Depression and marital satisfaction: the mediating role of sexual satisfaction and perceived partner acceptance in women after mastectomy
More details
Hide details
Institute of Psychology, University of Silesia, Katowice, Poland
Submission date: 2018-11-24
Final revision date: 2019-03-04
Acceptance date: 2019-03-04
Online publication date: 2019-04-08
Publication date: 2019-04-08
Health Psychology Report 2019;7(2):121–132
Diagnosis and treatment of breast cancer disrupts women’s functioning on both individual and dyadic levels. The main objective of the present study was to examine whether the partner’s acceptance of the woman and her sexual satisfaction can play a key role in mediating the relationship between depression and marital satis-faction in women treated for breast cancer after mastectomy.

Participants and procedure:
The sample consisted of 97 women with breast cancer after mastectomy (mean age = 55.68 years). The partic-ipants completed the following self-reported assessments: Beck’s Depression Inventory, Scale of Assessment of Self-Attractiveness in the Relationship by Chybicka and Karasiewicz and the Good Marriage Questionnaire KDM-2 by Plopa and Rostowski. All women were married (89.70%) or in informal relationships (10.30%). Re-cruitment for the study was conducted among women from the Amazonki community.

The time since the first diagnosis and the commencement of surgical treatment was a negative predictor (β = –.36, p < .001) of marital satisfaction in women with breast cancer after mastectomy, whereas acceptance by the partner was a significant positive predictor (β = .30, p = .023); the mediation analyses showed that acceptance by the partner fully mediated the relationship between depression and marital satisfaction. Sexual satisfaction can also be considered as a significant total mediator between depression and marital satisfaction in women with breast cancer after mastectomy.

The results highlight the importance of the analysed variables for marital satisfaction of women with breast cancer and can serve as a helpful guide for clinicians and other health professionals. One of the more im-portant findings concerned the importance of acceptance by the partner as a direct predictor of marital satisfac-tion. The research also showed that the women’s conviction about their partners’ acceptance and their sexual satisfaction renders their depression impactless in terms of marital satisfaction.

Alacacioglu, A., Dirican, U., & Yilmaz, I. (2013). Depression and anxiety in cancer patients and their relatives. Medical Oncology, 18, 767–774.
Andysz, A., Najder, A., Merecz-Kot, D., & Wójcik, A. (2015). Posttraumatic growth in women after breast cancer surgery – preliminary results from a study of Polish patients. Health Psychology Report, 3, 336–344. https://doi.org/10.5114/hpr.20....
Avci, I. A., & Kumcagiz, H. (2011). Marital adjustment and loneliness status of women with mastectomy and husbands reactions. Asian Pacific Journal of Cancer Prevention, 12, 453–459.
Baglama, B., & Atak, I. (2015). Posttraumatic growth and related factors among postoperative breast cancer patients. Procedia. Social and Behavioral Sciences, 190, 448–454.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Barthakur, M. S., Sharma, M. P., Chaturvedi, S. K., & Manjunath, S. K. (2017). Body image and sexuality in women survivors of breast cancer in India: Qualitative findings. Indian Journal of Palliative Care, 23, 13–17.
Beach, S. R. H., Sandeen, E. E., & O’Leary, K. D. (1990). Depression in marriage: A model for etiology and treatment. New York: Guilford Press.
Boeding, S. E., Pukay-Martin, N. D., Baucom, D. H., Porter, L. S., Kirby, J. S., Gremore, T. M., & Keefe, F. J. (2014). Couples and breast cancer: Women’s mood and partners’ marital satisfaction predicting support perception. Journal of Family Psychology, 28, 675–683.
Bolger, N., Foster, M., Vinokur, A. D., & Ng, R. (1996). Close relationships and adjustment to a life crisis: The case of breast cancer. Journal of Personality and Social Psychology, 70, 283–294.
Bookwala, J. (2012). Marriage and the other partnered relationships in middle and late adulthood. In R. Blieszner & V. H. Bedford (Eds.), Handbook of aging and the family (pp. 91–124). Santa Barbara, CA: ABC-CLIO.
