Cognitive Emotion Regulation and Its Impact on Sexual Function, Body Image, and Depression in Breast Cancer Survivors
Article information
Abstract
Objective
This study explored the differences in cognitive emotion regulation strategies, body image, and sexual functioning between women with breast cancer and healthy controls. It also investigated the relationships among these variables in breast cancer patients, considering the role of depression and anxiety.
Methods
This cross-sectional case-control study included 112 participants (56 breast cancer patients and 56 healthy controls). Participants were assessed using the Cognitive Emotion Regulation Questionnaire, Body Cathexis Scale, Female Sexual Function Index (FSFI), and Golombok Rust Inventory of Sexual Satisfaction (GRISS). Depression and anxiety levels were evaluated using the Hamilton Depression Rating Scale and Hamilton Anxiety Scale. Statistical analyses included group comparisons and partial correlation analyses.
Results
Breast cancer patients exhibited significantly higher scores on the depression scale, reflecting greater depressive symptoms, poorer body image, and greater impairments in sexual functioning compared to healthy controls. GRISS subscales indicated higher dissatisfaction, avoidance, nonsensuality, vaginismus, and anorgasmia in breast cancer patients, while FSFI subscales showed reduced desire, arousal, lubrication, satisfaction, and orgasm. Positive reappraisal, an adaptive cognitive emotion regulation strategy, was negatively associated with sexual dissatisfaction after controlling for depression and anxiety.
Conclusion
Breast cancer significantly impacts mental health, body image, and sexual functioning. The findings underscore the importance of integrating psychiatric screening and care into oncology. Interventions enhancing cognitive emotion regulation, particularly positive reappraisal, may improve psychological and sexual well-being in breast cancer survivors.
INTRODUCTION
Breast cancer is the most prevalent cancer among women and the leading cause of cancer-related death [1]. The loss of all or part of the breast due to surgery in breast cancer treatment can be seen as the loss of a body part that symbolizes femininity, motherhood, and sexuality [2,3]. For this reason, many studies have been conducted on the effects of breast cancer diagnosis and treatment methods on body image and sexual functions. The most commonly reported sexual dysfunctions in women diagnosed with breast cancer are decreased sexual desire, decreased sexual arousal, vaginal dryness, dyspareunia, and anorgasmia [4-6].
The concept of body image is currently defined as the way one experiences one’s body, and it is highly subjective. The way a person experiences her/his body is the sum of her/his perceptions, thoughts, and feelings about the form, competence, and function of her/his body [5-7]. In women diagnosed with breast cancer, age, depression, breast cancer treatment methods, and their side effects may affect body image [8,9].
Cognitive emotion regulation can be defined as the cognitive way of managing the reception of emotionally stimulating information. Nine different cognitive emotion regulation strategies, theoretically classified as maladaptive strategies and adaptive strategies, have been identified by considering people’s thoughts after stressful life events. Accordingly, positive reappraisal, putting into perspective, positive refocusing, refocusing on planning, and acceptance are considered adaptive; rumination, catastrophizing, self, and other-blame are considered maladaptive cognitive emotion regulation strategies [10]. Adaptive strategies are thought to be necessary for the initiation, maintenance, and regulation of adaptive behaviors following negative life events [11]. It is thought that those who use maladaptive cognitive emotion regulation strategies in response to negative life events are more likely to develop psychopathological symptoms [12]. The process that starts with the diagnosis of cancer includes many difficulties, such as adaptation to diagnosis and treatment, side effects of treatment, changes in the person’s living standards, giving a new direction to one’s life, and tolerating uncertainties in the process. Coping strategies are thought to play an important role in the face of these challenges [13,14].
Despite considerable research into the psychosocial aspects of breast cancer, there is a lack of comprehensive studies examining the relationships between cognitive emotion regulation, sexual functioning, body image, depression, and anxiety levels in this population.
