Journal of Behavioral Medicine

, Volume 42, Issue 3, pp 452–460 | Cite as

Ambivalence over emotional expression and intrusive thoughts as moderators of the link between self-stigma and depressive symptoms among Chinese American breast cancer survivors

  • William TsaiEmail author
  • Qian LuEmail author


Due to successful public health campaigns, breast cancer has successfully transformed from a highly stigmatized illness to a philanthropically supported disease in the United States. However, Chinese American breast cancer survivors continue to experience high levels of self-stigma and associated negative mental health outcomes. In the present study, we examined the relations between self-stigma and depressive symptoms, and further tested individual difference variables such as ambivalence over emotional expression and intrusive thoughts that may exacerbate the harmful effects of self-stigma among this population. One hundred and twelve foreign-born Chinese breast cancer survivors living in the United States completed questionnaires measuring self-stigma, depressive symptoms, AEE, and intrusive thoughts. We found significant AEE × self-stigma and intrusive-thought × self-stigma interaction effects in predicting depressive symptoms. Specifically, the relationships between self-stigma and depressive symptoms were exacerbated among individuals with high levels of AEE and intrusive thoughts. Self-stigma represents a significant predictor of depressive symptoms among Chinese breast cancer survivors, and particularly so for individuals with higher levels of AEE and intrusive thoughts. The findings suggest that for interventions designed to reduce the negative mental health outcomes associated with self-stigma, targeting risk factors such as AEE and intrusive thoughts might be promising.


Self-stigma Chinese American breast cancer survivors Intrusive thoughts Depressive symptoms Ambivalence over emotion expression 



This study was funded by National Cancer Institute (NCI) Grant CA180896 (principal investigator, Qian Lu).

Compliance with ethical standards

Conflict of interest

William Tsai and Qian Lu declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Applied PsychologyNew York UniversityNew YorkUSA
  2. 2.Department of Health Disparities ResearchUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of PsychologyUniversity of HoustonHoustonUSA

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