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Mindfulness

, Volume 9, Issue 2, pp 521–533 | Cite as

Mindfulness and Cancer Patients’ Emotional States: a Latent Profile Analysis Among Newly Diagnosed Cancer Patients

  • Kevin F. Y. Lam
  • Haikel A. Lim
  • Ee Heok Kua
  • Konstadina Griva
  • Rathi Mahendran
ORIGINAL PAPER

Abstract

Variable-centred approaches indicate that mindfulness might protect against psychological distress. Person-centred approaches, such as latent profile analysis (LPA), provide researchers with additional tools to identify profiles of mindfulness based on individuals’ patterns of response to each facet of the construct. Recent studies using LPA in non-cancer populations suggest that individuals demonstrate one of four profiles of mindfulness: low mindfulness, judgmentally observing, non-judgmentally aware, or high mindfulness. However, it is not known whether such profiles hold true in cancer or Asian populations. The present cross-sectional study therefore sought to identify profiles of mindfulness in a cohort of newly diagnosed cancer patients in Asia, and examined their associations with sociodemographic and medical variables, and depressive and anxious symptoms. A total of 212 patients (M age = 49.26, SD = 9.30 years; 68% female; 60% Chinese) completed the short form of the Five Facet Mindfulness Questionnaire and the Hospital Anxiety and Depression Scale. In line with previous research, four profiles of mindfulness were identified using LPA: low mindfulness (51%), judgmentally observing (24%), non-judgmentally aware (7%), and high mindfulness (18%). As compared to the high mindfulness profile, the non-judgmentally aware profile was associated with male gender and lower education; both the low mindfulness and the judgmentally observing profiles were associated with higher levels of depressive and anxious symptoms. A majority of patients demonstrated profiles characterised by globally low levels of mindfulness and which were associated with higher levels of emotional distress. A consideration of these profiles might allow clinicians to provide more targeted interventions to cancer patients.

Keywords

Mindfulness Depression Anxiety Cancer Latent profile analysis Bolck-Croon-Hagenaars approach 

Notes

Acknowledgements

The authors would like to thank the study team members and healthcare professionals who have assisted in all aspects of the present study.

Funding Information

The HOPE Study, from which this study is based on, was funded by the National University of Singapore Start-Up Grant (R-177-000-039-133 and R-177-000-039-733).

