title: Psychological distress as a mediator of the association between disease severity and occupational functioning among employed spouses of women recently diagnosed with breast cancer.
abstract: OBJECTIVE
  The purpose was to evaluate whether patient and spouse cancer-specific distress mediated the association between cancer severity and occupational functioning among employed spouses of women diagnosed with breast cancer. We examined whether sociodemographic characteristics, lower spouse-reported marital quality, and lower spouse self-rated health were associated with poorer spouse occupational functioning.
  
  
  METHODS
  One hundred forty-three currently employed spouses of women diagnosed with breast cancer were administered measures of socioeconomic status, occupational functioning (work absenteeism, low productivity, and poor performance), cancer-specific distress, marital quality, and self-rated health. Patients completed measures of cancer-related distress and functional impairment and cancer stage were collected from medical charts.
  
  
  RESULTS
  In the model evaluating work absenteeism, greater patient functional impairment was associated with more absenteeism, but there was no evidence of a mediating effect for either partners' cancer-specific distress. Higher cancer stage and more functional impairment were associated with higher spouse cancer-specific distress, which in turn predicted poorer work productivity. Patient cancer-specific distress did not mediate the association between patient functional impairment or cancer stage and spouse work productivity. Finally, higher cancer stage was associated with more spouse cancer-specific distress, which in turn predicted poorer work performance. There were no direct or indirect effects of the patient's functional impairment on spouse work performance.
  
  
  CONCLUSIONS
  Distressed spouses are more likely to have poorer work productivity after their partners' breast cancer diagnosis. These spouses may need assistance in managing their distress and the patient's functional impairment to ensure that their work productivity is not adversely affected.
authors.affiliation: Section of Population Science, Rutgers Cancer Institute of New Jersey and Fox Chase Cancer Center, New Brunswick, NJ, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Manne
authors.affiliation: Helen F. Graham Cancer Center, Christiana Care Health Systems, Newark, DE, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Siegel
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Heckman
authors.affiliation: Department of Psychology, Michigan State University, East Lansing, MI, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kashy
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D059026:Diagnostic Self Evaluation; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008393:Marriage / Q000523:psychology; D008875:Middle Aged; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology* / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000523:psychology*