This study aims to compare levels of depressive symptoms, sexual functions, and body image between women with breast cancer and healthy controls. Additionally, it seeks to examine the relationships among cognitive emotion regulation strategies, sexual functions, body image, and level of depressive symptoms in the breast cancer group. This investigation seeks to provide insights into the psychological and sexual health challenges faced by women with breast cancer and to inform integrated, multidisciplinary care approaches.
The hypotheses proposed in this study are as follows: 1) Women diagnosed with breast cancer are hypothesized to exhibit higher levels of sexual dysfunction, negative body image, depressive symptoms, and the use of maladaptive cognitive emotion regulation strategies compared to a healthy control group. 2) In women diagnosed with breast cancer, the use of maladaptive cognitive emotion regulation strategies is hypothesized to be positively correlated with levels of depressive symptoms, sexual dysfunction, and negative body image.
METHODS
Participants and procedure
This single-center, prospective study was initiated after obtaining approval from the Clinical Research Ethics Committee of Kartal Dr. Lutfi Kırdar City Hospital on February 10, 2021 (approval number 514/195/1). All participants provided written informed consent before inclusion in the study.
The sample size in the study was calculated in the G*Power (version 3.1. 9.2, Kiel University) analysis program, and considering previous studies, the minimum sample size was determined as 102 by accepting an effect size of 0.5, power of 0.80, and alpha error value of 0.05. In order to increase the power of the study, the sample size was determined as 112, and 56 breast cancer patients and 56 healthy control groups were planned to be included in the study. The sample of this cross-sectional case-control study consisted of 56 patients with histologically-cytologically-confirmed breast cancer who received outpatient follow-up and treatment at the Radiation Oncology Clinic of Istanbul Kartal Dr. Lutfi Kirdar City Hospital between February 2021 and July 2021 and a control group of 56 randomly selected hospital staff and their relatives who matched the patient group in terms of sex, age, and education.
A group of 56 female patients aged 18–50 years, with a histologically-cytologically confirmed breast cancer diagnosis, three years or less since the diagnosis, not receiving active chemotherapy or radiotherapy during the study period, not having an additional cancer diagnosis other than breast cancer, having undergone breast surgery after diagnosis, not having a history of any interventional procedure for a body part other than the breast, literate, and willing to participate in the study by signing the informed consent form were included in the study.
A control group of 56 randomly selected hospital staff and their relatives aged 18–50 years, female, literate, meeting the inclusion and exclusion criteria, with no current or past diagnosis of breast cancer and no history of any interventional procedure on the breast, who were willing to participate in the study by signing the informed consent form, were included in the study.
Exclusion criteria are as follows: Diagnosis of attention-deficit/hyperactivity disorder, obsessive-compulsive disorder and related disorders, schizophrenia and other disorders with psychosis, bipolar and related disorders, substance-related disorders and addictive disorders as it will affect judgment and reality assessment; use of antidepressant and antipsychotic medication; intellectual deficiency, diagnosis of neurologic or systemic disease, reporting that they are not sexually active and not completing self-report scales related to sexual functioning.
Main outcome measures
The Structured Clinical Interview for DSM-5
The Structured Clinical Interview for DSM-5 is a semi-structured diagnostic tool developed by First in 2015 to assess DSM-5 disorders [15]. A Turkish study to establish its validity and reliability was conducted by Elbir et al. [16].
Sociodemographic form
It is a form prepared by the researchers to collect information about sociodemographic characteristics, medical and psychiatric history, chronic diseases, sexual life, and data related to breast cancer, in accordance with the study’s objectives.
Hamilton Depression Rating Scale
Hamilton Depression Rating Scale (HAM-D), developed by Hamilton [17] to measure the severity of depressive symptoms, is a clinician-administered scale. The Turkish validity and reliability study of the scale was conducted by Akdemir et al. [18].
Hamilton Anxiety Scale
Hamilton Anxiety Scale (HAM-A) is a clinician-administered semi-structured scale developed by Hamilton [19] to measure anxiety severity and symptom distribution. The Turkish validity and reliability study of the scale was conducted by Yazıcı et al. [20].
