The associations of self-stigma, social constraints, and sleep among Chinese American breast cancer survivors

Purpose: The aim of the current study was to examine the incidence of poor sleep quality, medication use, and dysfunction and the association of self-stigma and perceived social constraints (i.e., ambivalence over emotional expression; AEE) on sleep among a sample of Chinese American breast cancer survivors. Methods: The data were based on self-report baseline data (n = 136) from an expressive writing intervention study for Chinese American breast cancer survivors (M_{Time since diagnosis} = 27.17 months; SD = 19.31). Participants completed self-report questionnaires related to psychological and physical health and health behaviors. Using linear regression and path modeling, our hypotheses were tested using models where (1) self-stigma predicted sleep characteristics (i.e., quality, medication use, and dysfunction) with (2) AEE mediating the relationship between self-stigma and sleep. Results: Participants frequently reported poor sleep quality (44.9%), use of sleep aids (37.5%), and difficulty staying awake during the day (37.5%). Greater self-stigma was related to greater AEE (b =.48, SE =.09, p <.05), which was related to worse sleep quality (b = −.19, SE =.08, p <.05), greater use of sleep aids (b =.25, SE =.11, p <.05), and greater difficulty staying awake during the day (b =.30, SE =.09, p <.05). Further, the indirect effect of self-stigma on sleep quality (ab = −.09, 95% CI −.19, −.03), use of sleep aids (ab =.12, 95% CI.03,.25), and difficulty staying awake during the day (ab =.15, 95% CI.06,.18) through AEE was significant. Conclusion: The results of this study highlight significant sleep-related problems among Chinese American breast cancer survivors and the importance of considering cultural beliefs of cancer in counseling. Implication for cancer survivors: Chinese American breast cancer survivors are at risk for sleep-related difficulties due, in part, to perceived self-stigma and emotional constraints. Greater education and community outreach to Chinese communities may help destigmatize breast cancer and encourage emotional expression around cancer-related topics.