The associations of self-stigma, social constraints, and sleep among Chinese American breast cancer survivors
Abstract
Purpose The aim of the current study was to examine the incidence of poor sleep quality, medication use, and dysfunction and the association of self-stigma and perceived social constraints (i.e., ambivalence over emotional expression; AEE) on sleep among a sample of Chinese American breast cancer survivors.Methods The data were based on self-report baseline data (n = 136) from an expressive writing intervention study for Chinese American breast cancer survivors (M Time since diagnosis = 27.17 months; SD = 19.31). Participants completed self-report questionnaires related to psychological and physical health and health behaviors. Using linear regression and path modeling, our hypotheses were tested using models where (1) self-stigma predicted sleep characteristics (i.e., quality, medication use, and dysfunction) with (2) AEE mediating the relationship between self-stigma and sleep.Results Participants frequently reported poor sleep quality (44.9%), use of sleep aids (37.5%), and difficulty staying awake during the day (37.5%). Greater self-stigma was related to greater AEE (b = .48, SE = .09, p < .05), which was related to worse sleep quality (b = - .19, SE = .08, p < .05), greater use of sleep aids (b = .25, SE = .11, p < .05), and greater difficulty staying awake during the day (b = .30, SE = .09, p < .05). Further, the indirect effect of self-stigma on sleep quality (ab = - .09, 95% CI - .19, - .03), use of sleep aids (ab = .12, 95% CI .03, .25), and difficulty staying awake during the day (ab = .15, 95% CI .06, .18) through AEE was significant.Conclusion The results of this study highlight significant sleep-related problems among Chinese American breast cancer survivors and the importance of considering cultural beliefs of cancer in counseling.Implication for cancer survivors Chinese American breast cancer survivors are at risk for sleep-related difficulties due, in part, to perceived self-stigma and emotional constraints. Greater education and community outreach to Chinese communities may help destigmatize breast cancer and encourage emotional expression around cancer-related topics.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In Chinese society and culture, internalization of patient stereotypes, direct rejection by others, and discrimination in the social system have contributed to the creation of societal self-isolation.
“In the development of Chinese society and culture, the internalization of patient stereotypes, direct rejection by others, and discrimination in the social system have contributed to the creation of societal self-isolation [51,52].”
From Symptom Experiences before Medical Help-Seeking and Psychosocial Responses of Patients with Esophageal Cancer: A Qualitative Study. (2023) · cites this paper as [52]
Cites
(2013) · Cited by 44,563 · see citing works
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989) · Psychiatry Research · doi:10.1016/0165-1781(89)90047-4 · Cited by 35,234 · see citing works
Back-translation for cross-cultural research.
Brislin, R. W. (1970) · Journal of Cross-Cultural Psychology · doi:10.1177/135910457000100301 · Cited by 14,091 · see citing works
Harvey, A. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00061-4 · Cited by 1,790 · see citing works
Culture and stigma: Adding moral experience to stigma theory
Yang, L. H., Kleinman, A., Link, B. G., Phelan, J. C., Lee, S., & Good, B. J. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.11.013 · Cited by 1,382 · see citing works
The psychological implications of concealing a stigma: A cognitive-affective-behavioral model
Pachankis, J. E. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.2.328 · Cited by 1,305 · see citing works
Trends in the Use of Complementary Health Approaches Among Adults in the United States
Jackson, C. (2015) · Holistic Nursing Practice · doi:10.1097/hnp.0000000000000088 · Cited by 1,174 · see citing works
Insomnia in the Context of Cancer: A Review of a Neglected Problem
Savard, J., & Morin, C. M. (2001) · Journal of Clinical Oncology · doi:10.1200/jco.2001.19.3.895 · Cited by 861 · see citing works
Conflict over emotional expression: Psychological and physical correlates.
King, L. A., & Emmons, R. A. (1990) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.58.5.864 · Cited by 757 · see citing works
Conflict over emotional expression: Psychological and physical correlates.
