Self‐concept and health anxiety relate to psychological outcomes for BRCA1/2 carriers

Abstract

Objective: Leventhal's common sense model of self-regulation highlights how specific beliefs about illness influence psychological outcomes. Little is known on how such beliefs relate to BRCA1/2 adjustment. Furthermore, beliefs about one's self-concept may be relevant to genetic conditions and may relate to psychological wellbeing. Methods: One-hundred and eighteen female BRCA1/2 carriers from an Irish University Hospital completed questionnaires for this cross-sectional study. Outcomes measured were state anxiety and physical and mental health-related quality of life (HRQOL). Explanatory variables included sociodemographics, health anxiety, illness perceptions, coping and self-concept. Hierarchical multiple regression analyses were conducted. Results: Then, 44% of participants had clinically significant state anxiety and 12% had clinically significant health anxiety. Vulnerability, stigma, mastery and health anxiety explained 42% of the variance in state anxiety. Previous mental health difficulty, vulnerability, stigma, mastery and health anxiety explained 40% of the variance in mental HRQOL. Dysfunctional coping strategies were strongly related to the physical functioning aspect of quality of life. Conclusion: BRCA-specific beliefs related to self and health anxiety are important factors to consider in the adjustment to BRCA1/2 confirmation. K E Y W O R D S anxiety, BRCA1/2, common sense model, coping, genetic testing, oncology, psychological, psycho-oncology, quality of life, self-concept 1 | BACKGROUND Testing positive for BRCA1/2 gene mutations is associated with increased risk of breast and/or ovarian cancers: the average cumulative risk of breast and ovarian cancer by 80 years of age is 72% and 44% for BRCA1-mutation carriers and 69% and 17% for BRCA2-mutation carriers, respectively. 1 Health-related quality of life (HRQOL) and levels of anxiety are important measures of adjustment for BRCA1/2 carriers. 2 BRCA1/2 carriers often report that managing anxiety regarding the uncertainty of genetic confirmation is a primary concern: research reports that 14% of BRCA1/2 carriers had clinically significant anxiety 12 months after BRCA1/2 confirmation. 3 HRQOL encompasses the psychological and physical domains impacted by the increased risk of illness. 4 These domains have been found to be distinct but related concepts as measured by the SF-12. 5 BRCA1/2 carriers can experience distressing psychological and physical changes related to self-concept, body-image and adjustment difficulties. 6 Leventhal's common sense model (CSM) of self-regulation is used to understand responses to illness, and is supported by meta-analytic

Breast/ovarian cancer genetic counseling: Do anxiety, depression, and health care‐related fears influence cancer worry and risk perception?

“…These data are consistent with Leventhal's self‐regulation model, 12 which posits that the representation of illness is generated from external stimuli (witnessing a family member's illness or acquiring information from the media or doctors) and internal stimuli (direct experience of symptoms) through processes in which elements of both emotional and cognitive nature converge. The contribution of emotional factors to the genesis of the disease representation is confirmed by the works of Butler and Brand 4,13 . In their studies, the disease representation and the self‐concept, in which stigma and vulnerability dimensions converge, are associated with anxious symptomatology in these patients, showing that women with negative emotional representations present a higher level of anxiety and distress.…”

“…The contribution of emotional factors to the genesis of the disease representation is confirmed by the works of Butler and Brand. 4 , 13 In their studies, the disease representation and the self‐concept, in which stigma and vulnerability dimensions converge, are associated with anxious symptomatology in these patients, showing that women with negative emotional representations present a higher level of anxiety and distress.…”

“…Women potentially carrying the BRCA1/2 genetic mutations may have a complex psychological profile, both as a result of their family members' experiences and their own illness. Scientific evidence shows that symptoms of anxiety and depression are significantly present in those undergoing genetic counseling 3,4 . Symptoms can develop in relation to being carriers of the mutation, having had direct illness experience, 5,6 having multiple family members with a history of breast/ovarian cancer, 7 being the first tested subject in the family, 8 and having to communicate the test outcome to their family 9 .…”

“…Scientific evidence shows that symptoms of anxiety and depression are significantly present in those undergoing genetic counseling. 3 , 4 Symptoms can develop in relation to being carriers of the mutation, having had direct illness experience, 5 , 6 having multiple family members with a history of breast/ovarian cancer, 7 being the first tested subject in the family, 8 and having to communicate the test outcome to their family. 9 From the cited studies, it clearly emerges how the interaction between the individual and the family contributes to increase psychological distress.…”

The Role of Biological Differences in Sexual Self-Concept and Mental Health in Homosexual and Heterosexual Women

“…BRCA1/2specific self-concepts and health anxiety are critical considerations in the adjustment to BRCA1/2 confirmation. (Butler et al, 2020).…”