Emotional awareness (EA) is thought to facilitate psychological health by aiding emotion regulation in oneself and garnering social support from others. This study tested these potential relationships within a one-year longitudinal study of 460 women (age 23–91 years, mean 56.4 years) recently diagnosed with breast cancer (i.e., within four months). The women completed measures of emotional awareness, social support, social stress, affective symptoms, and well-being. Linear models tested EA as a moderator of social support and stress on affective symptoms and well-being. In those with higher EA, low social support was associated with greater depression and lower optimism. There was some evidence that higher EA predicted greater depression at baseline but lower depression at nine-month follow-up. These results support the idea that EA increases sensitivity to available social support and facilitates emotional adjustment over time, suggesting that assessment of EA could help guide clinicians in identifying those at greatest risk of adverse mental health outcomes in this population.
AhoieeKFaramarziMHassanzadehR (2017) Psychological well-being of patients with breast cancer and its relationship with emotional intelligence. Journal of Babol University of Medical Sciences19(8): 20–27.
2.
AmirifardNPayandehMAeinfarM, et al. (2017) A survey on the relationship between emotional intelligence and level of depression and anxiety among women with breast cancer. International Journal of Hematology-Oncology and Stem Cell Research11(1): 54.
3.
BailenNHWuHThompsonRJ (2019) Meta-emotions in daily life: Associations with emotional awareness and depression. Emotion19(5): 776.
4.
BarchardKABajgarJLeafDE, et al. (2010) Computer scoring of the levels of emotional awareness scale. Behavior Research Methods42: 586–595.
5.
Ben-ShlomoSKabizon-PerryO (2023) On the way to adulthood: Factors contributing to the life satisfaction of young Israeli modern orthodox women. Journal of Religion and Health62(5): 3364–3381.
6.
BloomJRSpiegelD (1984) The relationship of two dimensions of social support to the psychological well-being and social functioning of women with advanced breast cancer. Social Science & Medicine19(8): 831–837.
7.
BodenMTThompsonRJ (2015) Facets of emotional awareness and associations with emotion regulation and depression. Emotion15(3): 399.
8.
BrownEMTaylorJMBurgessDL, et al. (2024) Burnout, racial trauma, and protective experiences of Black psychologists and counselors. Psychological Trauma: Theory, Research, Practice, and Policy. Epub ahead of print 18 July 2024. DOI: 10.1037/tra0001726.
9.
CampoRAUchinoBNHolt-LunstadJ, et al. (2009) The assessment of positivity and negativity in social networks: The reliability and validity of the social relationships index. Journal of Community Psychology37(4): 471–486.
10.
CarmeliAYitzhak-HalevyMWeisbergJ (2009) The relationship between emotional intelligence and psychological wellbeing. Journal of Managerial Psychology24(1): 66–78.
11.
ChenWYWangSPengX, et al. (2022) Trait emotional intelligence and quality of life among breast cancer patients: The mediating role of fear of cancer recurrence. International Journal of Nursing Practice28(4): e12953.
12.
CloverKLambertSDOldmeadowC, et al. (2022) Apples to apples? Comparison of the measurement properties of hospital anxiety and depression-anxiety subscale (HADS-A), depression, anxiety and stress scale-anxiety subscale (DASS-A), and generalised anxiety disorder (GAD-7) scale in an oncology setting using Rasch analysis and diagnostic accuracy statistics. Current Psychology41: 4592–4601.
13.
ConleyCCBishopBTAndersenBL (2016) Emotions and emotion regulation in breast cancer survivorship. Healthcare4(3): 56.
14.
CostantiniLPasquarellaCOdoneA, et al. (2021) Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. Journal of Affective Disorders279: 473–483.
15.
DowneyLAJohnstonPJHansenK, et al. (2008) The relationship between emotional intelligence and depression in a clinical sample. The European Journal of Psychiatry22(2): 93–98.
16.
EckhertELansingerORitterV, et al. (2023) Breast cancer diagnosis, treatment, and outcomes of patients from sex and gender minority groups. JAMA Oncology9(4): 473–480.