Compliance with Ethical Standards

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. Akaike, H. (1987). Factor analysis and AIC. Psychometrika, 52(3), 317–332.  https://doi.org/10.1007/BF02294359.
  2. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.  https://doi.org/10.1177/1073191105283504.
  3. Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., & Williams, J. M. G. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342.  https://doi.org/10.1177/1073191107313003.
  4. Bakk, Z., & Vermunt, J. K. (2016). Robustness of stepwise latent class modelling with continuous distal outcomes. Structural Equation Modeling: A Multidisciplinary Journal, 23, 20–31.  https://doi.org/10.1080/10705511.2014.955104.
  5. Bakk, Z., Tekle, F. B., & Vermunt, J. K. (2013). Estimating the association between latent class membership and external variables using bias-adjusted three-step approaches. Sociological Methodology, 43, 272–311.  https://doi.org/10.1177/0081175012470644.
  6. Bohlmeijer, E., ten Klooster, P. M., Fledderus, M., Veehof, M., & Baer, R. (2011). Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment, 18(3).  https://doi.org/10.1177/1073191111408231.
  7. Bolck, A., Croon, M., & Hagenaars, J. (2004). Estimating latent structure models with categorical variables: one-step versus three-step estimators. Political Analysis, 12(1), 3–27.  https://doi.org/10.1093/pan/mph001.
  8. Boyle, C. C., Stanton, A. L., Ganz, P. A., Crespi, C. M., & Bower, J. E. (2017). Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. Journal of Consulting and Clinical Psychology, 85(4), 397–402.  https://doi.org/10.1037/ccp0000186.
  9. Bränström, R., Duncan, L. G., & Moskowitz, J. T. (2011). The association between dispositional mindfulness, psychological well-being, and perceived health in a Swedish population-based sample. British Journal of Health Psychology, 16(Pt 2), 300–316.  https://doi.org/10.1348/135910710X501683.
  10. Bravo, A. J., Boothe, L. G., & Pearson, M. R. (2016). Getting personal with mindfulness: A latent profile analysis of mindfulness and psychological outcomes. Mindfulness, 7, 420–432.  https://doi.org/10.1007/s12671-015-0459-7.
  11. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.  https://doi.org/10.1037/0022-3514.84.4.822.
  12. Brown, D. B., Bravo, A. J., Roos, C. R., & Pearson, M. R. (2015). Five facets of mindfulness and psychological health: evaluating a psychological model of the mechanisms of mindfulness. Mindfulness, 6(5), 1021–1032.  https://doi.org/10.1007/s12671-014-0349-4.
  13. Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31(1), 23–33.  https://doi.org/10.1007/s10865-007-9130-7.
  14. Cattell, R. B. (1966). The scree test for the number of factors. Multivariate Behavioral Research, 1(2), 245–276.  https://doi.org/10.1207/s15327906mbr0102.
  15. Creswell, J. D. (2017). Mindfulness interventions. Annual Review of Psychology, 68, 491–516.  https://doi.org/10.1146/annurev-psych-042716-051139.
  16. Fogarty, F. A., Lu, L. M., Sollers, J. J., Krivoschekov, S. G., Booth, R. J., & Consedine, N. S. (2015). Why it pays to be mindful: trait mindfulness predicts physiological recovery from emotional stress and greater differentiation among negative emotions. Mindfulness, 6(2), 175–185.  https://doi.org/10.1007/s12671-013-0242-6.
  17. Greene, P. B., Philip, E. J., Poppito, S. R., & Schnur, J. B. (2012). Mindfulness and psychosocial care in cancer: historical context and review of current and potential applications. Palliative and Supportive Care, 10(4), 287–294.  https://doi.org/10.1017/S1478951511001015.
  18. Gu, J., Karl, A., Baer, R., Strauss, C., Barnhofer, T., & Crane, C. (2017). Latent profile analysis of the five facet mindfulness questionnaire in a sample with a history of recurrent depression. Assessment, 1–15.  https://doi.org/10.1177/1073191117715114.
