Article

Psychological Distress, Social Withdrawal, and Coping Following Receipt of an Abnormal Mammogram Among Different Ethnicities: A Mediation Model

Yamile Molina

Shirley A.A. Beresford

Noah Espinoza

Beti Thompson

breast cancer, coping, cultural competence, Hispanic, prevention, detection, quality of life
ONF 2014, 41(5), 523-532. DOI: 10.1188/14.ONF.523-532

Purpose/Objectives: To explore ethnic differences in psychological distress and social withdrawal after receiving an abnormal mammogram result and to assess if coping strategies mediate ethnic differences.

Design: Descriptive correlational.

Setting: Two urban mobile mammography units and a rural community hospital in the state of Washington.

Sample: 41 Latina and 41 non-Latina Caucasian (NLC) women who had received an abnormal mammogram result.

Methods: Women completed standard sociodemographic questions, Impact of Event Scale-Revised, the social dimension of the Psychological Consequences Questionnaire, and the Brief COPE.

Main Research Variables: Ethnicity, psychological distress, social withdrawal, and coping.

Findings: Latinas experienced greater psychological distress and social withdrawal compared to NLC counterparts. Denial as a coping strategy mediated ethnic differences in psychological distress. Religious coping mediated ethnic differences in social withdrawal.

Conclusions: Larger population-based studies are necessary to understand how ethnic differences in coping strategies can influence psychological outcomes. This is an important finding that warrants additional study among women who are and are not diagnosed with breast cancer following an abnormal mammogram.

Implications for Nursing: Nurses may be able to work with Latina patients to diminish denial coping and consequent distress. Nurses may be particularly effective, given cultural values concerning strong interpersonal relationships and respect for authority figures.