17.
EsserPHartungTJFriedrichM, et al. (2018) The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients. Psycho-oncology27(6): 1509–1516.
18.
FehlAFerrariSWechtZ, et al. (2019) Breast cancer in the transgender population. Journal of the Advanced Practitioner in Oncology10(4): 387.
19.
FongAJScarapicchiaTMMcDonoughMH, et al. (2017) Changes in social support predict emotional well-being in breast cancer survivors. Psycho-oncology26(5): 664–671.
20.
FunchDPMarshallJ (1983) The role of stress, social support and age in survival from breast cancer. Journal of Psychosomatic Research27(1): 77–83.
21.
Guerra-BustamanteJLeón-del-BarcoBYuste-TosinaR, et al. (2019) Emotional intelligence and psychological well-being in adolescents. International Journal of Environmental Research and Public Health16(10): 1720.
22.
GuilRMorales-SánchezLRuiz-GonzálezP, et al. (2022) The key role of emotional repair and emotional clarity on depression among breast cancer survivors. International Journal of Environmental Research and Public Health19(8): 4652.
23.
GuimondA-JKeSTworogerSS, et al. (2024) Fulfilled mind, healthy gut? Relationships of eudaimonic psychological well-being with the gut microbiome in postmenopausal women. Psychosomatic Medicine86(5): 398–409.
24.
HammenCAdrianCGordonD, et al. (1987) Children of depressed mothers: Maternal strain and symptom predictors of dysfunction. Journal of Abnormal Psychology96(3): 190.
25.
HarrisLNBauerMRWileyJF, et al. (2017) Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis. Journal of Behavioral Medicine40: 875–885.
26.
HashemiS-MRafiemaneshHAghamohammadiT, et al. (2020) Prevalence of anxiety among breast cancer patients: A systematic review and meta-analysis. Breast Cancer27: 166–178.
27.
HellerHMDraismaSHonigA (2022) Construct validity and responsiveness of instruments measuring depression and anxiety in pregnancy: A comparison of EPDS, HADS-A and CES-D. International Journal of Environmental Research and Public Health19(13): 7563.
28.
HendricksonKWHopkinsROGroatDL, et al. (2023) Patient experiences with SARS-CoV-2: Associations between patient experience of disease and coping profiles. PLoS One18(11): e0294201.
29.
HinzAFriedrichMGlaesmerH, et al. (2024) Temporal stability of optimism and pessimism (LOT-R) over 6 years in the general population. Frontiers in Psychology15: 1379651.
30.
HinzASchulteTErnstJ, et al. (2023) Sense of coherence, resilience, and habitual optimism in cancer patients. International Journal of Clinical and Health Psychology23(2): 100358.
31.
HinzASchulteTFinckC, et al. (2022) Psychometric evaluations of the Life Orientation Test-Revised (LOT-R), based on nine samples. Psychology & Health37(6): 767–779.
32.
HirschJKBrittonPCConnerKR (2010) Psychometric evaluation of the life orientation test—Revised in treated opiate dependent individuals. International Journal of Mental Health and Addiction8(3): 423–431.
33.
HislopTGWaxlerNEColdmanAJ, et al. (1987) The prognostic significance of psychosocial factors in women with breast cancer. Journal of Chronic Diseases40(7): 729–735.
34.
Holt-LunstadJUchinoBN (2019) Social ambivalence and disease (SAD): A theoretical model aimed at understanding the health implications of ambivalent relationships. Perspectives on Psychological Science14(6): 941–966.
35.
Howard-AndersonJGanzPABowerJE, et al. (2012) Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: A systematic review. Journal of the National Cancer Institute104(5): 386–405.
36.
JägerCBänninger-HuberE (2015) Looking into meta-emotions. Synthese192: 787–811.
37.
KimJHBrightEEWilliamsonTJ, et al. (2021) Transitions in coping profiles after breast cancer diagnosis: Implications for depressive and physical symptoms. Journal of Behavioral Medicine44: 1–17.
