- Academic Editor
Background: We investigated the mediating role of personality
compatibility, couple communication, and sexual life in the psychological
resilience and marital satisfaction of women with breast cancer.
Methods: This is a cross-sectional survey. From March 2022 to June 2022,
we enrolled 212 women with breast cancer from a tertiary tumor hospital in
Xinjiang, China using a convenient sampling method. The basic information of
patients was collected. The marriage quality and psychological resilience were
assessed with the Enrich Marital Inventory and Connor-Davidson resilience scale,
respectively. Counting data are expressed using the number and frequency while
measuring data are presented using mean
Breast cancer is one of the most common malignant tumors that seriously affect women’s physical and mental health [1]. According to statistics, there are 2,261,419 new cases of breast cancer worldwide in 2020, ranking first among emerging female malignant tumors. Its incidence accounts for 25.84% of the global incidence of female malignant tumors. Once breast cancer is diagnosed, almost all patients will undergo surgical treatment, and most patients will undergo comprehensive treatment such as chemotherapy and radiotherapy, which may bring heavy psychological trauma to breast cancer [2, 3]. The psychological trauma may be present throughout the processes of disease treatment, rehabilitation, and follow-up, and causes a series of serious impacts on the marriage and family of women with breast cancer. Some patients exhibit psychological problems such as anxiety, fear, and disappointment, which are not only detrimental to the recovery of patients but also affect couple communication, thereby seriously affecting the quality of life of patients [4]. Women with breast cancer also face obstacles in fertility and sexual life, leading to communication barriers between spouses, thus seriously affecting their marital quality. Marital quality is the most important and direct predictive indicator for measuring marital happiness, family harmony, and social stability [5]. In recent years, the marital quality of women with breast cancer patients has gained increasing attention [6].
The American psychologist Anthony proposed the concept of psychological resilience in the 1970s. It refers to the ability of individuals to maintain good psychological adaptability when facing crisis or stress. Psychological resilience is the main factor determining whether individuals can successfully recover from stress and crises [7]. Some scholars believe that people with higher marital quality have higher levels of mental health, while those with poor marital quality have lower levels of mental health [6]. From the perspective of positive psychology, individuals with good psychological resilience have better mental health, indicating that psychological resilience can predict the state of mental health [8]. Currently, there is a lack of research on the relationship between psychological resilience and marital quality. In particular, there is a lack of research on the mediating effects of personality compatibility, marital communication, and sexual life on the psychological resilience and marital satisfaction of women with breast cancer.
Herein, we investigated the mediating role of personality compatibility, couple communication, and sexual life in the psychological resilience and marital satisfaction of women with breast cancer. Our findings may provide a basis for the development of psychological intervention measures for women with breast cancer, therefore improving the quality of life and marriage quality of women with breast cancer.
From March 2022 to June 2022, 212 women with breast cancer were selected from a tertiary tumor hospital in Xinjiang using a convenient sampling method. Inclusion criteria: (1) Female patients; (2) Patients with pathologically diagnosed breast cancer; (3) Patients who received treatment for breast cancer for at least 6 months; (4) Patients who were married; (5) Patients willing to participate in this study. Exclusion criteria: (1) Patients with multiple distant metastases to the heart, lung, brain, liver, etc., who were critically ill and unable to complete the questionnaire; (2) Patients who were not conscious, had communication difficulties, or could not complete the questionnaire even with assistance; (3) Unmarried or divorced patients; (4) Male patients with breast cancer; (5) Patients who refused to participate in this study. This study was approved by the Ethics Committee of Cancer Hospital Affiliated to Xinjiang Medical University. All patients signed informed consent.
The basic information of patients, including age, gender, ethnicity, education level, monthly income, occupation status, and disease duration, was collected through the self-designed questionnaire.
