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Caregiving burden and self-efficacy mediate the association between individual characteristics and depressive symptoms among husbands of Chinese breast cancer patients

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Abstract

Purpose

Perceptions of caregiving burden and self-efficacy are found to be associated with well-being among husbands of breast cancer patients (BCP). However, little is known about how individual characteristics associate with such caregiving-related perceptions and cancer caregivers’ well-being. This study examined the associations between two individual characteristics (male gender role norms and ambivalence over emotional expression (AEE)) and depressive symptoms among husbands of Chinese BCP, and the potential mediating roles of caregiving burden and self-efficacy in such associations.

Methods

Participants (n = 176) were recruited in two hospitals in Weifang, China. Their endorsement of male gender role norms (e.g., “men should not ask for help”), AEE, caregiving burden, and depressive symptoms were measured in a cross-sectional survey.

Results

Path analysis results supported the proposed mediation model with satisfactory fit indices (χ2(2) = 2.73, p = .26, CFI = 1.00; IFI = 1.00; RMSEA = 0.05). Specifically, male gender role norms and AEE were associated with higher caregiving burden and lower caregiving self-efficacy, which in turn were associated with more depressive symptoms. Bootstrapping results supported that both male gender role norms (β = 0.16; 95%CI = 0.09, 0.25) and AEE had significant indirect effects on depressive symptoms (β = 0.11; 95%CI = 0.04, 0.18) via caregiving burden and self-efficacy, indicating that caregiving-related perceptions could mediate between individual characteristics and depressive symptoms.

Conclusions

Male gender role norms and AEE might affect depressive symptoms among husbands of Chinese BCP through caregiving-related perceptions. Future interventions that reduce those husbands’ barriers to express emotions, appreciate their commitment to take good care of their spouses, enhance caregiving skills, and reduce caregiving burden may decrease their depressive symptoms.

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References

  1. Bigatti SM, Wagner CD, Lydon-Lam JR, Steiner JL, Miller KD (2011) Depression in husbands of breast cancer patients: relationships to coping and social support. Support Care Cancer 19:455–466

    PubMed  Google Scholar 

  2. Fletcher KA, Lewis FM, Haberman MR (2010) Cancer-related concerns of spouses of women with breast cancer. Psycho-Oncology 19:1094–1101

    PubMed  PubMed Central  Google Scholar 

  3. Moreira H, Canavarro MC (2013) Psychosocial adjustment and marital intimacy among partners of patients with breast cancer: a comparison study with partners of healthy women. J Psychosoc Oncol 31:282–304

    PubMed  Google Scholar 

  4. Kuang J, Zhou Q, Yang XM, Chen YX, Han BX (2010) The investigation of anxiety and depression status in spouses of patients with breast cancer and the related factors analysis [In Chinese]. Journal of Bengdu Medical College 35:1170–1172

    Google Scholar 

  5. Zhu P, Fu JF, Wang Y, Jiang PP, Guo SJ, Fang NN, Wang DD (2013) Quality of life of spouses of women with breast cancer and its influencing factors [In Chinese]. Nurs J Chin PLA 30:1–5,34

    Google Scholar 

  6. Stanton AL, Revenson TA (2011) Adjustment to chronic disease: progress and promise in research. In: Friedman HS (ed) The Oxford handbook of health psychology. Oxford University Press, Oxford

    Google Scholar 

  7. Fletcher BS, Miaskowski C, Given B, Schumacher K (2012) The cancer family caregiving experience: an updated and expanded conceptual model. Eur J Oncol Nurs 16:387–398

    PubMed  Google Scholar 

  8. Carter PA, Action GJ (2006) Personality and coping: predictors of depression and sleep problems among caregivers of individuals who have cancer. J Gerontol Nurs 32:45–53

    PubMed  Google Scholar 

  9. Vespa A, Spatuzzi R, Merico F, Ottaviani M, Fabbietti P, Meloni C, Raucci L, Ricciuti M, Bilancia D, Pelliccioni G, Giulietti MV (2018) Spiritual well-being associated with personality traits and quality of life in family caregivers of cancer patients. Support Care Cancer 26:2633–2640