38.
KroenkeKSpitzerRLWilliamsJB (2001) The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine16(9): 606–613.
39.
LaneRDQuinlanDMSchwartzGE, et al. (1990) The Levels of Emotional Awareness Scale: A cognitive-developmental measure of emotion. Journal of Personality Assessment55(1–2): 124–134.
40.
LaneRDSchwartzGE (1987) Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology. The American Journal of Psychiatry144(2): 133–143.
41.
LaneRDSmithR (2021) Levels of emotional awareness: Theory and measurement of a socio-emotional skill. Journal of Intelligence9(3): 42.
42.
LeungJPachanaNAMcLaughlinD (2014) Social support and health-related quality of life in women with breast cancer: A longitudinal study. Psycho-oncology23(9): 1014–1020.
43.
LimZXChuaWLLimWS, et al. (2022) Psychometrics of the Pearlin Mastery Scale among family caregivers of older adults who require assistance in activities of daily living. International Journal of Environmental Research and Public Health19(8): 4639.
44.
LiuYPetterssonESchandlA, et al. (2021) Higher dispositional optimism predicts better health-related quality of life after esophageal cancer surgery: A nationwide population-based longitudinal study. Annals of Surgical Oncology28: 7196–7205.
45.
LosiewiczOMMettsAVZinbargRE, et al. (2023) Examining the indirect contributions of irritability and chronic interpersonal stress on symptoms of anxiety and depression in adolescents. Journal of Affective Disorders329: 350–358.
46.
LöweBDeckerOMüllerS, et al. (2008) Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care46(3): 266–274.
47.
McFarlandDCWalshLNapolitanoS, et al. (2019) Suicide in patients with cancer: Identifying the risk factors. Oncology (08909091)33(6): 221.
48.
MarroquínBCzamanski-CohenJWeihsKL, et al. (2016) Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors. Journal of Behavioral Medicine39: 832–844.
49.
MartonGMonzaniDVerganiL, et al. (2020) Optimism is a strategy for making a better future. European Psychologist27(1): 41–61.
50.
MaunsellEBrissonJDeschěnesL (1995) Social support and survival among women with breast cancer. Cancer76(4): 631–637.
51.
MausbachBTSchwabRBIrwinSA (2015) Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: A systematic review and meta-analysis. Breast Cancer Research and Treatment152: 239–246.
52.
MayerJDSPeter (1997) Emotional Development and Emotional Intelligence: Educational Implications. New York, NY: Basic Books, pp.3–31.
53.
MejarehZNAbdollahiBHoseinipalangiZ, et al. (2021) Global, regional, and national prevalence of depression among cancer patients: A systematic review and meta-analysis. Indian Journal of Psychiatry63(6): 527.
54.
MillerLMUtzRLSupianoK, et al. (2020) Health profiles of spouse caregivers: The role of active coping and the risk for developing prolonged grief symptoms. Social Science & Medicine266: 113455.
55.
MinekaSWilliamsALWolitzky-TaylorK, et al. (2020) Five-year prospective neuroticism–stress effects on major depressive episodes: Primarily additive effects of the general neuroticism factor and stress. Journal of Abnormal Psychology129(6): 646.
56.
MirzaeiSTameAIAnbiaieR, et al. (2019) Emotional intelligence as a predictor of health-related quality of life in breast cancer Survivors. Asia-Pacific Journal of Oncology Nursing6(3): 261–268.
57.
MontiJDRudolphKD (2014) Emotional awareness as a pathway linking adult attachment to subsequent depression. Journal of Counseling Psychology61(3): 374.
58.
OsmaneSBrennanMDolanP (2021) Understanding and assessing construct validity of the social provisions scale: Implications for youth development. Journal of Youth Development16(4): 183–201.
59.
PearlinLISchoolerC (1978) The structure of coping. Journal of Health and Social Behavior19(1): 2–21.
60.
PennebakerJWBeallSK (1986) Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology95(3): 274.