The marriage quality was assessed with the Enrich Marital Inventory developed by
Professor Olson in 1981. The Enrich Marital Inventory was translated into the
Chinese version by Li et al. [9] in 1993. It included 12 factors and 124
items. A 5-level scoring method was used, with a total score of 60 points for
each dimension [10]. A higher score indicated higher marriage quality. The
Cronbach’s
Psychological resilience was assessed with the Connor-Davidson resilience scale,
which has satisfactory psychometric properties [11]. This study used the Chinese
version translated and revised by Yu and Zhang [12] in 2007, which included 25
items and 3 factors, namely resilience (13 items), strength (8 items), and
optimism (4 items). A 5-level method was used for scoring (score range 25–125),
and a higher score suggested a higher level of psychological resilience. The
Cronbach’s
The survey was conducted using the Questionnaire Star system. The investigators used unified guidelines to explain the filling methods and precautions of the questionnaires. The participants independently filled out the questionnaires on mobile phones. For those who had difficulty reading or could not fill out the questionnaires themselves, the investigators would fill out the questionnaires for them using their answers. The investigators promptly reviewed and rectified any misinterpretations or ambiguous inputs during the survey, and promptly confirmed accuracy with the participants. The questionnaire must be completed before submission, and the submission deadline was on the spot. Following the participants’ completion of the survey, the investigators delivered oral feedback on the survey results.
SPSS22.0 statistical software (IBM Corp., Armonk, NY, USA) was used for
analysis. Counting data are expressed using the number and frequency while
measuring data such as marital quality score and psychological resilience score
are presented using mean
In this study, we issued 223 questionnaires and recovered 212 valid
questionnaires, with an effective recovery rate of 95.0%. Finally, 212 women
with breast cancer were included in this study. Their baseline information is
shown in Table 1. Their mean age was (45.73
Variables | Number of cases | Composition ratio (%) | |
Age (years) | |||
20–30 | 4 | 1.9 | |
31–40 | 36 | 17 | |
41–50 | 80 | 37.7 | |
51–60 | 68 | 32.1 | |
24 | 11.3 | ||
Ethnicity | |||
Han | 130 | 61.3 | |
Uyghur | 50 | 23.6 | |
Hui | 18 | 8.5 | |
Kazakh | 10 | 4.7 | |
Others | 4 | 1.9 | |
Education level | |||
Master or Ph.D. | 12 | 5.7 | |
Junior college or undergraduate | 74 | 34.9 | |
Senior high school | 54 | 25.5 | |
Junior high school or below | 72 | 33.9 | |
Monthly income ( |
|||
4 | 1.9 | ||
8000–10,000 | 22 | 10.4 | |
6000–8000 | 64 | 30.2 | |
4000–6000 | 46 | 21.7 | |
2000–4000 | 76 | 35.8 | |
Disease duration (years) | |||
122 | 57.5 | ||
2–5 | 62 | 29.2 | |
5–8 | 12 | 5.7 | |
8–10 | 4 | 1.9 | |
12 | 5.7 | ||
Occupational status | |||
Currently employed | 44 | 20.7 | |
On sick leave | 28 | 13.2 | |
Retired | 68 | 32.1 | |
Unemployed | 72 | 34 |
As shown in Table 2, there was a significant difference in marital quality
scores between patients of Han and Uyghur ethnicity (p = 0.001), and
between currently employed patients and patients on sick leave (p =
0.026). Regarding psychological resilience score, there was a significant
difference between patients of Han and Uyghur ethnicity (p
Variable | n | Marital quality score | F | p | Psychological resilience score | F | p | |
Total | 212 | 256.745 |
53.60 |
|||||
Age (years) | ||||||||
20–30 | 4 | 225.00 |
1.001 | 0.408 | 52.00 |
1.579 | 0.181 | |
31–40 | 36 | 262.00 |
51.78 |
|||||
41–50 | 80 | 261.18 |
55.53 |