Boostani, H., Hoseini, S. M., Khodadadi, N., & Froozi, N. (2015). Marital satisfaction in women with breast cancer: A comparison between mastectomy and breast conserved patients. Biomedical & Pharmacology Journal, 8, 1237–1242.
Brandt-Salmeri, A., & Przybyła-Basista, H. (2018). Obraz ciała a samoocena kobiet z rakiem piersi – rola akceptacji ciała [Body image and self-esteem in women with breast cancer – the role of body acceptance]. Psychoonkologia, 22, 1–10.
Brix, S. A., Bidstrup, P. E., Christensen, J., Rottmann, N., Olsen, A., Tjønneland, A., Johansen, C., & Dalton, S. O. (2013). Post-traumatic growth among elderly women with breast cancer compared to breast cancer-free women. Acta Oncologica, 52, 345–354.
Bulotiene, G., Veseliunas, J., Ostapenko, V., & Furmonavicius, T. (2008). Women with breast cancer: relationships between social factors involving anxiety and depression. Archives of Psychiatry and Psychotherapy, 4, 57–62.
Bulsa, M., Rzepa, T., Foszczyńska-Kłoda, M., Czaja-Bulsa, G., & Teichert, H. (2002). Stan psychiczny kobiet po mastektomii. Doniesienie z badań [The mental state of women after mastectomy. A study report]. Postępy Psychiatrii i Neurologii, 11, 55–70.
Chybicka, A., & Karasiewicz, K. (2008). Scale of Assessment of Self-Attractiveness in Relationship – validation research. Polish Journal of Social Science, 3, 159–180.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.
Cordero, A., Mur-Villar, N., Sanchez, M., Pimente-Ramirez, M., Garcia-Rillo, A., & Gomez-Valverde, E. (2015). Breast cancer and body image as a prognostic factor of depression: a case study in México City. Nutrición Hospitalaria, 31, 371–379.
Cordova, M. J., Riba, M. B., & Spiegel, D. (2017). Post-traumatic stress disorder and cancer. Lancet Psychiatry, 4, 330–338. https://doi.org/10.1016/S2215-....
Davila, J., Karney, B. R., Hall, T. W., & Bradbury, T. N. (2003). Depressive symptoms and marital satisfaction: Within subject associations and the moderating effects of gender and neuroticism. Journal of Family Psychology, 17, 557–570.
Derbis, R., & Machnik-Czerwik, A. (2016). Adaptation of the Body Image after Breast Cancer Questionnaire in the Polish context: Factorial structure and validity of the scale. Health Psychology Report, 4, 170–187. https://doi.org/10.5114/hpr.20....
Fagundes, C., LeRoy, A., & Karuga, M. (2015). Behavioral symptoms after breast cancer treatment: A biobehavioral approach. Journal of Personalized Medicine, 5, 280–295.
Fang, S. Y., Chang, H. T., & Shu, B. C. (2014). Objectified body consciousness, body image discomfort, and depressive symptoms among breast cancer survivors in Taiwan. Psychology of Women Quarterly, 38, 563–574.
Fowler, C., & Gasiorek, J. (2017). Depressive symptoms, excessive reasurance seeking, and relationship maintenance. Journal of Social and Personal Relationships, 34, 91–113. https://doi.org/10.1177/026540....
Ghizzani, A., Bruni, S., & Luisi, S. (2018). The sex life of women surviving breast cancer. Gynecological Endocrinology, 34, 821–825. https://doi:org/10.1080/095135....
Gilbert, E., Ussher J. M., & Perz, J. (2010b). Renegotiating sexuality and intimacy in the context of cancer: The experiences of carers. Archives of Sexual Behavior, 39, 998–1009.
Gilbert, E., Ussher, J. M., & Perz, J. (2010a). Sexuality after breast cancer: A review. Maturitas, 66, 397–407.