King, L. A., & Emmons, R. A. (1990) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.58.5.864 · Cited by 545 · see citing works
Patel, N. P., Grandner, M. A., Xie, D., Branas, C. C., & Gooneratne, N. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-475 · Cited by 451 · see citing works
Prevalence, Clinical Characteristics, and Risk Factors for Insomnia in the Context of Breast Cancer
Savard, J., Simard, S., Blanchet, J., Ivers, H., & Morin, C. M. (2001) · SLEEP · doi:10.1093/sleep/24.5.583 · Cited by 414 · see citing works
Natural Course of Insomnia Comorbid With Cancer: An 18-Month Longitudinal Study
Savard, J., Ivers, H., Villa, J., Caplette‐Gingras, A., & Morin, C. M. (2011) · Journal of Clinical Oncology · doi:10.1200/jco.2010.33.2247 · Cited by 389 · see citing works
van Dalfsen, J. H., & Markus, C. R. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2017.10.002 · Cited by 329 · see citing works
National Use of Prescription Medications for Insomnia: NHANES 1999-2010
Bertisch, S. M., Herzig, S. J., Winkelman, J. W., & Buettner, C. (2014) · SLEEP · doi:10.5665/sleep.3410 · Cited by 308 · see citing works
Self-stigma among concealable minorities in Hong Kong: Conceptualization and unified measurement.
Mak, W. W. S., & Cheung, R. Y. M. (2010) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.2010.01030.x · Cited by 288 · see citing works
Haller, H., Winkler, M. M., Klose, P., Dobos, G., Kümmel, S., & Cramer, H. (2017) · Acta Oncologica · doi:10.1080/0284186x.2017.1342862 · Cited by 277 · see citing works
Social Constraints on Disclosure and Adjustment to Cancer
Lepore, S. J., & Revenson, T. A. (2007) · Social and Personality Psychology Compass · doi:10.1111/j.1751-9004.2007.00013.x · Cited by 260 · see citing works
Stigma and social support in substance abuse: Implications for mental health and well-being
Birtel, M. D., Wood, L., & Kempa, N. J. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.097 · Cited by 253 · see citing works
Understanding the breast cancer experience of Asian American women
Ashing, K. T., PADILLA, G. V., Tejero, J. S., & Kagawa‐Singer, M. (2002) · Psycho-Oncology · doi:10.1002/pon.632 · Cited by 240 · see citing works
Palesh, O. G., Aldridge-Gerry, A. A., Zeitzer, J. M., Koopman, C., Neri, E., Giese‐Davis, J., Jo, B., KRAEMER, H. C., Nouriani, B., & Spiegel, D. (2014) · SLEEP · doi:10.5665/sleep.3642 · Cited by 235 · see citing works
The impact of rumination on sleep quality following a stressful life event
Guastella, A. J., & Moulds, M. L. (2007) · Personality and Individual Differences · doi:10.1016/j.paid.2006.04.028 · Cited by 228 · see citing works
Rumination predicts longer sleep onset latency after an acute psychosocial stressor
Zoccola, P. M., Dickerson, S. S., & Lam, S. (2009) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181ae58e8 · Cited by 209 · see citing works
Insomnia and its treatment in women with breast cancer
Fiorentino, L., & Ancoli‐Israel, S. (2006) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2006.03.005 · Cited by 197 · see citing works
Sleep Disturbances in Women With Metastatic Breast Cancer
Koopman, C., Nouriani, B., Erickson, V., Anupindi, R., Butler, L. D., Bachmann, M. H., Sephton, S. E., & Spiegel, D. (2002) · The Breast Journal · doi:10.1046/j.1524-4741.2002.08606.x · Cited by 156 · see citing works
Depression in lung cancer patients: the role of perceived stigma