|||||
51–60 | 68 | 256.00 |
53.97 |
|||||
24 | 241.50 |
49.17 |
||||||
Ethnicity | ||||||||
Han | 130 | 267.86 |
4.038 | 0.004 | 55.83 |
10.109 | 0.000 | |
Uyghur | 50 | 232.92 |
46.28 |
|||||
Hui | 18 | 247.11 |
52.11 |
|||||
Kazakh | 10 | 250.80 |
56.00 |
|||||
Others | 4 | 251.50 |
73.50 |
|||||
Education level | ||||||||
Master or Ph.D. | 12 | 222.83 |
1.650 | 0.179 | 36.67 |
10.230 | 0.000 | |
Junior college or undergraduate | 74 | 257.38 |
56.19 |
|||||
Senior high school | 54 | 260.63 |
53.56 |
|||||
Junior high school or below | 72 | 258.83 |
53.81 |
|||||
Monthly income ( |
||||||||
4 | 317.00 |
1.411 | 0.231 | 67.00 |
2.490 | 0.044 | ||
8000–10,000 | 22 | 264.09 |
50.36 |
|||||
6000–8000 | 64 | 254.22 |
53.47 |
|||||
4000–6000 | 46 | 257.35 |
51.35 |
|||||
2000–4000 | 76 | 253.21 |
55.32 |
|||||
Disease duration (years) | ||||||||
122 | 252.46 |
1.071 | 0.372 | 54.59 |
2.723 | 0.031 | ||
2–5 | 62 | 266.03 |
51.61 |
|||||
5–8 | 12 | 259.67 |
50.67 |
|||||
8–10 | 4 | 221.00 |
42.50 |
|||||
12 | 261.33 |
60.50 |
||||||
Occupational status | ||||||||
Currently employed | 44 | 275.00 |
2.923 | 0.035 | 56.36 |
2.047 | 0.108 | |
On sick leave | 28 | 237.00 |
49.21 |
|||||
Retired | 68 | 255.21 |
53.44 |
|||||
Unemployed | 72 | 254.72 |
53.78 |
Note: Data are expressed as mean
The scores of marital satisfaction (31.38
Variable | Women with breast cancer (n = 212) | Female norm | t | p |
Marital satisfaction | 31.38 |
37.04 |
–9.87 | |
Personality compatibility | 29.61 |
34.43 |
–9.58 | |
Couple communication | 31.28 |
34.10 |
–5.73 | |
Sexual life | 31.16 |
37.60 |
–12.09 | |
Psychological resilience | 53.60 |
65.40 |
–14.252 |
Note: Data are expressed as mean
The relationship between marital quality and psychological resilience
of women with breast cancer was analyzed with Pearson correlation. As shown in
Table 4, marital satisfaction, personality compatibility, marital communication,
and sexual life of marital quality were all positively correlated with the
resilience, strength, and optimism of psychological resilience (p
Marital quality | Personality compatibility | Couple communication | Sexual life | Resilience | Strength | Optimism | |
Marital quality | 1 | ||||||
Personality compatibility | 0.691** | 1 | |||||
Couple communication | 0.791** | 0.729** | 1 | ||||
Sexual life | 0.754** | 0.732** | 0.763** | 1 | |||
Resilience | 0.391** | 0.351** | 0.354** | 0.352** | 1 | ||
Strength | 0.493** | 0.331** | 0.405** | 0.515** | 0.660** | 1 | |
Optimism | 0.381** | 0.399** | 0.383** | 0.354** | 0.490** | 0.416** | 1 |
Note: Data are expressed as mean
Few studies have used the marriage quality scale as a mediator, and most of them have analyzed the mediation of psychological resilience and marital satisfaction through coping strategies [16] and cognitive reappraisal [17]. Professor Lingjiang Li, the translator of the Chinese version of the Enrich Marital Inventory, stated in the Chinese Mental Health Assessment Scale Manual that according to the research situation, the marriage quality scale could be used. We considered the physical and mental conditions of women with breast cancer and selected the marriage quality scale (marital satisfaction, marital communication, sexual life, and personality compatibility) for the mediation of psychological resilience and marital satisfaction. Since marriage quality and psychological resilience are both correlated with each other, we used the Baron and Kenny stepwise method [13, 14, 15] to analyze and verify the mediation effects of personality compatibility, couple communication, and sexual life on psychological resilience and marital satisfaction. The parallel mediation model is shown in Fig. 1.
