Direct Effects of Marital Empathy, Body Image, and Perceived Social Support on Quality of Life of Married Women with Breast Cancer and the Mediating Role of Perceived Marital Quality
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Abstract
Objective: Breast cancer is the most commonly diagnosed cancer in women worldwide, and its incidence has increased recently. Diagnosing cancer can create many challenges, especially for married women. The aim of the present study was thus to evaluate the effect of the relationships among marital empathy, body image, and perceived social support on quality of life (QoL) and the mediating role of perceived marital quality.
Method: Married women with breast cancer (N = 160) were selected through purposive accessible sampling. Measures included body image scale, Batson empathy adjectives, multidimensional scale of perceived social support, perceived marital quality, and QoL. The research method was descriptive-correlational and using structural equation modeling.
Results: The best model obtained showed that all predictors directly predicted QoL: marital empathy, body image, and perceived social support (P < 0.001). Predictors (except for perceived social support by family, friends, and others) also worked indirectly through perceived marital quality to predict QoL (P < 0.001).
Conclusion: Several variables predicted QoL for women with breast cancer, including body image and marital empathy. Most of such variables had both a direct effect and an indirect effect, working through perceived marital quality to affect QoL. Social support, however, had only a direct effect on QoL.
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2. Pirl WF, Fann JR, Greer JA, Braun I, Deshields T, Fulcher C, et al. Recommendations for the implementation of distress screening programs in cancer centers: report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force. Cancer. 2014;120(19):2946-54.
3. Bowen DJ, Fernandez Poole S, White M, Lyn R, Flores DA, Haile HG, et al. The Role of Stress in Breast Cancer Incidence: Risk Factors, Interventions, and Directions for the Future. Int J Environ Res Public Health. 2021;18(4).
4. Hanson Frost M, Suman VJ, Rummans TA, Dose AM, Taylor M, Novotny P, et al. Physical, psychological and social well-being of women with breast cancer: the influence of disease phase. Psychooncology. 2000;9(3):221-31.
5. Brennan J. Adjustment to cancer - coping or personal transition? Psychooncology. 2001;10(1):1-18.
6. Rolland JS. Cancer and the family: an integrative model. Cancer. 2005;104(11 Suppl):2584-95.
7. Lewis FM. The impact of cancer on the family: A critical analysis of the research literature. Patient Educ Couns. 1986;8(3):269-89.
8. Mallinger JB, Griggs JJ, Shields CG. Family communication and mental health after breast cancer. Eur J Cancer Care (Engl). 2006;15(4):355-61.
9. Manne S, Badr H. Intimacy and relationship processes in couples' psychosocial adaptation to cancer. Cancer. 2008;112(11 Suppl):2541-55.
10. Billington J, Baron-Cohen S, Wheelwright S. Cognitive style predicts entry into physical sciences and humanities: Questionnaire and performance tests of empathy and systemizing. Learn Individ Differ. 2007;17(3):260-8.
11. Kimmes JG, Edwards AB, Wetchler JL, Bercik J. Self and other ratings of dyadic empathy as predictors of relationship satisfaction. Am J Fam Ther. 2014;42(5):426-37.
12. Cramer D, Jowett S. Perceived empathy, accurate empathy and relationship satisfaction in heterosexual couples. J Soc Pers. 2010;27(3):327-49.
13. Carson JW, Carson KM, Gil KM, Baucom DH. Mindfulness-based relationship enhancement. Behav Ther. 2004;35(3):471-94.
14. Ming VMW. Psychological predictors of marital adjustment in breast cancer patients. Psychol Health Med. 2002;7(1):37-51.
15. Manne SL, Ostroff JS, Norton TR, Fox K, Goldstein L, Grana G. Cancer-related relationship communication in couples coping with early stage breast cancer. Psycho-Oncol. 2006;15(3):234-47.
16. Pistrang N, Barker C. The partner relationship in psychological response to breast cancer. Soc Sci Med. 1995;40(6):789-97.
17. Fallbjörk U, Rasmussen BH, Karlsson S, Salander P. Aspects of body image after mastectomy due to breast cancer - a two-year follow-up study. Eur J Oncol Nurs. 2013;17(3):340-5.