  19. Ho, R. T. H., Fong, T. C. T., Lo, P. H. Y., Ho, S. M. Y., Lee, P. W. H., Leung, P. P. Y., et al. (2016). Randomized controlled trial of supportive-expressive group therapy and body-mind-spirit intervention for Chinese non-metastatic breast cancer patients. Supportive Care in Cancer, 24(12), 4929–4937.  https://doi.org/10.1007/s00520-016-3350-8.
  20. Huang, H. P., He, M., Wang, H. Y., & Zhou, M. (2016). A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer, 23(4), 568–576.  https://doi.org/10.1007/s12282-015-0604-0.
  21. Johannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., & Zachariae, R. (2017). Mindfulness-based cognitive therapy and persistent pain in women treated for primary breast cancer: exploring possible statistical mediators—results from a randomized controlled trial. The Clinical Jurnal of Pain.  https://doi.org/10.1097/AJP.0000000000000510.
  22. Josefsson, T., Larsman, P., Broberg, A. G., & Lundh, L. G. (2011). Self-reported mindfulness mediates the relation between meditation experience and psychological well-being. Mindfulness, 2(1), 49–58.  https://doi.org/10.1007/s12671-011-0042-9.
  23. Jung, T., & Wickrama, K. A. (2008). An introduction to latent class growth analysis and growth mixture modeling. Social and Personality Psychology Compass, 2(1), 302–317.  https://doi.org/10.1111/j.1751-9004.2007.00054.x.
  24. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.  https://doi.org/10.1093/clipsy/bpg016.
  25. Kadziolka, M. J., Di Pierdomenico, E. A., & Miller, C. J. (2016). Trait-like mindfulness promotes healthy self-regulation of stress. Mindfulness, 7(1), 236–245.  https://doi.org/10.1007/s12671-015-0437-0.
  26. Kass, R. E., & Wasserman, L. (1995). A reference Bayesian test for nested hypotheses and its relationship to the Schwarz criterion. Journal of the American Statistical Association, 90(431), 773–795.  https://doi.org/10.2307/2291327.
  27. Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056.  https://doi.org/10.1016/j.cpr.2011.04.006.
  28. Kimmes, J. G., Durtschi, J. A., & Fincham, F. D. (2017). Perception in romantic relationships: a latent profile analysis of trait mindfulness in relation to attachment and attributions. Mindfulness.  https://doi.org/10.1007/s12671-017-0708-z.
  29. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613.  https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
  30. Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., et al. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112.  https://doi.org/10.1016/j.brat.2010.08.003.
  31. Lilja, J. L., Lundh, L. G., Josefsson, T., & Falkenström, F. (2013). Observing as an essential facet of mindfulness: a comparison of FFMQ patterns in meditating and non-meditating individuals. Mindfulness, 4(3), 203–212.  https://doi.org/10.1007/s12671-012-0111-8.
  32. Lim, H. A., Mahendran, R., Chua, J., Peh, C. X., Lim, S. E., & Kua, E. H. (2014). The distress thermometer as an ultra-short screening tool: a first validation study for mixed-cancer outpatients in Singapore. Comprehensive Psychiatry, 55(4), 1055–1062.  https://doi.org/10.1016/j.comppsych.2014.01.008.
  33. Lindsay, E. K., & Creswell, J. D. (2017). Mechanisms of mindfulness training: monitor and acceptance theory (MAT). Clinical Psychology Review, 51, 48–59.  https://doi.org/10.1016/j.cpr.2016.10.011.
  34. Lo, Y., Mendell, N. R., & Rubin, D. B. (2001). Testing the number of components in a normal mixture. Biometrika, 88(3), 767–778.CrossRefGoogle Scholar
  35. Mahendran, R., Lim, H. A., & Tan, J. Y. S. (2014). The relationship between hope, resilience, optimism, and psychiatric co-morbidities in cancer patients: the HOPE study overview. Annals, Academy of Medicine, Singapore, 43(10), S45.Google Scholar
  36. Masyn, K. E. (2013). Latent class analysis and finite mixture modeling. In T. D. Little (Ed.), The Oxford handbook of quantitative methods in psychology (Vol. 2, pp. 551–611). Oxford: Oxford University Press. i: https://doi.org/10.1093/oxfordhb/9780199934898.013.0025.