A parallel mediating model of personality compatibility, couple
communication, and sexual life in psychological resilience and marital
satisfaction. **p
The analysis was conducted using psychological resilience as the independent
variable X, marital satisfaction as the dependent variable Y, and personality
compatibility as the intermediary variable personality compatibility (M
Standardized regression equation | t | p | R |
F of model | p |
Step 1: Y = 0.496X | 8.280 | 0.246 | 68.556 | p | |
Step 2: M |
6.555 | 0.170 | 42.971 | p | |
Step 3: Y = 0.255X + 0.586M |
4.897 | 0.531 | 118.391 | p | |
11.273 |
X, psychological resilience; Y, marital satisfaction; M
We performed the analysis using psychological resilience as the independent
variable X, marital satisfaction as the dependent variable Y, and couple
communication as the intermediary variable couple communication (M
Standardized regression equation | t | p | R |
F of model | p |
Step 1: Y = 0.496X | 8.280 | 0.246 | 68.556 | p | |
Step 2: M |
7.111 | 0.194 | 50.561 | p | |
Step 3: Y = 0.183X + 0.710M |
4.035 | 0.653 | 196.514 | p | |
15.648 |
X, psychological resilience; Y, marital satisfaction; M
Finally, we analyzed the mediating effect of sexual life (Fig. 1) (Table 7). In
the regression equation, psychological resilience was used as the independent
variable X, marital satisfaction was used as the dependent variable Y, and sexual
life was used as the intermediary variable sexual life (M
Standardized regression equation | t | p | R |
F of model | p |
Step 1: Y = 0.496X | 8.280 | 0.246 | 68.556 | p | |
Step 2: M |
7.871 | 0.228 | 61.947 | p | |
Step 3: Y = 0.176X + 0.670M |
3.509 | 0.593 | 152.236 | p | |
13.345 |
X, psychological resilience; Y, marital satisfaction; M
In this study, the scores of marital satisfaction, couple communication, sexual life, personality compatibility, and psychological resilience of women with breast cancer were lower than the female norms, indicating that the marital quality and psychological resilience of women with breast cancer are not optimistic, which is consistent with previous studies [16, 18]. Due to the negative influence of cancer, women with breast cancer tend to be anxious, fearful, sensitive, and suspicious, may have low tolerance, and fear disease recurrence [19, 20]. They often bring bad emotions into the marriage relationship. High treatment costs, lack of role of housewives, increased pressure on caregivers, obstacles in couple communication [21, 22], low personality compatibility, and low level of psychological resilience make it difficult for them to be satisfied with the marriage relationship [23]. It is shown that the more negative family life events couples experience in marriage, the poorer their personality compatibility [24, 25, 26, 27], which is also consistent with the results of this study. Both women with breast cancer and their husbands are worried that sexual life may increase the risk of breast cancer recurrence [28, 29]. In addition, the sexual desire of women with breast cancer may be reduced after surgery, radiotherapy, chemotherapy, endocrine therapy, and ovarian function suppression treatment [30]. Therefore, the sexual life of women with breast cancer is not harmonious, or there is no sexual life for a long time.
Further analysis showed that the score of marital quality and psychological resilience of Han patients was higher than that of Uyghur patients. This may be because we enrolled patients from a tertiary tumor hospital in Xinjiang, which is a remote area in China. In addition, marital quality is also related to the educational level and economic conditions of women with breast cancer [31]. Moreover, for occupational status, the marital quality score of currently employed patients was higher than that of patients on sick leave. This may be related to the high proportion of medical insurance reimbursement and economic income of currently employed patients, which may have a lesser impact on marital quality. Furthermore, when the patients are on sick leave, the financial burden of the family becomes heavier, which may further affect marital quality [32]. For psychological resilience, patients with a high level of education had a low score of psychological resilience, inconsistent with the study by Wister et al. [33]. This may be because of the small number of participants with a bachelor’s degree or higher education level in this study. Patients with a monthly income of more than ¥10,000 in this study had the highest psychological resilience score. Patients with low monthly incomes may have more concerns about medical expenses and are accompanied by greater psychological pressure in terms of individual treatment and family expenses [34]. Sometimes, patients may experience greater feelings of helplessness and even give up treatment. Additionally, the score of psychological resilience in patients with a disease duration of more than 10 years was also high. This is related to the fact that the stress tolerance and psychological endurance of patients may be enhanced over time, which also confirms the view that psychological resilience can be improved [35]. Moreover, patients with a disease duration of more than 10 years have formed a dependent and supportive marital relationship with their spouses, and the support of their spouses also affects the psychological resilience of the patients [36].
Correlation analysis showed that the tenacity, strength, and optimism of psychological resilience of women with breast cancer were positively correlated with marital quality (marital satisfaction, personality compatibility, couple communication, and sexual life), suggesting that psychological resilience is an important predictor of marital quality. This result is in line with the previous study [17]. Individuals with high levels of psychological resilience are more likely to receive long-term treatment from experts, and they expect the diagnosis and treatment of diseases to develop in a positive direction. Therefore, they seek higher levels of personal growth, such as social support, family support, positive emotions, and self-reliance. Individuals with good psychological resilience can effectively and positively respond to adverse environments or events, have higher individual coping resources [37], and thus feel higher marital quality.