The Cognitive Emotion Regulation Questionnaire
Cognitive Emotion Regulation Questionnaire (CERQ) was developed by Garnefski et al. [10] to assess specific cognitive emotion regulation strategies that individuals employ in response to stressful life events. Nine distinct cognitive emotion regulation strategies have been conceptually delineated: Otherblame, Self-blame, Acceptance, Catastrophizing, Rumination, Positive Reappraisal, Positive Refocusing, Refocus on planning, and Putting into perspective [10,12,21,22]. A higher subscale score indicates that cognitive emotion regulation strategy is used more [12]. The Turkish validity and reliability study of the scale was conducted by Onat and Otrar. [21].
Body Cathexis Scale
Body Cathexis Scale (BCS) was developed by Secord and Jourard [23] to measure a person’s satisfaction with various parts of their body and body functions. High scores indicate a high level of satisfaction. The Turkish validity and reliability study of the scale was conducted by Hovardaoğlu [24].
Female Sexual Function Index
Female Sexual Function Index (FSFI) is a multidimensional, self-report scale developed by Rosen et al. [25] to evaluate basic dimensions of sexual function in women. The scale has 6 sub-dimensions: desire, arousal, pain, lubrication, satisfaction, and orgasm. The Turkish validity and reliability study of the scale was conducted by Aygin and Aslan [26].
Golombok Rust Inventory of Sexual Satisfaction
Golombok Rust Inventory of Sexual Satisfaction (GRISS) is a scale developed by Rust and Golombok [27] that evaluates the quality of sexual intercourse and sexual dysfunctions. The female form used in our study has 7 sub-dimensions: infrequency, noncommunication, dissatisfaction, avoidance, nonsensuality, vaginismus, and anorgasmia. An increase in the score on the scale indicates a greater deterioration in the quality of the sexual relationship and sexual functions. The Turkish validity and reliability study of the scale was conducted by Tuğrul et al. [28].
Statistical analysis
While evaluating the findings obtained in the study, the SPSS version 25.0 program (IBM Corp.) was used for statistical analysis. The conformity of the variables to normal distribution was evaluated by histogram plots and Kolmogorov-Smirnov test. Mean, standard deviation, and median values were used to present descriptive analyses. Categorical variables were compared with the Pearson chi-square test. Mann-Whitney U test was used for non-normally distributed (nonparametric) variables between two groups, and the Kruskal-Wallis test was used for variables between more than two groups. Spearman’s correlation test was used to analyze the measured data with each other. When HAM-D and HAM-A scores were controlled, partial correlation analysis was used to determine the relationships. For all analyses, p<0.05 was considered statistically significant.
RESULTS
A total of 112 women, 56 breast cancer patients, and 56 healthy controls without breast cancer were included in our study. When the patient group and the control group were compared, there was no statistically significant difference in terms of age, marital status, education level, income level, and place of residence (p>0.05) (Table 1).
Comparison of sociodemographic characteristics of breast cancer patients and control group
There was no significant difference between the groups regarding menopausal status; 64.29% of the participants in the breast cancer patient group stated that they experienced menopausal symptoms related to the treatment process at some point.
HAM-D, HAM-A, CERQ, BCS, GRISS, and FSFI scores of the patient group and the control group were compared. The HAM-D score was found to be statistically significantly higher in the patient group compared to the control group (p<0.001). The BCS score was statistically significantly lower in the breast cancer patient group compared to the control group (p=0.003). GRISS total and subscale (except noncommunication) scores were statistically significantly higher in the patient group with breast cancer compared to the control group (p<0.05). FSFI total and subscale scores were statistically significantly lower in the patient group with breast cancer compared to the control group (p<0.001). No statistically significant difference was observed between the groups in terms of HAM-A and CERQ sub-dimensions (p>0.05) (Table 2).
