Ambivalence over emotional expression and physical functioning and limitations: mediating and moderating effects of PTSD symptoms and acculturation among Chinese breast cancer survivors.

OBJECTIVE

The psychosocial correlates of physical functioning and limitations are not well-known among Chinese breast cancer survivors. Previous research suggests a link between ambivalence over emotional expression (AEE) and physical functioning. The current study built upon this research by examining post-traumatic stress symptoms (PTSS) as a mechanism. Further, we also examined the moderating effects of mainstream cultural orientation. To this end, we tested study hypotheses using moderated mediation models.

METHODS

Participants were 96 Chinese-speaking breast cancer survivors in the USA. Participants were diagnosed within the past five years with stages 0-III breast cancer. Participants completed questionnaires related to AEE, PTSS, SF-36 physical functioning, and role limitations due to physical health subscales, and acculturation.

RESULTS

Results from moderated mediation models provided support for study hypotheses. AEE was positively related to overall PTSS and its three subscales (i.e., re-experiencing symptoms, avoidance, and arousal). Further, PTSS and the three subscales were negatively related to physical functioning and positively related to role limitations due to physical health. The indirect effects of AEE on physical functioning and role limitations due to physical health through PTSS and the three subscales were significant. Moderated mediation models showed that the indirect effects of AEE on physical functioning through PTSS and the re-experiencing subscale were stronger for those high, compared to low, in mainstream culture orientation.

CONCLUSION

Those with high AEE experience had worse physical functioning and greater role limitations due to increased PTSS. However, the indirect effects were stronger for those who endorse greater mainstream culture. Implications for results suggest that interventions aimed at addressing AEE and PTSS may help alleviate physical health problems especially those high in mainstream culture orientation.