title: The link between ambivalence over emotional expression and depressive symptoms among Chinese breast cancer survivors.
abstract: OBJECTIVE
  Ambivalence over emotional expression (AEE) is the conflict between wanting to express emotion yet fearing the consequences of such expression. Recent literature reveals a close link between AEE and depressive symptoms among college students. Although cancer survivors experience intense emotions, few studies have examined the relationship between AEE and depressive symptoms and the underlying mechanisms among cancer survivors. Furthermore, relevant research is absent among Asians, whose culture discourages emotional expression. The present study investigated AEE's associations with depressive symptoms in Asian breast cancer survivors, and examined intrusive thoughts as a mediator. Intrusive thoughts are repetitive and unwanted thoughts about stressful events. We hypothesized that AEE would increase intrusive thoughts which in turn would increase depressive symptoms.
  
  
  METHODS
  A total of 118 Chinese American breast cancer survivors completed a questionnaire packet containing the Ambivalence over Emotional Expression Questionnaire (AEQ), Brief Symptom Inventory (BSI), and the Impact of Event Scale (IES).
  
  
  RESULTS
  AEE was positively associated with depressive symptoms (β=.45, p<.001) and intrusive thoughts (β=.41, p<.001). Additionally, intrusive thoughts partially explained the relationship between AEE and depressive symptoms (z=3.77, p<.001).
  
  
  CONCLUSIONS
  These results suggest that Chinese breast cancer survivors who are highly ambivalent over emotional expression may have increased risk for depressive symptoms, and such relationships can be partially explained by a cognitive mechanism: intrusive thoughts. Future research may explore other mediators and design interventions specifically targeted at reducing AEE and intrusive thoughts with the ultimate goal of reducing depression.
authors.affiliation: University of Houston, USA. Electronic address: qlu3@uh.edu.
authors.forename: Qian
authors.initials: Q
authors.lastname: Lu
authors.affiliation: University of Houston, USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Man
authors.affiliation: Wuhan University, China.
authors.forename: Jin
authors.initials: J
authors.lastname: You
authors.affiliation: University of Houston, USA.
authors.forename: Angie S
authors.initials: AS
authors.lastname: LeRoy
mesh_terms: D000339:Affect; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology*; D002681:China; D003863:Depression / Q000150:complications / Q000523:psychology*; D018450:Disease Progression; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
keywords: Ambivalence over emotional expression; Breast cancer; Chinese; Depression; Intrusive thoughts