Gonzalez, B. D., & Jacobsen, P. B. (2010) · Psycho-Oncology · doi:10.1002/pon.1882 · Cited by 142 · see citing works
Sleep duration, melatonin and breast cancer among Chinese women in Singapore
Wu, A. H., Wang, R., Koh, W., Stanczyk, F. Z., Lee, H.-P., & Yu, M. C. (2008) · Carcinogenesis · doi:10.1093/carcin/bgn100 · Cited by 140 · see citing works
The evolving experience of illness for Chinese women with breast cancer: A qualitative study
Lam, W., & Fielding, R. (2002) · Psycho-Oncology · doi:10.1002/pon.621 · Cited by 138 · see citing works
Bardwell, W. A., Profant, J., Casden, D. R., Dimsdale, J. E., Ancoli‐Israel, S., Natarajan, L., Rock, C. L., Pierce, J. P., & for the Women's Healthy Eating & Living (WHEL) Study Group (2007) · Psycho-Oncology · doi:10.1002/pon.1192 · Cited by 136 · see citing works
Cho, J., Choi, E., Kim, S. Y., Shin, D. W., Cho, B., Kim, C., Koh, D. H., Güallar, E., Bardwell, W. A., & Park, J. H. (2013) · Psycho-Oncology · doi:10.1002/pon.3302 · Cited by 134 · see citing works
Internalised HIV-stigma, loneliness, depressive symptoms and sleep quality in people living with HIV
Fekete, E. M., Williams, S. L., & Skinta, M. D. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1357816 · Cited by 128 · see citing works
Clevenger, L., Schrepf, A., DeGeest, K., Bender, D., Goodheart, M., Ahmed, A., Dahmoush, L., Penedo, F., Lucci, J., Thaker, P. H., et al. (2013) · Cancer · doi:10.1002/cncr.28188 · Cited by 127 · cited 1× · see citing works
“Recent estimates suggest that symptoms of insomnia and sleep disturbance among BCSs can range from 42 to 63% for 1-year and 18-month post-treatment, respectively [3, 6].”
BackgroundSleep Disruption in Breast Cancer Patients and Survivors
Palesh, O. G., Aldridge-Gerry, A. A., Ulusakarya, A., Ortiz‐Tudela, E., Capuron, L., & Innominato, P. F. (2013) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2013.0179 · Cited by 120 · see citing works
Sleep and immunity: A growing field with clinical impact
Opp, M. R., & Krueger, J. M. (2015) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2015.03.011 · Cited by 119 · see citing works
Decomposing the construct of ambivalence over emotional expression in a Chinese cultural context
Chen, S. X., Cheung, F. M., Bond, M. H., & Leung, J. (2004) · European Journal of Personality · doi:10.1002/per.538 · Cited by 118 · see citing works
Insomnia and mortality: A meta-analysis
Lovato, N., & Lack, L. C. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.10.004 · Cited by 117 · see citing works
Pink Ribbons Inc: breast cancer activism and the politics of philanthropy
King, S. (2004) · International Journal of Qualitative Studies in Education · doi:10.1080/09518390410001709553 · Cited by 111 · see citing works
Stigma consciousness, racial microaggressions, and sleep disturbance among Asian Americans.
Ong, A. D., Cerrada, C. J., Lee, R. A., & Williams, D. R. (2017) · Asian American Journal of Psychology · doi:10.1037/aap0000062 · Cited by 105 · see citing works
Krueger, J. M., Takahashi, S., Kapás, L., Bredow, S., Roky, R., Fang, J., Floyd, R. A., Renegar, K. B., Guha‐Thakurta, N., Novitsky, S. V., et al. (1995) · Advances in Neuroimmunology · doi:10.1016/0960-5428(95)00007-o · Cited by 98 · see citing works
Carlson, L. E., Campbell, T. S., Garland, S. N., & Grossman, P. (2007) · Journal of Behavioral Medicine · doi:10.1007/s10865-006-9082-3 · Cited by 98 · see citing works
