Journal of Immigrant and Minority Health

, Volume 18, Issue 5, pp 1159–1167 | Cite as

Understanding the Stress Process of Chinese- and Korean-American Breast Cancer Survivors

  • Min-So PaekEmail author
  • Jung-won Lim
Original Paper


Guided by the stress process model (SPM), this study investigated the direct and indirect pathways of primary (negative self-image and life stress), secondary stressors (family communication strain) and family coping (external and internal) on mental health outcomes among Chinese- and Korean-American breast cancer survivors (BCS). A total of 156 Chinese- and Korean-American BCS were surveyed. Results showed primary and secondary stressors had a negative effect on better mental health outcomes. External coping was associated with better mental health. Family communication strain mediated the relationship between life stress and mental health outcomes. External coping mediated the relationship between family communication strain and mental health outcomes. Multi-group analysis revealed the stress process did not differ across ethnic groups. Findings suggest the SPM may be applicable to understand the stress process of Chinese- and Korean-American BCS and provide valuable insight into the role of family communication and external coping on mental health outcomes.


Breast cancer survivor Asian-American Stress process Quality of life Family coping 



This study was funded by NIH/NCI, 1R03CA139941 (PI: Jung-won Lim, PhD). Min-So Paek is supported by the Comprehensive Cancer Center of Wake Forest University Cancer Control Traineeship, NCI/NIH grant #R25CA122061 (PI: Nancy E. Avis).