Hagedoorn, M., Kuijer, R. G., Buunk, B. P., DeJong, G. M., Wobbes, T., & Sanderman, R. (2000). Marital satisfaction in patients with cancer: Does support from intimate partners benefit those who need it the most? Health Psychology, 19, 274–282.
Heidari, M., Shahbazi, S., & Ghodusi, M. (2015). Evaluation of body esteem and mental health in patients with breast cancer after mastectomy. Journal of Mid-life Health, 6, 173–177.
Helgeson, V. S., & Cohen, S. (1996). Social support and adjustment to cancer: Reconciling descriptive, correlational, and intervention research. Health Psychology, 15, 135–148.
Hopwood, P., Fletcher, I., Lee, A., & Al Ghazal, S. (2001). A body image scale for use with cancer patients. European Journal of Cancer, 37, 189–197.
Hopwood, P., Lee, A., Shenton, A., Baildam, A., Brain, A., Lalloo, F., Evans, G., & Howell, A. (2000). Clinical follow‐up after bilateral risk reducing (‘prophylactic’) mastectomy: mental health and body image outcomes. Psycho-Oncology, 9, 462–472.
Izydorczyk, B., Kwapniewska, A., Lizinczyk, S., & Sitnik-Warchulska, K. (2018). Psychological resilience as a protective factor for the body image in post-mastectomy women with breast cancer. International Journal of Environmental Research and Public Health, 15, 1181. https://doi.org/10.3390/ijerph....
Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J., Murray, T., & Thun, M. J. (2008). Cancer statistics. CA: A Cancer Journal for Clinicians, 58, 71–96.
Juczyński, Z., Ogińska-Bulik, N. (2009). Pomiar zaburzeń po stresie traumatycznym – polska adaptacja Zrewidowanej Skali Wydarzeń [Measurement of post-traumatic stress disorder Polish version of Impact Event Scale-Revised]. Psychiatria, 6, 15–25.
Kamińska, M., Ciszewski, T., Kukiełka-Budny, B., Kubiatowski, T., Baczewska, B., Makara-Studzińska, M., Starosławska, E., & Bojar, I. (2015). Life quality of women with breast cancer after mastectomy or breast conserving therapy treated with adjuvant chemotherapy. Annals of Agricultural and Environmental Medicine, 22, 724–730.
Karabulutlu, E., Mehmet, B., Kerim, Ç., Salim, T., & Ragibe, K. (2010). Anxiety and Depression in Turkish Patients with Cancer. European Journal of General Medicine, 7, 296–302.
Kinsinger, S. W., Laurenceau, J. P., Carver, C. S., & Antoni, M. H. (2011). Perceived partner support and psychosexual adjustment to breast cancer. Psychology and Health, 26, 1571–1588.
Koçan, S., & Gürsoy, A. (2016). Body image of women with breast cancer after mastectomy: A qualitative research. Journal of Breast Health, 12, 145–150.
Koczwara, B., & Clark, M. M. (2003). A couple with cancer: conflicting wishes, joint decisions. Journal of Clinical Oncology, 21, 174–176.
Li, Q., & Loke, A. Y. (2014). A literature review on the mutual impact of the spousal caregiver-cancer patients dyads: ‘communication’, ‘reciprocal influence’, and ‘caregiver-patient congruence’. European Journal of Oncology Nursing, 18, 58–65.
Madhumanti, M., & Sathiyaseelan, A. (2014). Marital adjustment in women after one year of mastectomy. Global Journal of Biology and Health Sciences, 3, 43–47.
Maly, R. C., Umezawa, Y., Leak, B., & Silliman, R. A. (2005). Mental Health Outcomes in Older Women with Breast Cancer: Impact of Perceived Family Support and Adjustment. Psycho-Oncology, 14, 535–545.
Manne, S., Sherman, M., Ross, S., Ostroff, J., Heyman, R. E., & Fox, K. (2004). Couples’ support-related communication, psychological distress, and relationship satisfaction among women with early stage breast cancer. Journal of Consulting and Clinical Psychology, 72, 660–670. https://doi.org/10.1037/0022-0....