This study showed that personality compatibility, couple communication, and sexual life exerted significant mediating effects on the psychological resilience and marital satisfaction of women with breast cancer. This indicates that psychological resilience can not only directly affect the marital satisfaction of women with breast cancer, but also indirectly affect their marital quality through personality compatibility, couple communication, and sexual life. Patients with good psychological resilience also have a stronger ability to rationally analyze issues and obtain positive results [37]. The positive attitude towards the life of women with breast cancer can affect their husbands [36]. Couples with positive and optimistic attitudes can have harmonious marital relationships, higher personality compatibility, higher marital quality, and longer marriage duration [38]. Furthermore, people with positive attitudes are more inclined to solve problems encountered in marriage and life, to communicate with family and friends, and to receive support and encouragement from family and friends, which can greatly help maintain marriage [39]. A harmonious sexual life is the guarantee of a good marriage. Patients with high levels of psychological resilience have more confidence in facing the disease, better adapt to the disease, and take various measures to actively respond to the negative impacts of the disease. Meanwhile, they are more likely to accept expert treatment and advice, expect the disease to develop in a better direction, and seek a higher level of personal growth, thereby promoting the harmony of marital relationships and improving the quality of marriage [40]. In 2006, the International Health Organization included malignant tumors as a chronic disease [41]. Breast cancer is one of the malignant tumors with the longest survival time and the highest cure rate. In addition to standardized diagnosis and treatment, as well as regular follow-up, more attention should be paid to life management. Medical workers can develop psychological intervention measures for women with breast cancer by using multi-disciplinary team, the internet, and the nursing services, guide patients to actively respond to the negative impacts of the disease, enhance their self-confidence, stimulate their internal potential, and promote harmonious relationships of couples, thereby creating a harmonious and happy family environment and social relationships [16].
This study has some limitations. First, this study is a single-center cross-sectional study. Second, the results of this study showed that patients with higher education levels had lower psychological resilience scores, which is inconsistent with previous studies and may be related to a small sample size. Third, this study did not differentiate between treatment methods or surgical methods, which may have led to data bias. Fourth, the population surveyed in this study was only from tertiary A hospitals, which may have certain representativeness limitations. Fifth, after using Baron and Kenny’s stepwise method, if the Bootstrap method is used to directly test the coefficient product to increase power, the results would be more convincing. Additionally, the Enrich scale provides male and female norms. This study used the female norm, but the psychological elasticity norm is not divided by gender. Gender may have a certain impact on psychological elasticity and marital satisfaction, which is also a limitation of this study. In the future, multicenter studies should be conducted to explore the mediating effects of personality compatibility, marital communication, and sexual life in psychological resilience and marital satisfaction among breast cancer patients in different regions.
Women with breast cancer exhibit low levels of both psychological resilience and marital satisfaction. This may be because of the small number of participants with a bachelor’s degree or higher education level in this study. The populations who were patients of ethnic minorities, on sick leave, with a bachelor’s degree or higher education level, low monthly income, and disease duration exceeding 8 years are the primary focus with poor psychological resilience. Psychological resilience can impact the marital satisfaction of women with breast cancer, not only directly, but also indirectly through personality compatibility, couple communication, and sexual life. Healthcare workers should pay attention to the psychological condition and marital quality of women with breast cancer, help patients obtain support from family, peers, and the community, and cultivate positive coping skills such as adjusting their mindset, reducing negative emotions, calmly facing difficulties, and enhancing their confidence, thereby improving their level of psychological resilience and actively solving problems encountered in marriage and life to promote a harmonious marital relationship and improve marital quality.
The data used to support the findings of this study are available from the corresponding author upon request.
All authors contributed to the study conception and design. MH, LC, NW, XM, YW, and LW performed the research. MH and BZ analyzed the data. YZ searched the literature. MH wrote the manuscript. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.
This study was approved by the Ethics Committee of Cancer Hospital Affiliated to Xinjiang Medical University (approval number: [2022] 01-133-11). All patients signed informed consent.
Not applicable.
This research was funded by the Natural Science Foundation of Xinjiang Uygur Autonomous Region, grant number 2022D01C527.
The authors declare no conflict of interest.
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