Gomez, S. L., Behren, J. V., McKinley, M. A., Clarke, C. A., Shariff‐Marco, S., Cheng, I. C., Reynolds, P., & Glaser, S. L. (2017) · Breast Cancer Research and Treatment · doi:10.1007/s10549-017-4229-1 · Cited by 98 · see citing works
Trudel-Fitzgerald, C., Zhou, E. S., Poole, E. M., Zhang, X., Michels, K. B., Eliassen, A. H., Chen, W. Y., Holmes, M. D., Tworoger, S. S., & Schernhammer, E. S. (2017) · British Journal of Cancer · doi:10.1038/bjc.2017.85 · Cited by 98 · see citing works
Wong-Kim, E., Sun, A. C., Merighi, J. R., & Chow, E. A. (2005) · Cancer Control · doi:10.1177/1073274805012004s02 · Cited by 85 · see citing works
Yang, X., & Mak, W. W. S. (2017) · Mindfulness · doi:10.1007/s12671-016-0635-4 · Cited by 84 · see citing works
Karbani, G., Lim, J. N. W., Hewison, J., Atkin, K. M., Horgan, K. J., Lansdown, M., & Chu, C. E. (2011) · PubMed · Cited by 78 · see citing works
Health-Related Stigma as a Determinant of Functioning in Young Adults with Narcolepsy
Kapella, M. C., Berger, B. E., Vern, B. A., Vispute, S., Prasad, B., & Carley, D. W. (2015) · PLoS ONE · doi:10.1371/journal.pone.0122478 · Cited by 74 · see citing works
The Experience of Cancer Stigma in Taiwan: A Qualitative Study of Female Cancer Patients
Tang, P., Mayer, D. K., Chou, F., & Hsiao, K.-Y. (2015) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2015.08.015 · Cited by 68 · see citing works
Pre-diagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival
Phipps, A. I., Bhatti, P., Neuhouser, M. L., Chen, C., Crane, T. E., Kroenke, C. H., Ochs‐Balcom, H. M., Rissling, M. B., Snively, B. M., Stefanick, M. L., et al. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.5674 · Cited by 68 · see citing works
Mindfulness Model of Stigma Resistance Among Individuals with Psychiatric Disorders
Chan, K. K. S., Lee, C. W. L., & Mak, W. W. S. (2018) · Mindfulness · doi:10.1007/s12671-018-0887-2 · Cited by 63 · see citing works
Lu, Q., Gallagher, M. W., Loh, A., & Young, L. (2018) · Annals of Behavioral Medicine · doi:10.1093/abm/kax067 · Cited by 53 · see citing works
Kabat, G. C., Xue, X., Kamensky, V., Zaslavsky, O., Stone, K. L., Johnson, K., Wassertheil-Smoller, S. W., Shadyab, A. H., Luo, J., Hale, L. E., et al. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.05.015 · Cited by 49 · see citing works
Sleep aid use during and following breast cancer adjuvant chemotherapy
Moore, T. A., Berger, A. M., & Dizona, P. J. (2010) · Psycho-Oncology · doi:10.1002/pon.1756 · Cited by 42 · see citing works
Chinese-Australian Women's Beliefs About Cancer
Kwok, C., & Sullivan, G. (2006) · Cancer Nursing · doi:10.1097/00002820-200609000-00014 · Cited by 39 · see citing works
Yeung, N. C. Y., Ramirez, J., & Lü, Q. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3632-9 · Cited by 39 · see citing works
Else-Quest, N. M., & Jackson, T. L. (2013) · American Psychological Association eBooks · doi:10.1037/14297-009 · Cited by 37 · see citing works
Insomnia and mortality: A meta‐analysis
(2019) · Journal of Sleep Research · doi:10.1111/jsr.16_12912 · Cited by 35 · see citing works
Ethnic Experience of Cancer: A Qualitative Study of Chinese–Australians in Brisbane, Queensland
Lui, C., Ip, D., & Chui, W. H. (2009) · Social Work in Health Care · doi:10.1080/00981380802440403 · Cited by 31 · see citing works