Comparison of HAM-D, HAM-A, CERQ, BCS, GRISS, and FSFI scores of the breast cancer patients and control group
The relationship between GRISS scores and HAM-D, HAM-A, CERQ, and BCS scores was analyzed in the patient group diagnosed with breast cancer. A statistically significant positive correlation was found between the HAM-D score and infrequency (p=0.010, r=0.341), avoidance (p=0.019, r=0.313), anorgasmia (p=0.025, r=0.299) sub-dimension scores, and GRISS Total score (p<0.001, r=0.348). A statistically significant negative correlation was found between the GRISS dissatisfaction sub-dimension score and the CERQ positive reappraisal sub-dimension score (p=0.029, r=-0.292) (Table 3).
Correlations among study variables in the breast cancer patient group
In the patient group diagnosed with breast cancer, the HAM-D and HAM-A controlled partial correlation between the GRISS dissatisfaction subscale score and CERQ positive reappraisal score was examined. When the effect of HAM-D and HAM-A scores were removed, it was observed that the relationship between the GRISS dissatisfaction subscale score and the CERQ Positive reappraisal score strengthened and maintained its statistical significance (p=0.012, r=-0.338).
The relationship between FSFI scores and HAM-D, HAM-A, CERQ, and BCS scores was analyzed in the patient group diagnosed with breast cancer. A statistically significant negative correlation was found between the HAM-D score and the FSFI arousal subscale score (p=0.030, r=-0.291). A statistically significant positive correlation was found between the FSFI desire subscale score and the BCS score (p=0.030, r=0.290) (Table 3).
In the patient group diagnosed with breast cancer, the HAM-D and HAM-A controlled partial correlation between the BCS score and the FSFI desire sub-dimension score was examined. When the effect of HAM-D and HAM-A scores were removed, it was observed that the relationship between the BCS score and the FSFI desire subscale score lost statistical significance (p>0.05).
The relationship between the BCS score and HAM-D, HAM-A, and CERQ scores was analyzed in a group of patients diagnosed with breast cancer. A statistically significant negative correlation was found between the BCS score and HAM-D score (p=0.002, r=-0.405), HAM-A score (p<0.001, r=-0.466). A statistically significant positive correlation was found between the BCS score and the CERQ positive reappraisal subscale score (p=0.007, r=0.359) (Table 3).
In the patient group diagnosed with breast cancer, the HAM-D and HAM-A controlled partial correlation between BCS score and the CERQ positive reappraisal subscale score was examined. When the effect of HAM-D and HAM-A scores were removed, it was observed that the relationship between the BCS score and the CERQ positive reappraisal subscale score lost its statistical significance (p>0.05).
The relationship between HAM-D, HAM-A scores, and CERQ scores was examined in the patient group diagnosed with breast cancer. A statistically significant negative correlation was found between the HAM-D score and CERQ refocus on planning (p=0.015, r=-0.324), positive reappraisal (p=0.044, r=-0.271), putting into perspective (p=0.027, r=-0.295) sub-dimension scores. A statistically significant negative correlation was found between the HAM-A score and CERQ refocusing on planning (p=0.010, r=-0.342), positive reappraisal (p=0.040, r=-0.275) sub-dimension scores (Table 3).
DISCUSSION
In accordance with the aim of our study, we compared the levels of depressive symptoms, sexual functions, and body image between women with breast cancer and healthy controls, highlighting the relationships among cognitive emotion regulation strategies, sexual functions, body image, and depressive symptom levels within the breast cancer group.
The findings of our study revealed that, compared to healthy controls, women with breast cancer exhibited higher levels of depressive symptoms, negative body image, and sexual dysfunctions, except for the GRISS communication subscale. A positive correlation was identified between depressive symptom levels and sexual dysfunctions in the areas of frequency of sexual intercourse, sexual avoidance, arousal, and orgasm in women with breast cancer. Additionally, a positive relationship was observed between depressive symptom levels and negative body image in this population. In contrast, a negative correlation was found between depressive symptom levels and the use of adaptive cognitive emotion regulation strategies, including refocusing on planning, positive reappraisal, and putting into perspective. Importantly, the use of the positive reappraisal strategy demonstrated a positive relationship with sexual satisfaction, emphasizing its potential role in improving the sexual quality of life for women with breast cancer.