18. Dittmar H. How do “body perfect” ideals in the media have a negative impact on body image and behaviors? Factors and processes related to self and identity. J Soc Clin Psychol 2009;28(1):1-8.
19. Antoni MH, Jacobs JM, Bouchard LC, Lechner SC, Jutagir DR, Gudenkauf LM, et al. Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up. Gen Hosp Psychiatry. 2017;44:16-21.
20. Suppli NP, Johansen C, Christensen J, Kessing LV, Kroman N, Dalton SO. Increased risk for depression after breast cancer: a nationwide population-based cohort study of associated factors in Denmark, 1998-2011. J Clin Oncol. 2014;32(34):3831-9.
21. Han MO, Park JY. Body image and physical suffering during radiotherapy in breast cancer patients following breast conserving operations. AON. 2014;14(3):155-61.
22. Begovic-Juhant A, Chmielewski A, Iwuagwu S, Chapman LA. Impact of body image on depression and quality of life among women with breast cancer. J Psychosoc Oncol. 2012;30(4):446-60.
23. Krajc K, Miroševič Š, Sajovic J, Klemenc Ketiš Z, Spiegel D, Drevenšek G, et al. Marital status and survival in cancer patients: A systematic review and meta-analysis. Cancer Med. 2023;12(2):1685-708.
24. Kinsinger SW, Laurenceau JP, Carver CS, Antoni MH. Perceived partner support and psychosexual adjustment to breast cancer. Psychol Health. 2011;26(12):1571-88.
25. Uchino BN, Bowen K, Carlisle M, Birmingham W. Psychological pathways linking social support to health outcomes: a visit with the "ghosts" of research past, present, and future. Soc Sci Med. 2012;74(7):949-57.
26. Fiszer C, Dolbeault S, Sultan S, Brédart A. Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology. 2014;23(4):361-74.
27. Brem S, Kumar NB. Management of treatment-related symptoms in patients with breast cancer. Clin J Oncol Nurs. 2011;15(1):63-71.
28. 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.
29. Eom CS, Shin DW, Kim SY, Yang HK, Jo HS, Kweon SS, et al. Impact of perceived social support on the mental health and health-related quality of life in cancer patients: results from a nationwide, multicenter survey in South Korea. Psychooncology. 2013;22(6):1283-90.
30. Hughes S, Jaremka LM, Alfano CM, Glaser R, Povoski SP, Lipari AM, et al. Social support predicts inflammation, pain, and depressive symptoms: longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology. 2014;42:38-44.
31. Yang HC, Schuler TA. Marital quality and survivorship: slowed recovery for breast cancer patients in distressed relationships. Cancer. 2009;115(1):217-28.
32. Fielder KV, Kurpius SER. Marriage, stress and menopause: Midlife challenges and joys. Psicologia. 2005;19(1-2):87-106.
33. Folkman S. Personal control and stress and coping processes: a theoretical analysis. J Pers Soc Psychol. 1984;46(4):839-52.
34. Richter J, Rostami A, Ghazinour M. Marital satisfaction, coping, and social support in female medical staff members in Tehran University Hospitals. Interpersona: An International Pers Relatsh. 2014;8(1):115–27-–27.
35. Cohen S. Social relationships and health. Am Psychol. 2004;59(8):676-84.
36. Mueller GP. Conflict buffers and marital satisfaction: On the effects of different forms of social support. Happiness Stud. 2006;7:499-515.
37. Chi P, Tsang SK, Chan KS, Xiang X, Yip PS, Cheung YT, et al. Marital satisfaction of Chinese under stress: Moderating effects of personal control and social support. Asian J Soc Psychol. 2011;14(1):15-25.
38. Batson CD, Batson JG, Slingsby JK, Harrell KL, Peekna HM, Todd RM. Empathic joy and the empathy-altruism hypothesis. J Pers Soc Psychol. 1991;61(3):413-26.
39. Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189-97.
40. Canty-Mitchell J, Zimet GD. Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. Am J Community Psychol. 2000;28(3):391-400.
41. Nejat S, Montazeri A, Holakouie Naieni K, Mohammad K, Majdzadeh S. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of school of public health and institute of public health research. 2006;4(4):1-12.
