The Relationship Between Negative Emotion And Emotion Regulation Strategy In Breast Cancer Patients With Metastasis

Background:Patients with breast cancer metastasis,comparing with those without metastasis,will suffer more stress source,such as body distress related to diseases,the side effects of a variety of treatments and high hospitalization costs,so they are more likely to have negative emotions.The emotional regulation strategy will affect the direction of emotions.Therefore,negative emotions and emotion regulation strategies in patients with breast cancer metastasis are in urgent need of attention,however,only a few researches on this aspect at home and abroad.Objective:It is necessary to pay attention to the negative emotions in patients with breast cancer metastasis and the emotional regulation strategies they use,however,there are few studies on this.This study aimed to investigate the status of negative emotions that female metastatic breast cancer patients have and emotion regulation strategies these patients use,and to explore the relationships between them.Methods:This is a cross-sectional study conducted among participants selected from a top three hospital in Jinan from April 2018 to June 2019.The General data Questionnaire was used to investigate the basic information and lifestyle of these patients and the 9-item Patients Health Questionnaire Depression Module(PHQ-9),the General Anxiety disorder7(GAD-7)and Penn State Worry Questionnaire(PSWQ)were used to investigate the depression,anxiety and worry.PHQ-9 and GAD-7 are widely used scales with good reliability and validity to evaluate depressive emotion and anxious emotion,thus our study focused on depressive emotion and anxious emotion rather than clinical diagnosed depression and anxiety.According to literature,this study used 10 points as the cutoff for the positive screening of depression and anxiety,respectively.We used Ruminative Responses Scale(RRS),Acceptance and Action Questionnaire-2nd Edition(AAQ-?)and Five Facet Mindfulness Questionnaire-short form(FFMQ-SF)to identify three types of emotion regulation strategies including rumination,experiential avoidance and mindfulness.Stratified multiple linear regression was used to analyze the relationships between patients'emotion regulation strategies and negative emotions.We used descriptive statistical analysis to describe the basic information,disease and the treatment situation of these patients,as well as their negative mood and emotion regulation strategies.Independent sample t-test and single factor variance analysis were used to compare the differences of negative emotions among basic data,disease conditions and their treatment situation.Spearman correlation analysis was used to investigate the correlation between negative emotion and emotion regulation strategies.We used hierarchical linear regression analysis to explore the influence factors of negative emotions of these patients.Results:(1)In this study,194 patients with breast cancer metastasis completed valid questionnaires.They were all female,and 70.6%of them were over 45 years old,and 58.2%patients were overweight or obese according to BMI(>23.9).There were 182 patients with lymph node metastasis,accounting for 93.8%,and 105 patients with distant metastasis,accounting for 54.1%.There were 95.8%patients received chemotherapy,63.4%patients received radiotherapy,and 43.8%patients received endocrine therapy.(2)Among negative emotions,the total score of PHQ-9 is(7.53±4.15),and the prevalence of depressive symptoms was 21.6%if we identified score of 10 as positive;and the total score of GAD-7 is(5.32±4.99),and the prevalence of anxiety symptoms was 14.9%if we identified score of 10 as positive;and the total score of PSWQ was(43.30±9.86).Among emotion regulation strategies,the score of rumination was 43.04±10.43,experiential avoidance was 23.07±7.27,and mindfulness was 62.97±6.22.(3)The results of univariate analysis and multivariate analysis showed that PSWQ score was significant different among patients lived in different residence(P<0.05)and those of whom lived in counties and towns was the highest.(4)Spearman correlation analysis showed that depression,anxiety and worry scores were significantly positively correlated with rumination and experiential avoidance(P<0.05),while significantly negatively correlated with mindfulness(P<0.05).(5)According to the stratified multiple linear regression model,depression was positively associated with rumination(B=0.112,P<0.001)and experiential avoidance(B=0.151,P=0.002)and negatively associated with mindfulness(B=-0.148,P=0.001);anxiety was positively associated with rumination(B=0.061,P=0.049)and experiential avoidance(B=0.228,P<0.001)and negatively associated with mindfulness(B=-0.196,P<0.001);as for worry,it was positively associated with rumination(B=0.585,P<0.001)and empirical avoidance(B=0.301,P<0.001,and negatively associated with mindfulness(B=-0.821,P<0.001).Conclusions:(1)Depression,anxiety and worry are common and severe in patients with metastatic breast cancer.(2)The degree of rumination in patients with metastatic breast cancer was positively associated with depression and anxiety,and the degree of experiential avoidance was positively associated with depression,anxiety and worry,while the level of mindfulness was negatively associated with depression,anxiety and worry.