Reviewing the literature, it is seen that the problems experienced by young women diagnosed with breast cancer are related to psychosocial, sexual functions, and body image due to their life stages being more intense and complex compared to older women, but they are underrepresented in the literature [4,5]. In a study conducted by Bakht and Najafi [29], which included women under the age of 50, it was emphasized that due to the decrease in breast cancer-related death rates, more studies are needed on the effect of the disease and treatment processes in the young patient group. Therefore, we aimed to examine, more specifically, the sexual functions, body image, and psychological problems of young women diagnosed with breast cancer and included participants aged 50 years and younger in our study.
Depressive symptoms are common in patients diagnosed with breast cancer, and studies have shown that psychological well-being is more impaired than in healthy controls [30]. In a study by Bakht and Najafi [29], negative body image was observed more in young women (≤50 years) diagnosed with breast cancer compared to healthy controls. In our study, in line with the literature, higher levels of depression and negative body image were observed in patients diagnosed with breast cancer compared to healthy controls.
These results highlight the importance of integrating routine psychological screening and targeted interventions into oncological care. Addressing depressive symptoms and body image disturbances through multidisciplinary approaches involving psychiatry and psychosocial support is essential to improve the psychological well-being in this population. Future studies should explore the longitudinal trajectory of these issues and assess the effectiveness of early, integrated therapeutic interventions to mitigate psychological distress and enhance patient outcomes.
Sexual dysfunctions are more common in women diagnosed with breast cancer compared to healthy controls [6,31]. In a study by Bakht and Najafi [29], it was shown that young women (≤50 years) diagnosed with breast cancer had more problems in the areas of sexual desire, sexual arousal, satisfaction, and pain than healthy controls. In our study, according to FSFI, breast cancer patients had less sexual desire, sexual arousal, and sexual satisfaction and had more sexual pain, lubrication, and orgasm problems than healthy controls.
According to GRISS breast cancer patients had more problems in frequency of sexual intercourse, communication during sexual intercourse, sexual satisfaction, sexual avoidance, sexual sensuality, vaginismus, and anorgasmia than healthy controls. Although the impairment in sexual communication was higher in the breast cancer patient group, this difference was not statistically significant. The importance of cultural differences in sexual communication with partners is emphasized in the literature [5]. This finding may suggest that sexual communication with partners is more affected by cultural factors than breast cancer. For this, studies including different ethnic groups are needed.
In a study by Li et al. [31] comparing women newly (<1 month) diagnosed with breast cancer with a healthy control group and examining the effect of cognitive emotion regulation strategies on quality of life, it was shown that women diagnosed with breast cancer used acceptance and catastrophizing strategies more than the control group and rumination, self-blame, blaming others, positive reappraisal, positive refocusing and refocus on planning strategies less than the control group. In our study, no significant difference was found in terms of cognitive emotion regulation strategies used in the breast cancer patient group compared to the control group. Since the study by Li et al. [31] was cross-sectional, it was stated as a limitation that it was not known whether the difference between the patient and control group was a reflection of individual differences that existed before the diagnosis of breast cancer or a reflection of the strategies activated as a result of stress caused by breast cancer. In our study, there was no significant difference in terms of cognitive emotion regulation strategies used between two groups, suggesting that individual differences existing before the diagnosis of breast cancer may have influenced the processing of the stressful life event. However, our study is limited by its cross-sectional design, which precludes definitive conclusions about causality or the potential influence of individual differences existing before the diagnosis of breast cancer. Additionally, unexamined variables may have influenced the observed outcomes. Future longitudinal research is needed to explore these relationships and better understand the complex interplay of these factors.