  37. Medvedev, O. N., Siegert, R. J., Kersten, P., & Krägeloh, C. U. (2017). Improving the precision of the five facet mindfulness questionnaire using a Rasch approach improving the precision of the five facet mindfulness questionnaire using a Rasch approach. Mindfulness.  https://doi.org/10.1007/s12671-016-0676-8.
  38. Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. The Lancet Oncology, 12(2), 160–174.  https://doi.org/10.1016/S1470-2045(11)70002-X.
  39. Muthén, B. O. (2003). Statistical and substantive checking in growth mixture modeling: Comment on Bauer and Curran (2003). Psychological Methods, 8(3), 369–377.  https://doi.org/10.1037/1082-989X.8.3.369.
  40. Muthén, B. O. (2004). Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In D. Kaplan (Ed.), Handbook of quantitative methodology for the social sciences (pp. 345–368). Newbury Park: SAGE Publications.Google Scholar
  41. Muthén, B. O., & Muthén, L. K. (2000). Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcoholism: Clinical and Experimental Research, 24(6), 882–891. : https://doi.org/10.1111/j.1530-0277.2000.tb02070.x.
  42. Nagin, D. S. (2005). Group-based modeling of development. Harvard University Press.  https://doi.org/10.1073/pnas.0703993104.
  43. National Registry of Diseases Office. (2014). Singapore cancer registry interim annual report: Trends in cancer incidence in Singapore 2010–2014. Singapore, Singapore.Google Scholar
  44. Nolen-hoeksema, S. (2008). The response styles theory. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination: nature, theory and treatment. Chichester: John Wiley & Sons Ltd..  https://doi.org/10.1002/9780470713853.ch6.
  45. Pasquini, M., & Biondi, M. (2007). Depression in cancer patients: a critical review. Clinical Practice and Epidemiology in Mental Health, 3(2).  https://doi.org/10.1186/1745-0179-3-Received.
  46. Paterson, C. L., Lengacher, C. A., Donovan, K. A., Kip, K. E., & Tofthagen, C. S. (2016). Body image in younger breast cancer survivors: a systematic review. Cancer Nursing, 39(1), 39–58.  https://doi.org/10.1097/NCC.0000000000000251.
  47. Pearson, M. R., Lawless, A. K., Brown, D. B., & Bravo, A. J. (2015). Mindfulness and emotional outcomes: identifying subgroups of college students using latent profile analysis. Personality and Individual Differences, 76, 33–38.  https://doi.org/10.1016/j.paid.2014.11.009.
  48. Piet, J., Würtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80(6), 1007–1020.  https://doi.org/10.1037/a0028329.
  49. Pinquart, M., & Duberstein, P. R. (2010). Depression and cancer mortality: a meta-analysis. Psychological Medicine, 40(11), 1797–1810.  https://doi.org/10.1017/S0033291709992285.
  50. Poulin, P. A., Romanow, H. C., Rahbari, N., Small, R., Smyth, C. E., Hatchard, T., et al. (2016). The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer survivors living with chronic neuropathic pain. Supportive Care in Cancer, 24(10), 4167–4175.  https://doi.org/10.1007/s00520-016-3243-x.
  51. Ramaswamy, V., Desarbo, W. S., Reibstein, D. J., & Robinson, W. T. (1993). An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Marketing Science, 12(1), 103–124.  https://doi.org/10.1287/mksc.12.1.103.
  52. Reynolds, L. M., Bissett, I. P., Porter, D., & Consedine, N. S. (2017). A brief mindfulness intervention is associated with negative outcomes in a randomised controlled trial among chemotherapy patients. Mindfulness, 1–13.  https://doi.org/10.1007/s12671-017-0705-2.
  53. Rodriguez, M. A., Xu, W., Wang, X., & Liu, X. (2015). Self-acceptance mediates the relationship between mindfulness and perceived stress 1, 2. Psychological Reports, 116(2), 513–522.  https://doi.org/10.2466/07.PR0.116k19w4.
  54. Rush, S. E., & Sharma, M. (2016). Mindfulness-based stress reduction as a stress management intervention for cancer care: a systematic review. Journal of Evidence-Based Complementary & Alternative Medicine, 1–13.  https://doi.org/10.1177/2156587216661467.
  55. Sahdra, B. K., & Shaver, P. R. (2013). Comparing attachment theory and Buddhist psychology. International Journal for the Psychology of Religion, 23(4), 282–293.  https://doi.org/10.1080/10508619.2013.795821.