Manos, D., Sebastian, J., Bueno, M. J., Mateos, N., & de la Torre, A. (2005). Body image in relation to self-esteem in a sample of Spanish women with early-stage breast cancer. Psicooncologia, 2, 103–116.
Mehnert, A., & Koch, U. (2007). Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study. Psychooncology, 16, 181–188.
Mehnert, A., & Koch, U. (2008). Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. Journal of Psychosomatic Research, 64, 383–391. https://doi.org/10.1016/j.jpsy....
Moreira, H., Crespo, C., Pereira, M., & Canavarro, M. C. (2010). Marital quality among women with breast cancer: The role of marital intimacy and quality of life. Psicooncologia, 7, 61–80.
Moyá, J., Prous, A. C., Fernández, A. S., & Alonso, Á. (2010). The impact a first episode of major depression has on marital dissatisfaction: Is remission associated with improvement in dissatisfaction? The European Journal of Psychiatry, 24, 46–58.
Ogińska-Bulik, N. (2010). Potraumatyczny rozwój w chorobie nowotworowej – rola prężności [Posttraumatic growth in cancer disease – the role of resiliency]. Polskie Forum Psychologiczne, 15, 125–139.
Ogińska-Bulik, N. (2013). The role of social support in posttraumatic growth in people struggling with cancer. Health Psychology Report, 1, 1–8. https://doi.org/10.5114/hpr.20....
Ogińska-Bulik, N. (2018). The role of ruminations in the relation between personality and positive posttraumatic changes resulting from struggling with cancer. Health Psychology Report, 6, 296–306. https://doi.org/10.5114/hpr.20....
O’Mahoney, J. M., & Carroll, R. A. (1997). The impact of breast cancer and its treatment on marital functioning. Journal of Clinical Psychology in Medical Settings, 4, 397–415.
Parnowski, T., & Jernajczyk, W. (1977). Inwentarz Depresji Becka w ocenie nastroju osób zdrowych i chorych na choroby afektywne [Beck’s Depression Inventory in the rating of mood in normal subjects and in patients with affective disturbances]. Psychitaria Polska, 11, 417–421.
Pintado, S. (2017). Self-concept and emotional well-being in patients with breast cancer. Revista Iberoamericana de Psicología y Salud, 8, 76–84.
Plopa, M. (2006). Więzi w małżeństwie i rodzinie. Metody badań [Marital and family ties. Research methods]. Kraków: Oficyna Wydawnicza Impuls.
Pruchno, R. A., Wilson-Genderson, M., & Cartwright, F. P. (2009). Depressive symptoms and marital satisfaction in the context of chronic disease: A longitudinal dyadic analysis. Journal of Family Psychology, 23, 573–584. https://doi.org/10.1037/a00158....
Ptacek, J. T., Ptacek, J. J., & Dodge, K. L. (1994). Coping with breast cancer from the perspectives of husbands and wives. Journal of Psychosocial Oncology, 12, 47–72.
Rehman, U. S., Gollan, J., & Mortimer, A. R. (2008). The marital context of depression: research, limitations, and new directions. Clinical Psychology Review, 28, 179–198. https://doi.org/10.1016/j.cpr.....
Reich, M., Lesur, A., & Perdrizet-Chevallier, C. (2008). Depression, quality of life and breast cancer: A review of the literature. Breast Cancer Research and Treatment, 110, 9–17. https://doi.org/10.1007/s10549....
Renshaw, K. D., Blais, R. K., & Smith, T. W. (2010). Components of negative affectivity and marital satisfaction: The importance of actor and partner anger. Journal of Research in Personality, 44, 328–334. https://doi.org/101016/j.jrp.2....
Rock, E. E., Steiner, J. L., Rand, K. L., & Bigatti, S. M. (2014). Dyadic influence of hope and optimism on patient marital satisfaction among couples with advanced breast cancer. Supportive Care in Cancer, 22, 2351–2359.