  1. 1.
    Gomez SL, Noone A-M, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L, et al. Cancer incidence trends among Asian American populations in the United States, 1990–2008. J Natl Cancer Inst. 2013;105(15):1096–110. doi: Scholar
  2. 2.
    American Cancer Society. Breast cancer facts and figures 2013–2014. Atlanta, GA: American Cancer Society; 2013.Google Scholar
  3. 3.
    Schnipper HH. Life After Breast Cancer. J Clin Oncol. 2003;21(9 suppl):104–7.Google Scholar
  4. 4.
    Thewes B, Butow P, Girgis A, Pendlebury S. Assessment of unmet needs among survivors of breast cancer. J Psychosoc Oncol. 2004;22(1):51–73.Google Scholar
  5. 5.
    Andrykowski MA, Lykins E, Floyd A. Psychological health in cancer survivors. Semin Oncol Nurs. 2008;24(3):193–201.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Howard-Anderson J, Ganz PA, Bower JE, Stanton AL. Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(5):386–405.PubMedGoogle Scholar
  7. 7.
    Mallinger JB, Griggs JJ, Shields CG. Family communication and mental health after breast cancer. Eur J Cancer Care. 2006;15(4):355–61.Google Scholar
  8. 8.
    Ashing-Giwa K, Padilla G, Tejero J, Kagawa-Singer M. Understanding the breast cancer experience of Asian American women. Psycho-Oncology. 2003;12(1):38–58.Google Scholar
  9. 9.
    Ashing-Giwa K, Lim JW. Exploring the association between functional strain and emotional well-being among a population-based sample of breast cancer survivors. Psycho-Oncology. 2010;19(2):150–9.PubMedGoogle Scholar
  10. 10.
    Xiaoli C, Ying Z, Wei Z, Kai G, Zhi C, Wei L, et al. Prevalence of depression and its related factors among Chinese women with breast cancer. Acta Oncol. 2009;48(8):1128–36. doi: Scholar
  11. 11.
    Pearlin LI. The stress process revisited: Reflections on concepts and their interrelationships. In: Aneshensel CS, Phelan JC, editors. Handbook of the sociology of mental health. Handbooks of sociology and social research. New York, NY: Springer; 1999. p. 395–415.Google Scholar
  12. 12.
    Pearlin LI, Mullan JT, Semple SJ, Skaff M. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist. 1990;30(5):583–94.PubMedGoogle Scholar
  13. 13.
    Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncology. 2006;15(4):306–20.PubMedGoogle Scholar
  14. 14.
    Land H, Hudson SM, Stiefel B. Stress and depression among HIV-positive and HIV-negative gay and bisexual AIDS caregivers. AIDS Behav. 2003;7(1):41–53.PubMedGoogle Scholar
  15. 15.
    Reich M, Lesur A, Perdrizet-Chevallier C. Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat. 2008;110(1):9–17.PubMedGoogle Scholar
  16. 16.
    Kornblith AB, Herndon JE, Zuckerman E, Viscoli CM, Horwitz RI, Cooper MR, et al. Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer. 2001;91(2):443–54.PubMedGoogle Scholar
  17. 17.
    Karakoyun-Celik O, Gorken I, Sahin S, Orcin E, Alanyali H, Kinay M. Depression and anxiety levels in woman under follow-up for breast cancer: relationship to coping with cancer and quality of life. Med Oncol. 2010;27(1):108–13.PubMedGoogle Scholar
  18. 18.
    Hilton BA, Koop PM. Family communication patterns in coping with early breast cancer. West J Nurs Res. 1994;16(4):366–91.PubMedGoogle Scholar
  19. 19.
    Goldsmith DJ, Miller LE, Caughlin JP. Openness and avoidance in couples communicating about cancer. In: Beck C, editor. Communication Yearbook 31. Hillsdale, NJ: Erlbaum; 2007. p. 62–115.Google Scholar
  20. 20.
    Zhang AY, Siminoff LA. Silence and cancer: why do families and patients fail to communicate? Health Commun. 2003;15(4):415–29.PubMedGoogle Scholar
  21. 21.
    McCubbin HI, Joy CB, Cauble A, Comeau J, Patterson J, Needle R. Family stress and coping: a decade review. J Marriage Fam. 1980;42(4):855–71.Google Scholar
  22. 22.
    McCubbin HI, Larsen AS, Olson DH. Family inventories. In: Family Crisis Oriented Personal Evaluation Scales (F-COPES). St. Paul: University of Minnesota Press; 1985. p. 143–159.Google Scholar
  23. 23.
    Hack TF, Degner LF. Coping responses following breast cancer diagnosis predict psychological adjustment three years later. Psycho-Oncology. 2004;13(4):235–47.PubMedGoogle Scholar
  24. 24.
    Manne S, Glassman M. Perceived control, coping efficacy, and avoidance coping as mediators between spousal unsupportive behaviors and psychological distress. Health Psychol. 2000;19(2):155–64.PubMedGoogle Scholar
  25. 25.
    Myers RM, Balsamo L, Lu X, Devidas M, Hunger SP, Carroll WL, et al. A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia. Cancer. 2014;. doi: Scholar
  26. 26.
    Park M, Chesla C. Revisiting Confucianism as a conceptual framework for Asian family study. J Fam Nurs. 2007;13(3):293–311.PubMedGoogle Scholar
  27. 27.
    Shin DC. Confucianism and democratization in east Asia. Cambridge: Cambridge University Press; 2012.Google Scholar
  28. 28.
    Lim J-W, Paek M-S. The relationship between communication and health-related quality of life in survivorship care for Chinese-American and Korean-American breast cancer survivors. Support Care Cancer. 2013;21(4):1157–66. doi: Scholar
  29. 29.
    Derogatis LR. Brief symptom inventory 18: administration, scoring, and procedures manual (Clinical Psychometric Research). Minneapolis, MN: NCS Pearson Inc; 2001.Google Scholar
  30. 30.
    Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974–86.PubMedGoogle Scholar
  31. 31.
    Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83. doi: Scholar
  32. 32.
    Ashing-Giwa K, Ganz PA, Petersen L. Quality of life of African-American and white long term breast carcinoma survivors. Cancer. 1999;85(2):418–26.PubMedGoogle Scholar
  33. 33.
    Olson D. FACES IV and the circumplex model: validation study. J Marital Fam Ther. 2011;37(1):64–80.PubMedGoogle Scholar
  34. 34.
    McCubbin HI, Larsen A, Olson DH. Family crisis orientated personal evaluation scales (F-COPES). In: McCubbin HI, Thompson AI, editors. Family assessment inventories for research and practice. Madison, WI: University of Wisconsin-Madison; 1987. p. 193–207.Google Scholar
  35. 35.
    J-w Lim. Townsend A: cross-Ethnicity measurement equivalence of family coping for breast cancer survivors. Res Soc Work Pract. 2012;22(6):689–703. doi: Scholar
  36. 36.
    Allison P. Missing data techniques for structural equation modeling. J Abnorm Psychol. 2003;112:545–57.PubMedGoogle Scholar
  37. 37.
    Kline RB. Principles and practice of structural equation modeling. 3rd ed. New York, NY: The Guilford Press; 2010.Google Scholar
  38. 38.
    Pikler V, Winterowd C. Racial and body image differences in coping for women diagnosed with breast cancer. Health Psychol. 2003;22(6):632–7.PubMedGoogle Scholar
  39. 39.
    Donovan-Kicken E, Caughlin JP. Breast cancer patients’ topic avoidance and psychological distress: the mediating role of coping. J Health Psychol. 2011;16(4):596–606.PubMedGoogle Scholar
  40. 40.
    Kraemer LM, Stanton AL, Meyerowitz BE, Rowland JH, Ganz PA. A longitudinal examination of couples’ coping strategies as predictors of adjustment to breast cancer. J Fam Psychol. 2011;25(6):963–72.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355(3):229–31. doi: Scholar
  42. 42.
    Wong ST, Yoo GJ, Stewart AL. Examining the types of social support and the actual sources of support in older Chinese and Korean immigrants. Int J Aging Hum Dev. 2005;61(2):105–21.PubMedGoogle Scholar
  43. 43.
    Taylor SE, Sherman DK, Kim HS, Jarcho J, Takagi K, Dunagan MS. Culture and social support: Who seeks it and why? J Pers Soc Psychol. 2004;87(3):354–62. doi: Scholar
  44. 44.
    Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road and the emerald city: benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychol. 2003;22(5):487–97.PubMedGoogle Scholar
  45. 45.
    Kim J, Menon U, Wang E, Szalacha L. Assess the effects of culturally relevant intervention on breast cancer knowledge, beliefs, and mammography use among Korean American women. J Immigr Minor Health. 2010;12(4):586–97.PubMedGoogle Scholar
  46. 46.
    Yoo G, Levine E, Pasick R. Breast cancer and coping among women of color: a systematic review of the literature. Support Care Cancer. 2014;22(3):811–24. doi: Scholar
  47. 47.
    Folkman S, Lazarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol. 1986;50(3):571–9.PubMedGoogle Scholar
  48. 48.
    Manne S, Pape S, Taylor K, Dougherty J. Spouse support, coping, and mood among individuals with cancer. Ann Behav Med. 1999;21(2):111–21.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Public Health Sciences, Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston-SalemUSA
  2. 2.College of Social WelfareKangnam UniversityYongin-siKorea

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