  56. Sahdra, B. K., Ciarrochi, J., Parker, P. D., Marshall, S., & Heaven, P. (2015). Empathy and nonattachment independently predict peer nominations of prosocial behavior of adolescents. Frontiers in Psychology, 6.  https://doi.org/10.3389/fpsyg.2015.00263.
  57. Sahdra, B. K., Ciarrochi, J., & Parker, P. D. (2016). Nonattachment and mindfulness: related but distinct constructs. Psychological Assessment, 28(7), 819–829.  https://doi.org/10.1037/pas0000264.
  58. Sahdra, B. K., Ciarrochi, J., Parker, P. D., Basarkod, G., Bradshaw, E. L., & Baer, R. (2017). Are people mindful in different ways? Disentangling the quantity and quality of mindfulness in latent profiles and exploring their links to mental health and life effectiveness. European Journal of Personality.  https://doi.org/10.1002/per.2108.
  59. Sarenmalm, E. K., Mårtensson, L. B., Andersson, B. A., Karlsson, P., & Bergh, I. (2017). Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Medicine.  https://doi.org/10.1002/cam4.1052.
  60. Schellekens, M. P. J., Karremans, J. C., van der Drift, M. A., Molema, J., van den Hurk, D. G. M., Prins, J. B., & Speckens, A. E. M. (2017). Are mindfulness and self-compassion related to psychological distress and communication in couples facing lung cancer? A dyadic approach. Mindfulness, 8(2), 325–336.  https://doi.org/10.1007/s12671-016-0602-0.
  61. Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461–464.  https://doi.org/10.1214/aos/1176344136.
  62. Sclove, L. S. (1987). Application of model selection criteria to some problems in multivariate analysis. Psychometrika, 52(3), 333–343.  https://doi.org/10.1007/BF02294360.
  63. Stark, D., Kiely, M., Smith, A., Velikova, G., House, A., & Selby, P. (2002). Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. Journal of Clinical Oncology, 20(14), 3137–3148.  https://doi.org/10.1200/JCO.2002.08.549.
  64. Svendsen, J. L., Kvernenes, K. V., Wiker, A. S., & Dundas, I. (2017). Mechanisms of mindfulness: rumination and self-compassion. Nordic Psychology, 2276(November), 1–12.  https://doi.org/10.1080/19012276.2016.1171730.
  65. Tran, U. S., Glück, T. M., & Nader, I. W. (2013). Investigating the five facet mindfulness questionnaire (FFMQ): construction of a short form and evidence of a two-factor higher order structure of mindfulness. Journal of Clinical Psychology, 69(9), 951–965.  https://doi.org/10.1002/jclp.21996.
  66. Vermunt, J. K. (2010). Latent class modeling with covariates: two improved three-step approaches. Political Analysis, 18, 450–469.  https://doi.org/10.1093/pan/mpq025.
  67. Vuong, Q. H. (1989). Likelihood ratio tests for model selection and non-nested hypotheses. Econometrica: Journal of the Econometric Society, 307–333.Google Scholar
  68. World Health Organization. (2015). Cancer: Fact sheet N°297. Retrieved February 14, 2016, from http://www.who.int/mediacentre/factsheets/fs297/en/#.
  69. Zainal, N. Z., Booth, S., & Huppert, F. a. (2013). The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psycho-Oncology, 22(7), 1457–1465.  https://doi.org/10.1002/pon.3171.
  70. Zhang, J., Xu, R., Wang, B., & Wang, J. (2016). Effects of mindfulness-based therapy for patients with breast cancer: a systematic review and meta-analysis. Complementary Therapies in Medicine, 26(35), 1–10.  https://doi.org/10.1016/j.ctim.2016.02.012.
  71. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.  https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Kevin F. Y. Lam
    • 1
  • Haikel A. Lim
    • 1
    • 2
  • Ee Heok Kua
    • 1
    • 3
  • Konstadina Griva
    • 4
  • Rathi Mahendran
    • 1
    • 2
  1. 1.Department of Psychological MedicineNational University of SingaporeSingaporeSingapore
  2. 2.Duke-NUS Medical SchoolSingaporeSingapore
  3. 3.Department of Psychological MedicineNational University HospitalSingaporeSingapore
  4. 4.Department of PsychologyNational University of SingaporeSingaporeSingapore

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