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

Support Care Cancer. 2020 Aug;28(8):3935-3944. doi: 10.1007/s00520-019-05233-x. Epub 2019 Dec 19.


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 (MTime 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.

Keywords: Ambivalence over emotional expression; Breast cancer survivorship; Oncology; Self-stigma; Sleep.

MeSH terms

  • Affect
  • Asian / psychology*
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / physiopathology
  • Breast Neoplasms / psychology*
  • Cancer Survivors / psychology*
  • Dyssomnias / ethnology*
  • Dyssomnias / psychology*
  • Emotions
  • Female
  • Humans
  • Middle Aged
  • Quality of Life / psychology
  • Self Concept
  • Sleep / physiology*
  • Social Behavior
  • Social Stigma*
  • Surveys and Questionnaires