Relationships Among Stressor, Family Communication Strain, Family Coping, and Mental Health Outcomes in Chinese- and Korean-American Breast Cancer Survivors: the Moderating Effect of Acculturation

The mental health of breast cancer survivors is an important area of research for social work professionals. Chinese- and Korean-American breast cancer survivors (BCS) are at increased risk of developing mental health problems due to breast cancer-related and acculturative stresses. However, few studies have examined unique stresses, challenges, and subsequent mental health outcomes among Chinese- and Korean-American BCS. This study aims 1) to investigate the relationships among primary stressors (negative self-image and general life stressor), family communication strain, family coping, and mental health outcomes in Chinese- and Korean-American BCS and 2) to explore the moderating effect of acculturation in the overall model.

A cross-sectional and descriptive design was utilized. A total of 156 Chinese- (n=85) and Korean-American BCS (n=71) were recruited from the California Cancer Surveillance Program, hospitals, and community agencies in Los Angeles. Primary stressors were measured by scales assessing negative self-image and general life stressors. Family communication strain was assessed by general and cancer-related communication problems. Family coping was assessed by external family coping strategies (acquiring social support from friends/relatives, acquiring social support from neighbors, and seeking spiritual support) and internal family coping strategies (reframing). The latent construct of mental health outcomes consisted of emotional well-being, depression, and vitality. Acculturation, which was measured by three proxies, was divided by two groups (more vs. less) to test its moderating effect.

Confirmatory factor analysis demonstrated the adequacy of latent constructs (life stressor, external family coping, and mental health outcomes). The structural equation modeling (SEM) was conducted to test the relationships among stressors, family communication strain, external and internal family coping, and mental health outcomes, based on Pearlin’s stress process model. Cancer stage, comorbidity differences between before and after cancer diagnosis, and lumpectomy/mastectomy without reconstruction were controlled. The proposed model provided an adequate fit to the data; χ²(77) =114.19, CFI=.97, and RMSEA=.05. The current structural model explained 57.2% of the variance in mental health outcomes for Chinese- and Korean-American BCS. A key finding is that negative self-image, life stressor, family communication strain, and family coping were found to have direct relationships with mental health outcomes. Furthermore, family communication strain mediated the relationships between life stressor and mental health outcomes and between negative self-image and internal family coping. Multi-group analysis was used to test the moderating effect of acculturation in the overall model. The overall fit for both more and less acculturated groups showed adequate fit (CFI >.9, RMSEA<.08). Although statistical differences in baseline parameters were noted, the structural paths were equivalent between more and less acculturated groups; it indicates that acculturation does not have a moderating effect in the stress process interact to improve mental health outcomes.

This study explored the relationships among stressors, family communication strain, coping, and mental health outcomes in Chinese- and Korean-Americans BCS. Our study suggests that effective family communication and family coping may be beneficial to improve mental health in vulnerable Chinese- and Korean-American BCS. These findings have significant practical implications for psychosocial interventions that improve family communication and coping strategies for Chinese- and Korean-Americans BCS.