    PubMed  Google Scholar 

  10. Mahalik JR, Good GE, Englar-Carlson M (2003) Masculinity scripts, presenting concerns, and help seeking: implications for practice and training. Prof Psychol Res Pract 34:123–131

    Google Scholar 

  11. Louie K (2002) Theorizing Chinese masculinity. Cambridge University Press, Cambridge

    Google Scholar 

  12. Lopez V, Copp G, Molassiotis A (2012) Male caregivers of patients with breast and gynecologic cancer: experiences from caring for their spouses and partners. Cancer Nurs 35:402–410

    PubMed  Google Scholar 

  13. Yeung NCY, Mak WWS, Cheung LKL (2015) Conformity to the emotional-control masculine norm and psychological well-being among Chinese men in Hong Kong: the mediating role of stress appraisal for expressing tender emotions. Psychol Men Masculinity 16:304–311

    Google Scholar 

  14. Hoyt MA (2009) Gender role conflict and emotional approach coping in men with cancer. Psychol Health 24:981–996

    PubMed  Google Scholar 

  15. Bai X, Liu C, Baladon L, Rubio-Valera M (2018) Multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Aging Ment Health 22:986–995

    Google Scholar 

  16. King L, Emmons R (1990) Conflict over emotional expression: psychological and physical correlates. J Pers Soc Psychol 58:864–877

    CAS  PubMed  Google Scholar 

  17. Ussher JM, Perz J (2010) Gender differences in self-silencing and psychological distress in informal cancer carers. Psychol Women Q 34(2):228–242

    Google Scholar 

  18. Lu Q, Stanton AL (2010) How benefits of expressive writing vary as a function of writing instructions, ethnicity and ambivalence over emotional expression. Psychol Health 25:669–684

    PubMed  Google Scholar 

  19. Chen SX, Cheung FM, Bond MH, Leung JP (2005) Decomposing the construct of ambivalence over emotional expression in a Chinese cultural context. Eur J Personal 19:185–204

    Google Scholar 

  20. Bardwell WA, Natarajan L, Dimsdale JE, Rock CL, Mortimer JE, Hollenbach K, Pierce JP (2006) Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. J Clin Oncol 24:2420–2427

    PubMed  Google Scholar 

  21. Lu Q, Man J, You J, LeRoy AS (2015) The link between ambivalence over emotional expression and depressive symptoms among Chinese breast cancer survivors. J Psychosom Res 79:153–158

    PubMed  PubMed Central  Google Scholar 

  22. Porter LS, Keefe FJ, Lipkus I, Hurwitz H (2005) Ambivalence over emotional expression in patients with gastrointestinal cancer and their caregivers: associations with patient pain and quality of life. Pain 117:340–348

    PubMed  Google Scholar 

  23. Langer SL, Rudd ME, Syrjala KL (2007) Protective buffering and emotional desynchrony among spousal caregivers of cancer patients. Health Psychol 26:635–643

    PubMed  Google Scholar 

  24. Tsai W, Lu Q (2018) Perceived social support mediates the longitudinal relations between ambivalence over emotional expression and quality of life among Chinese American breast cancer survivors. Int J Behav Med 25:368–373

    PubMed  Google Scholar 

  25. Kim Y, Mitchell H, Ting A (2019) Application of psychological theories on the role of gender in caregiving to psycho-oncology research. Psycho-Oncology 28:228–254

    PubMed  Google Scholar 

  26. Wagner CD, Tanmoy Das L, Bigatti SM, Storniolo AM (2011) Characterizing burden, caregiving benefits, and psychological distress of husbands of breast cancer patients during treatment and beyond. Cancer Nurs 34:E21–E30

    PubMed  Google Scholar 

  27. Rhee YS, Yun YH, Park S, Shin DO, Lee KM, Yoo HJ, Kim JH, Kim SO, Lee R, Lee YO, Kim NS (2008) Depression in family caregivers of cancer patients: the feeling of burden as a predictor of depression. J Clin Oncol 26:5890–5895

