Difficulties in identifying and describing feelings, social constraints, affect, and functional well-being among Chinese breast cancer patients: A mediation model

Purpose: Functional well-being (i.e., individuals' functioning in daily living activities and social roles; FWB) is often an understudied aspect of quality of life among breast cancer patients (BCP). Previous research has suggested that patients’ emotional experience is associated with their FWB. However, little is known about how intrapersonal and interpersonal barriers of emotional processing and expression (i.e., social constraints, difficulties in identifying and expressing emotions) associated with FWB among Chinese BCP, plus how positive/negative affect might explain such associations. Method: Chinese BCP (N = 327) in Weifang, Shandong province, China completed a cross-sectional survey. The Functional Well-Being subscale from the Chinese version of the Functional Assessment of Cancer Therapy–Breast (FACT-B), the Social Constraints Scale, the Difficulty in Identifying Feelings (DIF; 7 items) and the Difficulty in Describing Feelings (DDF; 5 items) subscales from the Toronto Alexithymia Scale and the Positive Affect and Negative Affect Schedule were used as assessment scales. Results: Path analyses results supported the proposed mediation model with satisfactory fit indices (χ²(5) = 5.12, p =.40, CFI = 1.00; IFI = 1.00; RMSEA = 0.01). Specifically, difficulty in describing emotions was associated with poorer functional well-being through increased negative affect (β = −0.06, 95%CI = −0.10, −0.03); difficulty in identifying emotions was associated with poorer functional well-being through reduced positive affect (β = −0.04, 95%CI = −0.09, −0.003). Social constraints were associated with poorer functional well-being through both increased negative affect and decreased positive affect (β = −0.16, 95%CI = −0.22, −0.10). After considering the mediators, difficulties in describing emotions still contributed significantly to functional well-being (β = −0.20, 95%CI = −0.31, −0.08). Our results indicated that positive/negative affect could mediate between barriers of emotional processing/expression and FWB. Conclusions: This study was unique in revealing how intrapersonal and interpersonal barriers of emotional processing and expression could be associated with Chinese BCPs’ FWB through varied mechanisms. Practitioners should consider strategies to reduce those barriers through interventions.