61.
PereraH. N (2016). Construct validity of the social provisions scale: A bifactor exploratory structural equation modeling approach. Assessment. 23(6): 720–733.
62.
PilevarzadehMAmirshahiMAfsargharehbaghR, et al. (2019) Global prevalence of depression among breast cancer patients: A systematic review and meta-analysis. Breast Cancer Research and Treatment176: 519–533.
63.
Puigpinós-RieraRGraells-SansASerralG, et al. (2018) Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort). Cancer Epidemiology55: 123–129.
64.
RadloffLS (1977) The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement1(3): 385–401.
65.
RapaportMH (2001) Prevalence, recognition, and treatment of comorbid depression and anxiety. Journal of Clinical Psychiatry62(24): 6–10.
66.
RussellDCutronaCE (1984). The provisions of social relationships and adaptation to stress. Paper Presented at the Annual Meeting of the American Psychological Association, August1984, Anaheim, CA.
67.
SalonenPTarkkaMTKellokumpu-LehtinenPL, et al. (2013) Effect of social support on changes in quality of life in early breast cancer patients: A longitudinal study. Scandinavian Journal of Caring Sciences27(2): 396–405.
68.
ScheierMFCarverCS (1985) Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology4(3): 219.
69.
SeoJ-GParkS-P (2015) Validation of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with migraine. The Journal of Headache and Pain16: 1–7.
70.
StaffordLBerkMJacksonHJ (2007) Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. General Hospital Psychiatry29(5): 417–424.
71.
StantonALWileyJFKrullJL, et al. (2015) Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer. Breast Cancer Research and Treatment154: 105–115.
72.
StantonALWileyJFKrullJL, et al. (2018) Cancer-related coping processes as predictors of depressive symptoms, trajectories, and episodes. Journal of Consulting and Clinical Psychology86(10): 820.
73.
Stinesen KollbergKWileyJFRossKM, et al. (2019) Chronic stress in vocational and intimate partner domains as predictors of depressive symptoms after breast cancer diagnosis. Annals of Behavioral Medicine53(4): 333–344.
74.
Subic-WranaCBeutelMEBrahlerE, et al. (2014) How is emotional awareness related to emotion regulation strategies and self-reported negative affect in the general population?PLoS One9(3): e91846.
75.
SumnerJAGaoXGambazzaS, et al. (2023) Stressful life events and accelerated biological aging over time in youths. Psychoneuroendocrinology151: 106058.
76.
Tanner StapletonLRDunkel SchetterCDooleyLN, et al. (2016) The Community Child Health Network Life Stress Interview: A brief chronic stress measure for community health research. Anxiety, Stress, & Coping29(4): 352–366.
77.
UchinoBNHolt-LunstadJUnoD, et al. (2001) Heterogeneity in the social networks of young and older adults: Prediction of mental health and cardiovascular reactivity during acute stress. Journal of Behavioral Medicine24: 361–382.
78.
UchinoBNKiecolt-GlaserJKCacioppoJT (1992) Age-related changes in cardiovascular response as a function of a chronic stressor and social support. Journal of Personality and Social Psychology63(5): 839.
79.
WeihsKLEnrightTMSimmensSJ (2008) Close relationships and emotional processing predict decreased mortality in women with breast cancer: Preliminary evidence. Psychosomatic Medicine70(1): 117–124.
80.
WeissmanDGLambertHKRodmanAM, et al. (2020) Reduced hippocampal and amygdala volume as a mechanism underlying stress sensitization to depression following childhood trauma. Depression and Anxiety37(9): 916–925.
81.
YutrirakKRatta-AphaWDankulchaiP, et al. (2021) Psychometric properties of the PHQ-9, HADS, and CES-D questionnaires and the prevalence of depression in patients with cancer receiving radiotherapy. Siriraj Medical Journal73(12): 793–800.
82.
ZaorskyNGZhangYTuanquinL, et al. (2019) Suicide among cancer patients. Nature Communications10(1): 207.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