A study by Can et al. [32] showed a negative relationship between depression level and sexual desire, arousal, orgasm, and satisfaction in women diagnosed with breast cancer. In our study, in accordance with the literature, there was a positive correlation between depression level and sexual dysfunctions in the areas of frequency of sexual intercourse, sexual avoidance, arousal, and orgasm in women diagnosed with breast cancer. In a study conducted by Rosenberg et al. [33] on young women (≤40 years) diagnosed with breast cancer, it was shown that body perception was associated with depression and anxiety. In a study conducted by Zimmermann et al. [9], it was shown that one of the most important predictors of body image acceptance problems in women diagnosed with breast cancer was the level of depressive symptoms. Consistent with the literature, our study shows that there is a positive relationship between depression level, anxiety level, and negative body image in women diagnosed with breast cancer. Although this finding does not establish causality, it suggests that psychiatric interventions, including strategies to reduce depression and anxiety symptoms, may reduce problems related to sexual functioning and body image in women after breast cancer diagnosis [9].
In our study, we found a positive relationship between positive body image and sexual desire; however, when the effects of depression and anxiety were removed, the relationship between body image and sexual desire lost its significance. This supports the view that sexual desire may be a psychological phenomenon influenced by the emotional consequences of the threat of the disease rather than the quality of the relationship with the partner, body image, or treatment method [6]. Our findings suggest that it is important to consider depressive symptoms seen after breast cancer diagnosis together with decreased sexual desire.
It was revealed that there was a strong negative relationship between positive reappraisal, one of the adaptive cognitive emotion regulation strategies, and depression and anxiety symptoms [22,34]. It has been shown that underutilization of positive refocusing and putting into perspective strategies is a predictor of major depressive disorder [35]. In another study by Wang et al. [11] aiming to determine the effects of cognitive emotion regulation strategies on depressive symptoms in breast cancer patients, depressive symptoms were evaluated at the time of diagnosis and one month after diagnosis. It was observed that adaptive cognitive emotion regulation strategies not only enabled the individual to maintain a euthymic mood but also to recover quickly from a depressive mood. In the study, it was shown that positive reappraisal, positive refocusing, and acceptance strategies may be predictors of less depressive symptoms in breast cancer patients.
In our study, when the relationship between cognitive emotion regulation strategies and depression in the group of patients diagnosed with breast cancer was examined, it was seen that there was a negative relationship between depression level and the use of refocus on planning, positive reappraisal, and putting into perspective strategies. When the relationship between cognitive emotion regulation strategies and anxiety level in breast cancer patients was examined, it was seen that there was a negative relationship between anxiety level and the use of positive reappraisal, refocus on planning strategies. The data on the relationship between cognitive emotion regulation strategies and depression and anxiety in our study emphasize the importance of psychiatric interventions to increase the use of refocus on planning, positive reappraisal, and putting into perspective strategies and simultaneously reduce depression and anxiety symptoms in women diagnosed with breast cancer in accordance with the literature [12].
In our study, the GRISS scale was used in addition to the FSFI scale, which is frequently used in studies on sexual function in women diagnosed with breast cancer, to evaluate the sexual function of the participants and to reveal the difference between the patient and control groups. GRISS enabled us to evaluate sexual satisfaction, which is an important subdimension for our study. Sexual satisfaction can be defined as one’s feelings about the quality of sexual intercourse [36]. It has been shown that the most important predictors of sexual satisfaction in women are depressive symptoms, satisfaction in the relationship with the partner, sexual functioning, and social support [37]. Although there is no study examining the relationship between sexual satisfaction and cognitive emotion regulation strategies, sexual satisfaction has been shown to be positively associated with emotion regulation skills [38,39]. In our study, a positive relationship was observed between the use of positive reappraisal strategy and sexual satisfaction. When the effects of depression and anxiety were eliminated, it was observed that the relationship between positive reappraisal and sexual satisfaction strengthened and maintained its significance. In our study, it is important to show that women’s thoughts of attributing a positive meaning to the process in terms of personal development by using the positive reappraisal strategy during the breast cancer process are related to sexual satisfaction, suggesting that psychotherapy processes aimed at improving the positive reappraisal strategy may positively affect sexual satisfaction in women diagnosed with breast cancer.
