Esteem.

Figures

Figure 1
Figure 1
Full mediation model (standardized coefficients) standardized regression coefficients are shown next to each path. QoL: quality of life (EORTC QLQ-BR23).
Figure 2
Figure 2
Partial mediation model (standardized coefficients) standardized regression coefficients are shown next to each path. QoL: quality of life (EORTC QLQ-BR23).

References

    1. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71.
    1. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330:702.
    1. Somerset W, Stout SC, Miller AH, Musselman D. Breast cancer and depression. Oncology (Williston Park) 2004;18:1021–1034.
    1. Nail LM, Winningham ML. Fatigue and weakness in cancer patients: the symptom experience. Semin Oncol Nurs. 1995;11:272–278.
    1. Mystakidou K, Tsilika E, Parpa E, Katsouda E, Galanos A, Vlahos L. Assessment of anxiety and depression in advanced cancer patients and their relationship with quality of life. Qual Life Res. 2005;14:1825–1833.
    1. Kim SH, Jun EY, Lee WH. The factors influencing depression in patients with breast cancer. J Korean Oncol Nurs. 2006;6:133–142.
    1. Choi BJ, Park JH, Choe BM, Han SH, Kim SH. Factors influencing anxiety and depression in breast cancer patients treated with surgery. J Korean Soc Biol Ther Psychiatry. 2011;17:87–95.
    1. Ha EH. The influence of health related quality of life on depressive symptoms of breast cancer patients. Korean J Woman Psychol. 2011;16:499–515.
    1. Berterö CM. Affected self-respect and self-value: The impact of breast cancer treatment on self-esteem and QoL. Psychooncology. 2002;11:356–364.
    1. Helms RL, O'Hea EL, Corso M. Body image issues in women with breast cancer. Psychol Health Med. 2008;13:313–325.
    1. Min SH, Park SY, Kim JI. Effects of cancer-overcome BeHaS exercise program on shoulder joint function, stress, body image and self-esteem in breast cancer patients after surgery. J Korean Acad Fundam Nurs. 2011;18:328–336.
    1. Scheier MF, Carver CS. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 1985;4:219–247.
    1. Carver CS, Pozo-Kaderman C, Harris SD, Noriega V, Scheier MF, Robinson DS, et al. Optimism versus pessimism predicts the quality of women's adjustment to early stage breast cancer. Cancer. 1994;73:1213–1220.
    1. Friedman LC, Kalidas M, Elledge R, Chang J, Romero C, Husain I, et al. Optimism, social support and psychosocial functioning among women with breast cancer. Psychooncology. 2006;15:595–603.
    1. Westbrook JM. Attachment, optimism, coping, and social support as predictors of psychosocial and psychological adjustment in women with breast cancer women with breast cancer. Santa Barbara: Fielding Graduate University; 2005. Unpublished Doctoral dissertation.
    1. Ha EH, Lee SH, Jeong J, Lee HD, Lee JE, Nam SJ, et al. Biopsychosocial predictors of the quality of life in breast cancer patients. J Breast Cancer. 2010;13:219–226.
    1. Ha EH, Seo JE, Jeong J, Yang JH, Nam SJ, Lee JE, et al. Biopsychosocial predictors of depressive disorder in breast cancer patients. Korean J Clin Psychol. 2008;27:961–976.
    1. Yun YH, Bae SH, Kang IO, Shin KH, Lee R, Kwon SI, et al. Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) Breast-Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23) Support Care Cancer. 2004;12:441–445.
    1. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A. The EORTC QLQ-C30 Scoring Manual. 3rd Edition. Brussels: EORTC; 2001.
    1. Cho MJ, Kim KH. Diagnostic validity of the CES-D (Korean version) in assessment of DSM-III-R major depression. J Korean Neuropsychiatr Assoc. 1993;32:381–399.
    1. Chon KK, Rhee MK. Preliminary development of Korean version of CES-D. Korean J Clin Psychol. 1992;11:65–76.
    1. Rosenberg M. Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press; 1965.
    1. Jeon BJ. Self-esteem: a test of its measurability. Yonsei Nonchong. 1974;11:107–130.
    1. Park HS, Son JT. A Study on the relationship between optimism and depression in chronic low-back pain patients. J Korean Acad Psychiatr Ment Health Nurs. 2001;10:125–136.
    1. Curran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychol Methods. 1996;1:16–29.
    1. Goss PE, Ingle JN, Martino S, Robert NJ, Muss HB, Piccart MJ, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med. 2003;349:1793–1802.
    1. Mock V, Pickett M, Ropka ME, Muscari LE, Stewart KJ, Rhodes VA, et al. Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract. 2001;9:119–127.
    1. Rietman JS, Dijkstra PU, Hoekstra HJ, Eisma WH, Szabo BG, Groothoff JW, et al. Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review. Eur J Surg Oncol. 2003;29:229–238.
    1. Badger TA, Braden CJ, Mishel MH. Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer. Oncol Nurs Forum. 2001;28:567–574.
    1. Ebright PR, Lyon B. Understanding hope and factors that enhance hope in women with breast cancer. Oncol Nurs Forum. 2002;29:561–568.
    1. Tae YS, Kim MY. Relationships between family support, perceived health status, and self-esteem in Korean women with breast cancer. J Korean Oncol Nurs. 2011;11:41–48.
    1. Jeong KS, Park GJ. Relationships among body image, self-esteem and health promotion behavior in mastectomy patients. J Korean Oncol Nurs. 2007;7:36–46.
    1. Yang JC, Chung WK. Psychology and quality of life in cancer patients on radiation therapy. J Korean Soc Ther Radiol Oncol. 2004;22:271–279.
    1. Swinney JE. African Americans with cancer: the relationships among self-esteem, locus of control, and health perception. Res Nurs Health. 2002;25:371–382.
    1. Kim HY, So HS. A structural model for psychosocial adjustment in patients with early breast cancer. J Korean Acad Nurs. 2012;42:105–115.
    1. Carver CS, Pozo C, Harris SD, Noriega V, Scheier MF, Robinson DS, et al. How coping mediates the effect of optimism on distress: a study of women with early stage breast cancer. J Pers Soc Psychol. 1993;65:375–390.
    1. Carver CS, Smith RG, Antoni MH, Petronis VM, Weiss S, Derhagopian RP. Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer. Health Psychol. 2005;24:508–516.

Source: PubMed

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