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    References

    Alderete, E., Juarbe, T. C., Kaplan, C. P., Pasick, R., & Pérez-Stable, E. J. (2006). Depressive symptoms among women with an abnormal mammogram. Psycho-Oncology, 15, 66-78. doi:10.1002/pon.923
    Allen, J. D., Shelton, R. C., Harden, E., & Goldman, R. E. (2008). Follow-up of abnormal screening mammograms among low-income ethnically diverse women: Findings from a qualitative study. Patient Education and Counseling, 72, 283-292.
    American Cancer Society. (2012). Cancer facts and figures for Hispanics/Latinos, 2012-2014. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-034778.pdf
    American Cancer Society. (2014a). Cancer facts and figures, 2014. Retrieved from http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf
    American Cancer Society. (2014b). Detailed guide: Breast cancer. Retrieved from http://www.cancer.org/Cancer/BreastCancer/DetailedGuide
    Andrés-Hyman, R. C., Ortiz, J., Añez, L. M., Paris, M., & Davidson, L. (2006). Culture and clinical practice: Recommendations for working with Puerto Ricans and other Latinas(os) in the United States. Professional Psychology: Research and Practice, 37, 694-701.
    Ashing-Giwa, K. T., Gonzalez, P., Lim, J. W., Chung, C., Paz, B., Somlo, G., & Wakabayashi, M. T. (2010). Diagnostic and therapeutic delays among a multiethnic sample of breast and cerivcal cancer survivors. Cancer, 116, 3195-3204.
    Ashing-Giwa, K. T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., … Hills, D. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-Oncology, 13, 408-428. doi:10.1002/pon.750
    Ashing-Giwa, K. T., Padilla, G. V., Bohórquez, D. E., Tejero, J. S., & Garcia, M. (2006). Understanding the breast cancer experience of Latina women. Journal of Psychosocial Oncology, 24, 19-52. doi:10.1300/J077v24n03_02
    Austin, L. T., Ahmad, F., McNally, M. J., & Stewart, D. E. (2002). Breast and cervical screening in Hispanic women: A literature review using the Health Belief Model. Women's Health Issues, 12, 122-128.
    Bevers, T. B., Anderson, B. O., Bonaccio, E., Buys, S., Daly, M. B., Dempsey, P. J., … Yankeelov, T. (2009). NCCN clinical practice guidelines in oncology: Breast cancer screening and diagnosis. Journal of the National Comprehensive Cancer Network, 7, 1060-1096.
    Bickell, N. A., Wang, J. J., Oluwole, S., Schrag, D., Godfrey, H., Hiotis, K., … Guth, A. A. (2006). Missed opportunities: Racial disparities in adjuvant breast cancer treatment. Journal of Clinical Oncology, 24, 1357-1362. doi:10.1200/jco.2005.04.5799
    Boinon, D., Charles, C., Dauchy, S., & Sultan, S. (2011). Effects of emotional expression on adjustment to cancer: A systematic review of research. Psycho-Oncologie, 5, 173-190.
    Bond, M., Pavey, T., Welch, K., Cooper, C., Garisde, D., Dean, S., & Hyde, C. (2013). Systematic review of the psychological consequences of false-positive screening mammograms. Health Technology Assessment, 17(13), 1-170.
    Brewer, N. T., Salz, T., & Lillie, S. (2007). Systematic review: The long-term effects of false-positive mammograms. Annals of Internal Medicine, 146, 502-510. doi:10.7326/0003-4819-146-7-200704030-00006
    Buki, L. P., Garcés, D. M., Hinestrosa, M. C., Kogan, L., Carrillo, I. Y., & French, B. (2008). Latina breast cancer survivors' lived experiences: Diagnosis, treatment, and beyond. Cultural Diversity and Ethnic Minority Psychology, 14, 163-167. doi:10.1037/1099-9809.14.2.163
    Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4, 92-100. doi:10.1207/s15327558ijbm0401_6
    Chen, C. C., David, A., Thompson, K., Smith, C., Lea, S., & Fahy, T. (1996). Coping strategies and psychiatric morbidity in women attending breast assessment clinics. Journal of Psychosomatic Research, 40, 265-270. doi:10.1016/0022-3999(95)00529-3
    Cockburn, J., De Luise, T., Hurley, S., & Clover, K. (1992). Development and validation of the PCQ: A questionnaire to measure the psychological consequences of screening mammography. Social Science and Medicine, 34, 1129-1134.
    Culver, J. L., Arena, P. L., Antoni, M. H., & Carver, C. S. (2002). Coping and distress among women under treatment for early stage breast cancer: Comparing African Americans, Hispanics and non-Hispanic Whites. Psycho-Oncology, 11, 495-504. doi:10.1002/pon.615
    Culver, J. L., Arena, P. L., Wimberly, S. R., Antoni, M. H., & Carver, C. S. (2004). Coping among African-American, Hispanic, and non-Hispanic White women recently treated for early stage breast cancer. Psychology and Health, 19, 157-166.
    Fedewa, S. A., Ward, E. M., Stewart, A. K., & Edge, S. B. (2010). Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: A national cohort study 2004-2006. Journal of Clinical Oncology, 28, 4135-4141. doi:10.1200/jco.2009.27.2427
    Folkman, S., & Lazarus, R. S. (1988). Coping as a mediator of emotion. Journal of Personality and Social Psychology, 54, 466-475.
    Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233-239. doi:10.1111/j.1467-9280.2007.01882.x
    Guerra, C. E., Krumholz, M., & Shea, J. A. (2005). Literacy and knowledge, attitudes and behavior among mammography in Latinas. Journal of Health Care for the Poor and Underserved, 16, 152-166.
    Hafslund, B., Espeghaug, B., & Nortvedt, M. W. (2012). Effects of false-positive results in a breast screening program on anxiety, depression and health-related quality of life. Cancer Nursing, 35, E26-E35.
    Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408-420. doi:10.1080/03637750903310360
    Hayes, A. F., & Preacher, K. J. (2010). Quantifying and testing indirect effects in simple mediation models when the constituent paths are nonlinear. Multivariate Behavioral Research, 45, 627-660.
    Heckman, B. D., Fisher, E. B., Monsees, B., Merbaum, M., Ristvedt, S., & Bishop, C. (2004). Coping and anxiety in women recalled for additional diagnostic procedures following an abnormal screening mammogram. Health Psychology, 23, 42-48. doi:10.1037/0278-6133.23.1.42
    Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209-218.