Rowland, J. H., Meyerowitz, B. E., Crespi, C. M., Leedham, B., Desmond, K., Belin, T. R., & Ganz, P. A. (2009). Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention. Breast Cancer Research and Treatment, 118, 99–111.
Siegel, R. L., Miller, K. D., & Jemal, A. (2018). Cancer statistics, 2018. CA: A Cancer Journal for Clinicians, 68, 7–30.
Srivastava, V., Mumtaz, A., Anand, K., Shah, A., & Meena, R. (2016). Study of anxiety among breast cancer patients from North India. Clinical Psychiatry, 2. https://doi.org/10.21767/2471-....
Stadnicka, G., Pawłowska-Muc, A., Bańkowska, B., & Sadowska, M. (2014). Jakość życia kobiet po amputacji piersi [Quality of life in women after mastectomy]. European Journal of Medical Technologies, 4, 8–14.
Stankiewicz, A., Radziwiłłowicz, W., & Bidzan, M. (2011). Związek cech osobowości, depresyjności i lęku z przebiegiem leczenia kobiet z nowotworem piersi [Relationships between personality, fear and depression in patients with breast cancer]. Psychoonkologia, 2, 48–54.
Stephanson, E., Delongis, A., Esdaile, J. M., & Lehman, A. J. (2014). Depressive symptoms and rheumatoid arthritis: Spouse empathic responding as a buffer. Arthritis Care and Research, 66, 532–541.
Su, J. A., Yeh, D. C., Chang, C. C., Lin, T. C., Lai, C. H., Hu, P. Y., Ho, Y. F., Chen, V. C. H., Wang, T. N., & Gossop, M. (2017). Depression and family support in breast cancer patients. Neuropsychiatric Disease and Treatment, 13, 2389–2396.
Svetina, M., & Nastran, K. (2012). Family relationships and posttraumatic growth in breast cancer patients. Psychiatria Danubina, 24, 298–306.
Talley, A., Molix, L., Schlegel, R. J., & Bettencourt, A. (2010). The influence of breast cancer survivors’ perceived partner support and need satisfaction on depressive symptoms: A longitudinal analysis. Psychology and Health, 25, 433–449.
Thornton, A. A., Perez, M. A. (2007). Interpersonal relationships. In M. Feuerstein (Ed.), Handbook of cancer survivorship (pp. 191–210). New York: Springer.
Weihs, K., Enright, T., Howe, G., & Simmens, S. J. (1999). Marital satisfaction and emotional adjustment after breast cancer. Journal of Psychosocial Oncology, 17, 33–49.
Wiederman, M. W. (2000). Women’s body image self-consciousness during physical intimacy with a partner. Journal of Sex Research, 37, 60–68.
Wimberly, S. R., Carver, C. S., Laurenceau, J. P., Harris, S. D., & Antoni, M. H. (2005). Perceived partner reactions to diagnosis and treatment of breast cancer: Impact on psychosocial and psychosexual adjustment. Journal of Consulting and Clinical Psychology, 73, 300–311.
Zahlis, E. H., & Lewis, F. M. (2010). Coming to grips with breast cancer: the spouse’s experience with his wife’s six month. Journal of Psychosocial Oncology, 8, 79–97.
Zainal, N. Z., Nik-Jaafar, N. R., Baharudin, A., Sabki, Z. A., & Ng, C. G. (2013). Prevalence of depression in breast cancer survivors: A systematic review of observational studies. Asian Pacific Journal of Cancer Prevention, 14, 2649–2656.
Zawadzki, B., Popiel, A., & Pragłowska, E. (2009). Charakterystyka psychometryczna polskiej adaptacji Kwestionariusza Depresji BDI-II Aarona T. Becka [Psychometric characteristics of the Polish adapted version of the BDI-II by Aaron T. Beck]. Psychologia – Etologia – Genetyka, 19, 71–95.
Zimmermann, T. (2015). Intimate relationships affected by breast cancer: Interventions for couples. Breast Care, 10, 102–108.