42. Markman HJ, Renick MJ, Floyd FJ, Stanley SM, Clements M. Preventing marital distress through communication and conflict management training: a 4- and 5-year follow-up. J Consult Clin Psychol. 1993;61(1):70-7.
43. Levesque C, Lafontaine M-F, Caron A, Flesch JL, Bjornson S. Dyadic empathy, dyadic coping, and relationship satisfaction: A dyadic model. Eur J Psychol. 2014;10(1):118–34-–34.
44. Busby DM, Gardner BC. How do I analyze thee? Let me count the ways: considering empathy in couple relationships using self and partner ratings. Fam Process. 2008;47(2):229-42.
45. Zimmermann T. Intimate Relationships Affected by Breast Cancer: Interventions for Couples. Breast Care (Basel). 2015;10(2):102-8.
46. Bagheri M, Mazaheri M. Body image and quality of life in female patients with breast cancer and healthy women. JMRH. 2015;3(1):285-92.
47. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E. Exploring the influence of gender-role socialization and objectified body consciousness on body image disturbance in breast cancer survivors. Psychooncology. 2013;22(10):2177-85.
48. Buki LP, Reich M, Lehardy EN. "Our organs have a purpose": body image acceptance in Latina breast cancer survivors. Psychooncology. 2016;25(11):1337-42.
49. Bodenmann G, Shantinath SD. The Couples Coping Enhancement Training (CCET): A new approach to prevention of marital distress based upon stress and coping. Fam Relat. 2004;53(5):477-84.
50. Befort CA, Klemp J. Sequelae of breast cancer and the influence of menopausal status at diagnosis among rural breast cancer survivors. J Womens Health (Larchmt). 2011;20(9):1307-13.
51. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E, Malik N. Sexual functioning in breast cancer survivors experiencing body image disturbance. Psychooncology. 2016;25(1):66-76.
52. Giese-Davis J, Hermanson K, Koopman C, Weibel D, Spiegel D. Quality of couples' relationship and adjustment to metastatic breast cancer. J Fam Psychol. 2000;14(2):251-66.
53. Weihs K, Enright T, Howe G, Simmens SJ. Marital satisfaction and emotional adjustment after breast cancer. J Psychosoc Oncol. 1999;17(1):33-49.
54. Hassebrauck M, Fehr B. Dimensions of relationship quality. Pers Relatsh. 2002;9(3):253-70.
2. Pirl WF, Fann JR, Greer JA, Braun I, Deshields T, Fulcher C, et al. Recommendations for the implementation of distress screening programs in cancer centers: report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force. Cancer. 2014;120(19):2946-54.
3. Bowen DJ, Fernandez Poole S, White M, Lyn R, Flores DA, Haile HG, et al. The Role of Stress in Breast Cancer Incidence: Risk Factors, Interventions, and Directions for the Future. Int J Environ Res Public Health. 2021;18(4).
4. Hanson Frost M, Suman VJ, Rummans TA, Dose AM, Taylor M, Novotny P, et al. Physical, psychological and social well-being of women with breast cancer: the influence of disease phase. Psychooncology. 2000;9(3):221-31.
5. Brennan J. Adjustment to cancer - coping or personal transition? Psychooncology. 2001;10(1):1-18.
6. Rolland JS. Cancer and the family: an integrative model. Cancer. 2005;104(11 Suppl):2584-95.
7. Lewis FM. The impact of cancer on the family: A critical analysis of the research literature. Patient Educ Couns. 1986;8(3):269-89.
8. Mallinger JB, Griggs JJ, Shields CG. Family communication and mental health after breast cancer. Eur J Cancer Care (Engl). 2006;15(4):355-61.
9. Manne S, Badr H. Intimacy and relationship processes in couples' psychosocial adaptation to cancer. Cancer. 2008;112(11 Suppl):2541-55.
10. Billington J, Baron-Cohen S, Wheelwright S. Cognitive style predicts entry into physical sciences and humanities: Questionnaire and performance tests of empathy and systemizing. Learn Individ Differ. 2007;17(3):260-8.