Strengths and limitations
There are some limitations in our study. Although a sample suitable for the number determined according to the power analysis was taken in our study, the reservations of the participants, especially those diagnosed with cancer, about being in the hospital during the COVID-19 pandemic process limited us to increase our sample size.
Given that our study is a cross-sectional case-control study, it is necessary for our findings to be corroborated by future prospective studies. Our study’s cross-sectional design limits the ability to establish causality or fully account for pre-existing individual differences in cognitive emotion regulation strategies before the diagnosis of breast cancer. Additionally, unexamined variables may have influenced the observed outcomes. Future longitudinal research is necessary to explore these relationships comprehensively and to determine the potential impact of such factors.
Considering the sociocultural structure in Türkiye, it was observed that female participants living in Türkiye who constituted our sample avoided answering questions about sexual life. Although sexual functions were questioned with self-report scales in our study to minimize this limitation, it is thought that this may have caused participant bias. Since some sub-dimensions of sexual function, especially sexual communication with a partner, are affected by cultural factors, studies including different ethnic groups are needed.
When the literature was reviewed, there was no comprehensive study examining the relationship between cognitive emotion regulation strategies and sexual function, body image, and depression level in women diagnosed with breast cancer. Our study is important in terms of drawing attention to psychiatric problems such as depression and anxiety in women diagnosed with breast cancer, examining their relationship with sexual life and body image, and revealing the relationship of cognitive emotion regulation strategies with sexual function, body image, and depression level in women diagnosed with breast cancer. Considering our findings, it is thought that it is important to recognize depression and anxiety symptoms in the diagnosis and treatment process of breast cancer, body image, and sexual problems should be evaluated, and studies to increase the use of positive reappraisal, refocus on planning, putting into perspective strategies in therapeutic processes are important. It is thought that prospective studies to be conducted in the future by using different psychotherapy methods and evaluating depression, anxiety, sexual functions, body image, and cognitive emotion regulation strategies used before and after therapy may make an important contribution to the literature.
Conclusion and clinical implications
This study underscores the critical psychological and sexual health challenges experienced by young women with breast cancer, including elevated depression levels, negative body image perceptions, and pronounced sexual dysfunction compared to healthy controls. Although no group differences were found in cognitive emotion regulation strategies, positive reappraisal emerged as a key adaptive mechanism linked to enhanced sexual satisfaction and reduced depressive symptoms.
The findings emphasize the need for proactive psychiatric involvement within oncology care. Routine screening for depression, anxiety, and body image disturbances is essential to identify patients requiring targeted interventions. Implementing psychotherapeutic approaches that enhance adaptive emotion regulation, particularly positive reappraisal, could substantially improve psychological and sexual well-being.
Future research should employ longitudinal designs to evaluate the sustained impact of emotion regulation strategies on mental health outcomes. Moreover, culturally tailored, multidisciplinary models integrating psychiatry and oncology are vital to address the diverse needs of breast cancer survivors and optimize their quality of life. This collaborative approach could pave the way for holistic survivorship care.
Notes
Availability of Data and Material
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
Conflicts of Interest
We declare that this article is original, has not been previously published, and is not currently under consideration for publication elsewhere. There is no conflict of interest, including financial, consultant, institutional and other relationships that regarding this publication and no financial support was provided to this study that could have affected its outcome. As the Corresponding Author, I declare that the article has been read by all named authors and approved for submission. The study was conducted according to acceptable research standards, having obtained informed consent of study subjects.
Author Contributions
Conceptualization: Begüm Yıldırım Cinek, Merih Altıntaş. Data Curation: all authors. Formal analysis: Begüm Yıldırım Cinek. Investigation: Begüm Yıldırım Cinek. Methodology: Begüm Yıldırım Cinek, Merih Altıntaş. Supervision: Merih Altıntaş, Gökhan Yaprak. Writing—original draft: Begüm Yıldırım Cinek. Writing—review & editing: all authors.
Funding Statement
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Acknowledgements
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