    Janz, N. K., Mujahid, M. S., Hawley, S. T., Griggs, J. J., Alderman, A., Hamilton, A. S.… Katz, S. J. (2009). Racial/ethnic differences in quality of life after diagnosis of breast cancer. Journal of Cancer Survivorship, 3, 212-222. doi:10.1007/s11764-009-0097-y
    Jemal, A., Clegg, L. X., Ward, E., Ries, L. A., Wu, X., Jamison, P. M., … Edwards, B. K. (2004). Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer, 101, 3-27.
    Keyzer-Dekker, C. M., van Esch, L., de Vries, J., Ernst, M. F., Nieuwenhuijzen, G. A., Roukema, J. A., & van der Steeg, A. F. (2012). An abnormal screening mammogram causes more anxiety than a palpable lump in benign breast disease. Breast Cancer Research and Treatment, 134, 253-258.
    Kreuter, M. W., & McClure, S. M. (2004). The role of culture in health communication. Annual Review of Public Health, 25, 439-455.
    Kudadjie-Gyamfi, E., & Magai, C. (2008). The influence of coping styles on mammography screening in a multiethnic sample. Cultural Diversity and Ethnic Minority Psychology, 14, 183-192.
    Lantz, P. M., Mujahid, M., Schwartz, K., Janz, N. K., Fagerlin, A., Salem, B., … Katz, S. J. (2006). The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis. American Journal of Public Health, 96, 2173-2178. doi:10.2105/ajph.2005.072132
    Logan, J., Hackbusch-Pinto, R., & De Grasse, C. E. (2006). Women undergoing breast diagnostics: The lived experience of spirituality. Oncology Nursing Forum, 33, 121-126.
    Lopez-Class, M., Gomez-Duarte, J., Graves, K., & Ashing-Giwa, K. (2012). A contextual approach to understanding breast cancer survivorship among Latinas. Psycho-Oncology, 21, 115-124.
    Lowe, J. B., Balanda, K. P., Del Mar, C., & Hawes, E. (1999). Psychologic distress in women with abnormal findings in mass mammography screening. Cancer, 85, 1114-1118.
    Marcus, E. N., Koru-Sengul, T., Miao, F., Yepes, M., & Sanders, L. (2014). How do breast imaging centers communicate results to women with limited English proficiency and other barriers to care?. Journal of Immigrant and Minority Health, 16, 401-408.
    Marin, G., & Marin, B. V. (1991). Research with Hispanic populations (Vol. 23). Newbury Park, CA: Sage.
    Mojica, C. M., Bastani, R., Ponce, N. A., & Boscardin, W. J. (2007). Latinas with abnormal breast findings: Patient predictors of timely diagnostic resolution. Journal of Women's Health, 16, 1468-1477.
    Molina, Y., Thompson, B., Espinoza, N., & Ceballos, R. (2013). Breast cancer interventions serving US-based Latinas: Current approaches and directions. Women's Health, 9, 335-348.
    Montgomery, M. (2010). Uncertainty during breast diagnostic evaluation: State of the science. Oncology Nursing Forum, 37, 77-83.
    Moy, B., Park, E. R., Feibelmann, S., Chiang, S., & Weissman, J. S. (2006). Barriers to repeat mammography: Cultural perspectives of African-American, Asian, and Hispanic women. Psycho-Oncology, 15, 623-634.
    Ooi, S. L., Martinez, M. E., & Li, C. I. (2011). Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Research and Treatment, 127, 729-738. doi:10.1007/s10549-010-1191-6
    Pakenham, K. I., Clutton, S. J., & Buckley, B. M. (1999). Predictors of emotional well-being following a ‘false positive’ breast cancer screening result. Psychology and Health, 14, 263-275.
    Perczek, R., Carver, C. S., Price, A. A., & Pozo-Kaderman, C. (2000). Coping, mood, and aspects of personality in Spanish translation and evidence of convergence with English versions. Journal of Personality Assessment, 74, 63-87. doi:10.1207/s15327752jpa740105
    Poon, E. G., Haas, J. S., Puopolo, A., Gandhi, T. K., Burdick, E., Bates, D. W., & Brennan, T. A. (2004). Communication factors in the follow-up of abnormal mammograms. Journal of General Internal Medicine, 19, 316-323. doi:10.1111/j.1525-1497.2004.30261.x-i1
    Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891.
    Purc-Stephenson, R. J., & Gorey, K. M. (2008). Lower adherence to screening mammography guidelines among ethnic minority women in America: A meta-analytic review. Preventive Medicine, 46, 479-488.
    Requena, G. C., & Gil Moncayo, F. L. (2007). Propiedades psicométricas de la escala revisada del impacto del evento estresante (IES-R) en una muestra española de pacientes con cáncer. Análisis y Modificación de Conducta, 33(149), 311-331.
    Salz, T., Richman, A. R., & Brewer, N. T. (2010). Meta-analyses of the effects of false-positive mammograms on generic and specific psychosocial outcomes. Psycho-Oncology, 19, 1026-1034.
    Sammarco, A., & Konecny, L. M. (2008). Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncology Nursing Forum, 35, 844-849. doi:10.1188/08.ONF.844-849
    Santiago-Rivera, A. L., Arrendondo, P., Gallardo-Cooper, M. (2002). Counseling Latinos and la familia: A practical guide. Thousand Oaks, CA: Sage.
    Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147-177.
    Siegel, R., Naishadham, D., & Jemal, A. (2012). Cancer statistics for Hispanics/Latinos, 2012. CA: A Cancer Journal for Clinicians, 62, 283-293.
    Sobel, M. E. (1987). Direct and indirect effects in linear structural equation models. Sociological Methods and Research, 16, 155-176.
    Steffens, R. F., Wright, H. R., Hester, M. Y., & Andrykowski, M. A. (2011). Clinical, demographic, and situational factors linked to distress associated with benign breast biopsy. Journal of Psychosocial Oncology, 29, 35-50.
    Sundin, E. C., & Horowitz, M. J. (2002). Impact of Event Scale: Psychometric properties. British Journal of Psychiatry, 180, 205-209.
    U. S. Preventive Services Task Force. (2009). Screening for breast cancer: U. S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 151, 716-726.
    Umezawa, Y., Lu, Q., You, J., Kagawa-Singer, M., Leake, B., & Maly, R. C. (2012). Belief in divine control, coping, and race/ethnicity among older women with breast cancer. Annals of Behavioral Medicine, 44, 21-32.
    Weiss, D. (2007). The Impact of Event Scale: Revised. In J. Wilson & C. So-Kum Tang (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 219-238). New York, NY: Springer.