Depressive symptoms and positive affect in Chinese and United States breast cancer survivors: a cross-cultural comparison

Abstract

Purpose Research in the area of cultural response pattern on questionnaires in the oncological setting and direct cross-cultural comparisons are lacking. This study examined response pattern in the reporting of depressive symptoms in Chinese and US women with breast cancer. We hypothesized that Chinese women are less likely to endorse positive affect items compared to their US counterparts. Additionally, we explored cultural differences in the association between positive affect and QOL. Methods Secondary analyses of baseline assessments of two mind-body intervention studies for women with breast cancer undergoing radiotherapy in the USA (N = 62) and China (N = 97) are presented. All participants completed measures of depressive symptoms (CES-D) and cancer-specific QOL (FACT-B). We examined cultural differences on positive and negative affect items on the CES-D. Results Controlling for demographic factors, ANCOVA revealed a significant cultural difference in positive (F = 7.99, p = 0.005) but not negative affect (p = 0.82) with Chinese women reporting lower positive affect compared to US women (Chinese = 6.97 vs. US = 8.31). There was also a significant cultural difference (F = 3.94, p = 0.03) in the association between positive affect and QOL so that lower positive affect was more strongly associated with worse emotional well-being in Chinese (beta = 0.57, p < 0.0001) than US women (beta = 0.35, p < 0.01). Conclusions Chinese women reported lower positive affect compared to US women and lower levels of positive affect were more strongly associated with worse QOL. Special attention is needed when examining mental health in different cultures to ascertain effective delivery of clinical services to those in need.

The effect of fear of progression on quality of life among breast cancer patients: the mediating role of social support

“…Moreover, the mean score of QOL value was much lower than that of patients with breast cancer in other developed countries. Milbury et al reported that the mean score of QOL was 104.12 ± 14.77 in USA during the year 2017 [ 45 ], Matthies et al reported a mean QOL score of 102.66 ± 22 in Germany during the year 2019 [ 46 ]. However, the mean QOL score observed in our investigation was closer to the Asian situation-the mean score of QOL in Korea was 91.26 ± 20.08 as reported by Park et al in 2019 [ 47 ].…”

Prostate cancer‐specific anxiety and the resulting health‐related quality of life in couples

“…China have a greater influence on their emotional well-being than do the low positive emotions of people with breast cancer in the United States (Milbury et al, 2017). Regardless of cultural differences (Shih, 1996), the HRQOL of people and their spouses in Asia probably differs from that of people and spouses in Western countries.…”

“…Previous studies on other types of cancer in China and the United States have shown that the overall HRQOL of people with breast cancer in China is lower than that of people with breast cancer in the United States (Lu et al., ). Moreover, the low positive emotions of people with breast cancer in China have a greater influence on their emotional well‐being than do the low positive emotions of people with breast cancer in the United States (Milbury et al., ). Regardless of cultural differences (Shih, ), the HRQOL of people and their spouses in Asia probably differs from that of people and spouses in Western countries.…”

Resilience and positive affect contribute to lower cancer‐related fatigue among Chinese patients with gastric cancer

“…Previous surveys have found that those with high resilience shared common characteristics, for example, they experienced more positive affect (PA), optimism, hope, humour and curiosity when facing extreme adversity or trauma (Liu et al., ; Solano, da Silva, Soares, Ashmawi, & Vieira, ). Affect and its implications have been studied among cancer survivors, especially the importance of PA in QoL (Milbury et al., ; Moreno, Moskowitz, Ganz, & Bower, ). According to Fredrickson's broaden‐and‐build theory (Fredrickson, ), PA plays an important role in determining cognitive, physical and psychological activity.…”