    PubMed  Google Scholar 

  28. Porter LS, Keefe FJ, Garst J, McBride CM, Baucom D (2008) Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: associations with symptoms and distress. Pain 137:306–315

    PubMed  Google Scholar 

  29. Andersen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med 10:77–84

    Google Scholar 

  30. Nijober C, Triemstra M, Tempelaar R, Sanderman R, van den Bos GAM (1999) Measuring both negative and positive reactions to giving care to cancer patients: psychometric qualities of the caregiver reaction assessment (CRA). Soc Sci Med 48:1259–1269

    Google Scholar 

  31. Ge C, Yang X, Fu J, Chang Y, Wei J, Zhang F, Nutifafa AE, Wang L (2011) Reliability and validity of the Chinese version of the caregiver reaction assessment. Psychiatry Clin Neurosci 65:254–263

    PubMed  Google Scholar 

  32. Merluzzi TV, Philip EJ, Vachon DO, Heitzmann CA (2011) Assessment of self-efficacy for caregiving: the critical role of self-care in caregiver stress and burden. Palliat Support Care 9:15–24

    PubMed  Google Scholar 

  33. Parent MC, Moradi B (2009) Conformity factor analysis of the conformity to masculine norms inventory and development of the Conformity to Masculine Norms Inventory-46. Psychol Men Masculinity 10:175–189

    Google Scholar 

  34. Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55

    Google Scholar 

  35. Bentler PM, Chou CP (1987) Practical issues in structural modeling. Sociol Methods Res 16:78–117

    Google Scholar 

  36. Ussher JM, Sandoval M (2008) Gender differences in the construction and experience of cancer care: the consequences of the gendered positioning of carers. Psychol Health 23:945–963

    PubMed  Google Scholar 

  37. Bryan JL, Young CM, Lucas S, Quist MC (2018) Should I say thank you? Gratitude encourages cognitive reappraisal and buffers the negative impact of ambivalence over emotional expression on depression. Personal Individ Differ 120:253–258

    Google Scholar 

  38. National Bureau of Statistics of the People’s Republic of China (2016) China statistical yearbook 2016. www.stats.gov.cn/tjsj/ndsj/2016/indexch.htm. Accessed 15 Sept 2019.

  39. Shandong Provincial Bureau of Statistics (2016) The Shandong statistical yearbook 2016. http://old.stats-sd.gov.cn/tjnj/nj2016/indexch.htm. Accessed 15 Sept 2019.

  40. Kim Y, Carver CS, Cannady RS (2015) Caregiving motivation predicts long-term spirituality and quality of life of the caregivers. Ann Behav Med 49:500–509

    PubMed  Google Scholar 

  41. Falconier MK, Jackson JB, Hilpert P, Bodenmann G (2015) Dyadic coping and relationship satisfaction: a meta-analysis. Clin Psychol Rev 42:28–46

    PubMed  Google Scholar 

  42. Norman SA, Lumley MA, Dooley JA, Diamond MP (2004) For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain. Psychosom Med 66:174–183

    PubMed  Google Scholar 

  43. Bultz BD, Speca M, Brasher PM, Geggie PHS, Page SA (2000) A randomized controlled trial of a brief psychoeducational support group for partners of early stage breast cancer patients. Psycho-Oncology 9:303–313

    CAS  PubMed  Google Scholar 

Download references

Funding

This study was supported by the 2014 American Psychological Association Dissertation Research Award grant (PI: Nelson Yeung) and the College of Liberal Arts and Social Sciences (CLASS) Research Outreach Grant at the University of Houston (PI: Qian Lu).

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Correspondence to Guohua Lu or Qian Lu.

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The authors also have full control of all primary data and agree to allow the journal to review the data if requested. The study was approved by the relevant institutional review boards.

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The authors declare that they have no conflict of interest.

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Yeung, N.C.Y., Ji, L., Zhang, Y. et al. Caregiving burden and self-efficacy mediate the association between individual characteristics and depressive symptoms among husbands of Chinese breast cancer patients. Support Care Cancer 28, 3125–3133 (2020). https://doi.org/10.1007/s00520-019-05102-7

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  • DOI: https://doi.org/10.1007/s00520-019-05102-7

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