11. Kimmes JG, Edwards AB, Wetchler JL, Bercik J. Self and other ratings of dyadic empathy as predictors of relationship satisfaction. Am J Fam Ther. 2014;42(5):426-37.
12. Cramer D, Jowett S. Perceived empathy, accurate empathy and relationship satisfaction in heterosexual couples. J Soc Pers. 2010;27(3):327-49.
13. Carson JW, Carson KM, Gil KM, Baucom DH. Mindfulness-based relationship enhancement. Behav Ther. 2004;35(3):471-94.
14. Ming VMW. Psychological predictors of marital adjustment in breast cancer patients. Psychol Health Med. 2002;7(1):37-51.
15. Manne SL, Ostroff JS, Norton TR, Fox K, Goldstein L, Grana G. Cancer-related relationship communication in couples coping with early stage breast cancer. Psycho-Oncol. 2006;15(3):234-47.
16. Pistrang N, Barker C. The partner relationship in psychological response to breast cancer. Soc Sci Med. 1995;40(6):789-97.
17. Fallbjörk U, Rasmussen BH, Karlsson S, Salander P. Aspects of body image after mastectomy due to breast cancer - a two-year follow-up study. Eur J Oncol Nurs. 2013;17(3):340-5.
18. Dittmar H. How do “body perfect” ideals in the media have a negative impact on body image and behaviors? Factors and processes related to self and identity. J Soc Clin Psychol 2009;28(1):1-8.
19. Antoni MH, Jacobs JM, Bouchard LC, Lechner SC, Jutagir DR, Gudenkauf LM, et al. Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up. Gen Hosp Psychiatry. 2017;44:16-21.
20. Suppli NP, Johansen C, Christensen J, Kessing LV, Kroman N, Dalton SO. Increased risk for depression after breast cancer: a nationwide population-based cohort study of associated factors in Denmark, 1998-2011. J Clin Oncol. 2014;32(34):3831-9.
21. Han MO, Park JY. Body image and physical suffering during radiotherapy in breast cancer patients following breast conserving operations. AON. 2014;14(3):155-61.
22. Begovic-Juhant A, Chmielewski A, Iwuagwu S, Chapman LA. Impact of body image on depression and quality of life among women with breast cancer. J Psychosoc Oncol. 2012;30(4):446-60.
23. Krajc K, Miroševič Š, Sajovic J, Klemenc Ketiš Z, Spiegel D, Drevenšek G, et al. Marital status and survival in cancer patients: A systematic review and meta-analysis. Cancer Med. 2023;12(2):1685-708.
24. Kinsinger SW, Laurenceau JP, Carver CS, Antoni MH. Perceived partner support and psychosexual adjustment to breast cancer. Psychol Health. 2011;26(12):1571-88.
25. Uchino BN, Bowen K, Carlisle M, Birmingham W. Psychological pathways linking social support to health outcomes: a visit with the "ghosts" of research past, present, and future. Soc Sci Med. 2012;74(7):949-57.
26. Fiszer C, Dolbeault S, Sultan S, Brédart A. Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology. 2014;23(4):361-74.
27. Brem S, Kumar NB. Management of treatment-related symptoms in patients with breast cancer. Clin J Oncol Nurs. 2011;15(1):63-71.
28. 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.
29. Eom CS, Shin DW, Kim SY, Yang HK, Jo HS, Kweon SS, et al. Impact of perceived social support on the mental health and health-related quality of life in cancer patients: results from a nationwide, multicenter survey in South Korea. Psychooncology. 2013;22(6):1283-90.
30. Hughes S, Jaremka LM, Alfano CM, Glaser R, Povoski SP, Lipari AM, et al. Social support predicts inflammation, pain, and depressive symptoms: longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology. 2014;42:38-44.
31. Yang HC, Schuler TA. Marital quality and survivorship: slowed recovery for breast cancer patients in distressed relationships. Cancer. 2009;115(1):217-28.
32. Fielder KV, Kurpius SER. Marriage, stress and menopause: Midlife challenges and joys. Psicologia. 2005;19(1-2):87-106.
33. Folkman S. Personal control and stress and coping processes: a theoretical analysis. J Pers Soc Psychol. 1984;46(4):839-52.
