<p>The Cost of Bottling It Up: Emotion Suppression as a Mediator in the Relationship Between Anger and Depression Among Men with Prostate Cancer</p>

Abstract

Background: Prostate cancer is a risk factor for major depressive disorder. Recent psychooncology research suggests a potential role for male-specific mood-related symptoms in this relationship. Gender socialisation experiences may reinforce men's anger and emotion suppression responses in times of distress, and anger and emotion suppression may be implicated in pathways to, and maintenance of depression in prostate cancer. Patients and Methods: Data were collected online from men with a self-reported diagnosis of prostate cancer (N=100; mean age 64.8 years). Respondents provided information regarding diagnosis and treatment, in addition to current experience of major depression and male-specific externalising symptoms. Results: Prostate cancer diagnosis in the last 12 months occurred for 35.4% of the sample. Elevated major depression symptoms were observed for 49% of respondents, with 14% endorsing past 2-week suicide ideation. Parallel mediation analysis (99% CIs) controlling for prostatectomy and active surveillance indicated men's emotion suppression mediated the relationship between anger and depression symptoms (R 2 =0.580). Trichotimised emotion suppression scores with control variables yielded a large multivariate effect (p<0.001, partial η 2 =0.199). Univariate moderate-sized effects were observed for emotion suppression comparisons for symptoms of depressed mood and sleep disturbance, and a large effect observed for guilt-proneness. Conclusion: Findings highlight the salience of anger in the experience of depression symptoms for men with prostate cancer. The mediating role of emotion suppression, which in turn was strongly linked to men's feelings of guilt, suggests potential assessment and intervention targets. Future work should examine the role of androgen deprivation therapy and other treatments including active surveillance on the relationship between anger and depression in men with prostate cancer. Consideration of interventions focused on emotion processing skills in psycho-oncology settings may help reduce men's reliance on emotion suppression as a strategy for coping with feelings of anger or guilt in the context of prostate cancer.Men diagnosed with prostate cancer have a heightened risk for major depressive disorder, 1,2 with rates exceeding those seen in the general male population. 3,4 This finding has been linked to the unmet psychosocial needs of this population following diagnosis, 5 in addition to prostate cancer-related symptoms, 6 and treatmentinduced side effects including sexual dysfunction and urinary incontinence. 7-9 Even those men on active surveillance are at high risk for depression 10 whereby a decline Correspondence: Simon

The Anxiety Depression Pathway Among Men Following a Prostate Cancer Diagnosis: Cross-Sectional Interactions Between Anger Responses and Loneliness

“…Accordingly, assessing for the presence and consequence of anger among men with prostate cancer (possibly using the DAR-5), and providing this population with appropriate avenues to process their affective state (e.g., gender specific and transformative interventions) is a potential pathway to boosting quality of life, social connectedness and functioning. Men with prostate cancer who have a tendency to suppress negative emotion also report a stronger association between symptoms of anger and major depression ( Rice et al, 2020 ). If emotion suppression accentuates the anger-depression relationship, then approaches that lead to acceptance or reappraisal may offer more effective management strategies ( Chambers et al, 2012 ).…”

Psychosocial and Functional Predictors of Mental Disorder among Prostate Cancer Survivors: Informing Survivorship Care Programs with Evidence-Based Knowledge

“…For example, in a study of HIV patients, Brady et al (1999) found spiritual well-being to be as important a contributor to the healthrelated quality of life model of HIV as several physical factors [19]. Research has also shown that PCa patients commonly suppress emotions related to their disease, subsequently leading to anger, worsened quality of life and avoidance of emotional support [20]. Of note, spirituality has been shown to improve an individual's mental health through social support, meaning-making and self-regulation [21,22].…”

Improvements in mindfulness, interoceptive and emotional awareness, emotion regulation, and interpersonal emotion management following completion of an online emotional skills training program.

“…Within EFT, therapists work with participants to achieve greater (a) emotional awareness, (b) emotion regulation, and (c) emotion transformation. This may be especially important, as the use of unhealthy (e.g., suppressive) emotion regulation practices has been associated with several mental health issues, such as social anxiety disorder (Dryman & Heimberg, 2018), heightened arousal during negative emotional responses (Gross, 1998; Gross & Levenson, 1997), and interactions between heightened anxiety, depression, and anger (Hosogoshi et al, 2020; Rice et al, 2020). Emotional awareness and emotion regulation are also linked in important ways.…”