title: Depressive symptoms and positive affect in Chinese and United States breast cancer survivors: a cross-cultural comparison.
abstract: Research in the area of cultural response pattern on questionnaires in the oncological setting and direct cross-cultural comparisons are lacking. This study examined response pattern in the reporting of depressive symptoms in Chinese and US women with breast cancer. We hypothesized that Chinese women are less likely to endorse positive affect items compared to their US counterparts. Additionally, we explored cultural differences in the association between positive affect and QOL.
  
  
  
  Secondary analyses of baseline assessments of two mind-body intervention studies for women with breast cancer undergoing radiotherapy in the USA (N = 62) and China (N = 97) are presented. All participants completed measures of depressive symptoms (CES-D) and cancer-specific QOL (FACT-B). We examined cultural differences on positive and negative affect items on the CES-D.
  
  
  
  Controlling for demographic factors, ANCOVA revealed a significant cultural difference in positive (F = 7.99, p = 0.005) but not negative affect (p = 0.82) with Chinese women reporting lower positive affect compared to US women (Chinese = 6.97 vs. US = 8.31). There was also a significant cultural difference (F = 3.94, p = 0.03) in the association between positive affect and QOL so that lower positive affect was more strongly associated with worse emotional well-being in Chinese (beta = 0.57, p < 0.0001) than US women (beta = 0.35, p < 0.01).
  
  
  
  Chinese women reported lower positive affect compared to US women and lower levels of positive affect were more strongly associated with worse QOL. Special attention is needed when examining mental health in different cultures to ascertain effective delivery of clinical services to those in need.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Milbury
authors.affiliation: Texas A&M Health Science Center College of Medicine, Bryan, TX, USA.
authors.forename: April
authors.initials: A
authors.lastname: Kavanagh
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Meng
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.affiliation: University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Kavita D
authors.initials: KD
authors.lastname: Chandwani
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
authors.forename: Kay
authors.initials: K
authors.lastname: Garcia
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
authors.forename: George H
authors.initials: GH
authors.lastname: Perkins
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McQuade
authors.affiliation: Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India.
authors.forename: Nelamangala V
authors.initials: NV
authors.lastname: Raghuram
authors.affiliation: Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India.
authors.forename: Raghuram
authors.initials: R
authors.lastname: Nagarathna
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India.
authors.forename: Hongasandra Ramarao
authors.initials: HR
authors.lastname: Nagendra
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Jiayi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Xiaoma
authors.initials: X
authors.lastname: Guo
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Luming
authors.initials: L
authors.lastname: Liu
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
authors.forename: Banu
authors.initials: B
authors.lastname: Arun
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA. lcohen@mdanderson.org.
authors.forename: Lorenzo
authors.identifier: 0000-0003-4372-9208
authors.initials: L
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014481:United States
keywords: Breast cancer; Chinese-US cross-cultural comparison; Depressive symptoms; Quality of life; Response pattern