34. Richter J, Rostami A, Ghazinour M. Marital satisfaction, coping, and social support in female medical staff members in Tehran University Hospitals. Interpersona: An International Pers Relatsh. 2014;8(1):115–27-–27.
35. Cohen S. Social relationships and health. Am Psychol. 2004;59(8):676-84.
36. Mueller GP. Conflict buffers and marital satisfaction: On the effects of different forms of social support. Happiness Stud. 2006;7:499-515.
37. Chi P, Tsang SK, Chan KS, Xiang X, Yip PS, Cheung YT, et al. Marital satisfaction of Chinese under stress: Moderating effects of personal control and social support. Asian J Soc Psychol. 2011;14(1):15-25.
38. Batson CD, Batson JG, Slingsby JK, Harrell KL, Peekna HM, Todd RM. Empathic joy and the empathy-altruism hypothesis. J Pers Soc Psychol. 1991;61(3):413-26.
39. Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189-97.
40. Canty-Mitchell J, Zimet GD. Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. Am J Community Psychol. 2000;28(3):391-400.
41. Nejat S, Montazeri A, Holakouie Naieni K, Mohammad K, Majdzadeh S. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of school of public health and institute of public health research. 2006;4(4):1-12.
42. Markman HJ, Renick MJ, Floyd FJ, Stanley SM, Clements M. Preventing marital distress through communication and conflict management training: a 4- and 5-year follow-up. J Consult Clin Psychol. 1993;61(1):70-7.
43. Levesque C, Lafontaine M-F, Caron A, Flesch JL, Bjornson S. Dyadic empathy, dyadic coping, and relationship satisfaction: A dyadic model. Eur J Psychol. 2014;10(1):118–34-–34.
44. Busby DM, Gardner BC. How do I analyze thee? Let me count the ways: considering empathy in couple relationships using self and partner ratings. Fam Process. 2008;47(2):229-42.
45. Zimmermann T. Intimate Relationships Affected by Breast Cancer: Interventions for Couples. Breast Care (Basel). 2015;10(2):102-8.
46. Bagheri M, Mazaheri M. Body image and quality of life in female patients with breast cancer and healthy women. JMRH. 2015;3(1):285-92.
47. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E. Exploring the influence of gender-role socialization and objectified body consciousness on body image disturbance in breast cancer survivors. Psychooncology. 2013;22(10):2177-85.
48. Buki LP, Reich M, Lehardy EN. "Our organs have a purpose": body image acceptance in Latina breast cancer survivors. Psychooncology. 2016;25(11):1337-42.
49. Bodenmann G, Shantinath SD. The Couples Coping Enhancement Training (CCET): A new approach to prevention of marital distress based upon stress and coping. Fam Relat. 2004;53(5):477-84.
50. Befort CA, Klemp J. Sequelae of breast cancer and the influence of menopausal status at diagnosis among rural breast cancer survivors. J Womens Health (Larchmt). 2011;20(9):1307-13.
51. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E, Malik N. Sexual functioning in breast cancer survivors experiencing body image disturbance. Psychooncology. 2016;25(1):66-76.
52. Giese-Davis J, Hermanson K, Koopman C, Weibel D, Spiegel D. Quality of couples' relationship and adjustment to metastatic breast cancer. J Fam Psychol. 2000;14(2):251-66.
53. Weihs K, Enright T, Howe G, Simmens SJ. Marital satisfaction and emotional adjustment after breast cancer. J Psychosoc Oncol. 1999;17(1):33-49.
54. Hassebrauck M, Fehr B. Dimensions of relationship quality. Pers Relatsh. 2002;9(3):253-70.
| Files | ||
| Issue | Vol 19 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v19i1.14340 | |
| Keywords | ||
| Body Image Breast Cancer Empathy Marriage Perceived Social Support Quality of Life (QoL) | ||
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How to Cite
1.
KavehّFarsaniZ, Worthington, Jr EL. Direct Effects of Marital Empathy, Body Image, and Perceived Social Support on Quality of Life of Married Women with Breast Cancer and the Mediating Role of Perceived Marital Quality. Iran J Psychiatry. 2023;19(1):70-78.