Ruff, R. R., Ng, J., Jean‐Louis, G., Elbel, B. D., Chaix, B., & Duncan, D. T. (2016) · Behavioral Medicine · doi:10.1080/08964289.2016.1203754 · Cited by 30 · see citing works
Tsai, W., & Lü, Q. (2017) · International Journal of Behavioral Medicine · doi:10.1007/s12529-017-9705-9 · Cited by 29 · see citing works
Self-citationWong, C. C. Y., Warmoth, K., Ivy, S., Cheung, B., & Lü, Q. (2017) · Psycho-Oncology · doi:10.1002/pon.4604 · Cited by 28 · see citing works
Petrov, M. E. R., Howard, V. J., Kleindorfer, D., Grandner, M. A., Molano, J. R. V., & Howard, G. (2014) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2014.03.025 · Cited by 23 · see citing works
Sleep disturbance among Chinese breast cancer survivors living in the USA
Gonzalez, B. D., & Lü, Q. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4128-y · Cited by 23 · see citing works
Theories, Models, and Frameworks Related to Sleep-Wake Disturbances in the Context of Cancer
Otte, J. L., & Carpenter, J. S. (2009) · Cancer Nursing · doi:10.1097/01.ncc.0000339261.06442.7d · Cited by 21 · see citing works
Tsai, W., Wu, I. H. C., & Lü, Q. (2019) · Psycho-Oncology · doi:10.1002/pon.5053 · Cited by 21 · see citing works
Self-citationWarmoth, K., Wong-Meli, C. C. Y., Chen, L., Ivy, S., & Lü, Q. (2020) · Psychology Health & Medicine · doi:10.1080/13548506.2020.1734638 · Cited by 21 · see citing works
The Pain of Ambivalence over Emotional Expression
Wang, C., Wong, C. C. Y., & Lü, Q. (2017) · International Journal of Behavioral Medicine · doi:10.1007/s12529-017-9696-6 · Cited by 9 · see citing works
Agenda for Sleep Research in Older Adults With Cancer
Matthews, E. E., Hacker, E. D., Otte, J. L., & Dean, G. E. (2016) · Cancer Nursing · doi:10.1097/ncc.0000000000000464 · Cited by 5 · see citing works
Wu, I. H. C., McNeill, L. H., & Lü, Q. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4329-4 · Cited by 5 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Correlates of stigma for patients with cancer: a systematic review and meta-analysis
Huang, Z., Yu, T., Wu, S., & Hu, A. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-020-05780-8 · Cited by 90 · see citing works
Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study
Jin, R., Xie, T., Zhang, L., Gong, N., & Zhang, J. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.101972 · Cited by 82 · see citing works
Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis
Tang, W.-Z., Yusuf, A., Jia, K., Iskandar, Y. H. P., Mangantig, E., Mo, X.-S., Wei, T.-F., & Cheng, S.-L. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07506-4 · Cited by 61 · see citing works
Aquil, A., Kherchi, O. E., Azmaoui, N. E., Mouallif, M., Guerroumi, M., Chokri, A., Jayakumar, A. R., Benider, A., & Elgot, A. (2021) · BMC Women s Health · doi:10.1186/s12905-021-01375-5 · Cited by 48 · see citing works
“This result is consistent with a Chinese study showing a strong association between self-stigma and impaired sleep quality in cancer patients [19].”
ResultThe stigma in patients with breast cancer: A concept analysis
Wu, J., Zeng, N., Wang, L., & Yao, L. (2023) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2023.100293 · Cited by 45 · see citing works
“Some people believe that people develop cancer is a punishment for their immoral behavior 42 ; this belief results in the discrimination and exclusion of patients.”
