The Cost of Bottling It Up: Emotion Suppression as a Mediator in the Relationship Between Anger and Depression Among Men with Prostate Cancer
Received 13 November 2019
Accepted for publication 29 January 2020
Published 11 February 2020 Volume 2020:12 Pages 1039—1046
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Eileen O'Reilly
Simon M Rice,1,2 David Kealy,3 John S Ogrodniczuk,3 Zac E Seidler,1,2 Linda Denehy,4,5 John L Oliffe6,7
1Orygen, Melbourne, VIC, Australia; 2Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; 3Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; 4School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; 5Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; 6School of Nursing, University of British Columbia, Vancouver, BC, Canada; 7Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
Correspondence: Simon M Rice
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
Tel +613 9966 9100
Background: Prostate cancer is a risk factor for major depressive disorder. Recent psycho-oncology research suggests a potential role for male-specific mood-related symptoms in this relationship. Gender socialisation experiences may reinforce men’s anger and emotion suppression responses in times of distress, and anger and emotion suppression may be implicated in pathways to, and maintenance of depression in prostate cancer.
Patients and Methods: Data were collected online from men with a self-reported diagnosis of prostate cancer (N=100; mean age 64.8 years). Respondents provided information regarding diagnosis and treatment, in addition to current experience of major depression and male-specific externalising symptoms.
Results: Prostate cancer diagnosis in the last 12 months occurred for 35.4% of the sample. Elevated major depression symptoms were observed for 49% of respondents, with 14% endorsing past 2-week suicide ideation. Parallel mediation analysis (99% CIs) controlling for prostatectomy and active surveillance indicated men’s emotion suppression mediated the relationship between anger and depression symptoms (R2=0.580). Trichotimised emotion suppression scores with control variables yielded a large multivariate effect (p< 0.001, partial η2=0.199). Univariate moderate-sized effects were observed for emotion suppression comparisons for symptoms of depressed mood and sleep disturbance, and a large effect observed for guilt-proneness.
Conclusion: Findings highlight the salience of anger in the experience of depression symptoms for men with prostate cancer. The mediating role of emotion suppression, which in turn was strongly linked to men’s feelings of guilt, suggests potential assessment and intervention targets. Future work should examine the role of androgen deprivation therapy and other treatments including active surveillance on the relationship between anger and depression in men with prostate cancer. Consideration of interventions focused on emotion processing skills in psycho-oncology settings may help reduce men’s reliance on emotion suppression as a strategy for coping with feelings of anger or guilt in the context of prostate cancer.
Keywords: prostate, depression, anger, emotion suppression
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