BackgroundLi, H., Zheng, L., Le, H., Zhuo, L., Wu, Q., Ma, G., & Tao, H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249237 · Cited by 42 · see citing works
Nwanaji-Enwerem, U., Condon, E. M., Conley, S., Wang, K., Iheanacho, T., & Redeker, N. S. (2022) · Sleep Health · doi:10.1016/j.sleh.2022.03.004 · Cited by 39 · see citing works
Wang, Z., Dang, J., Zhang, X., Moore, J. B., & Li, R. (2020) · Quality of Life Research · doi:10.1007/s11136-020-02620-4 · Cited by 34 · see citing works
Grayson, S., Sereika, S. M., Harpel, C. K., Diego, E. J. B., Steiman, J. G., McAuliffe, P. F., & Wesmiller, S. W. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06373-9 · Cited by 31 · see citing works
Li, S., Wang, X., Wang, M., Jiang, Y., Mai, Q., Wu, J., & Ye, Z. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102453 · Cited by 27 · see citing works
Neurological disorders after hysterectomy: from pathogenesis to clinical manifestations
Солопова, А. Г., Blinov, D. V., Begovich, E., Николаевна, С. Л., Demyanov, S. V., & Demyanov, G. V. (2022) · Epilepsy and Paroxysmal Conditions · doi:10.17749/2077-8333/epi.par.con.2022.115 · Cited by 28 · see citing works
The interplay between stigma and sleep quality in breast cancer: A cross-sectional network analysis
Li, S., Jiang, Y., Yuan, B., Wang, M., Zeng, Y., Knobf, M. T., Wu, J., & Ye, Z. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102502 · Cited by 20 · see citing works
Cui, C., Wang, L., & Wang, X. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04407-y · Cited by 14 · see citing works
US Cancer Mortality Trends Among Asian and Pacific Islander Populations
Zhu, D. T., Pompa, I. R., Qi, D., Goldberg, S. I., Lee, R. J., & Kamran, S. C. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.42451 · Cited by 14 · see citing works
Development and validation of the Convalescence Symptom Assessment Scale for EsophageCtomy patients
Ge, H., Ma, X., Li, W., Wang, P., Zhang, Z., Qin, Q., & Li, S. (2024) · Nursing Open · doi:10.1002/nop2.2085 · Cited by 13 · see citing works
“In the development of Chinese society and culture, the internalization of cancer stereotypes by patients, over-protection by family members and direct rejection by others have contributed to the genera - tion of social self-isolation (Chu et al., 2021; Wu et al., 2020).”
BackgroundThe association between comorbidities and stigma among breast cancer survivors
Zhang, Y., Zhao, J., Jiang, N., Liu, Y., Wang, T., Yu, X., Wang, J., & Yu, J. (2022) · Scientific Reports · doi:10.1038/s41598-022-15460-8 · Cited by 11 · see citing works
Yan, Z., Xiao, L. D., Guo, X., Hu, Y., Wang, N., & Wang, Y. (2025) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2025.100740 · Cited by 8 · see citing works
“21,22 Additionally, their family members or other caregivers, influenced by traditional culture, also have a deep-rooted fear of death.”
Cui, C., & Wang, L. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06379-7 · Cited by 8 · see citing works
Ge, H., Zhang, L., Ma, X., Li, W., & Li, S. (2023) · European Journal of Cancer Care · doi:10.1155/2023/6506917 · Cited by 5 · see citing works
Zhang, X., Lin, R., Zhang, Z., Hu, Q., Li, P., Fei, X., Jiang, Z., Zhang, Q., Deng, Q., Wang, G., et al. (2025) · Psychology Research and Behavior Management · doi:10.2147/prbm.s529940 · Cited by 5 · see citing works
“14 Despite the varying findings on the influence of self-stigma on sleep patterns across these studies, the differences in sample sources, sizes, and methodologies limit the availability of robust evidence in the context of different patients.”
Gu, Z., Wang, J., Yang, C. X., & Wu, H. L. (2024) · Nature and Science of Sleep · doi:10.2147/nss.s457651 · Cited by 4 · see citing works
“16,17 It could be seen that patients with physical changes or defects and obvious disease characteristics were more likely to have a sense of shame.”
BackgroundTsai, W., Kim, J. H. J., Yeung, N. C. Y., & Lü, Q. (2024) · Asian American Journal of Psychology · doi:10.1037/aap0000330 · Cited by 3 · see citing works
Self-citationLin, H., Zhong, Y., Zheng, S., Jiang, X., Xu, Y., Chan, S., Liu, S., Chow, K. M., Yang, Q., Huang, W., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/85913 · Cited by 2 · see citing works
Sleep disorder among patients with breast cancer: A concept analysis
Aini, N., Janitra, F. E., Wicaksana, A. L., Mỹ, Đ. T. T., & Trung, N. V. (2022) · Jurnal Keperawatan Padjadjaran · doi:10.24198/jkp.v10i3.2056 · Cited by 2 · see citing works
“Additionally, most younger breast cancer patients have VMS, which both directly and indirectly affects sleep difficulty and, in turn, indirectly affects mood, which is partly mediated by sleep difficulty (Vincent et al., 2014; Weng et al., 2021; Wu et al., 2020).”
BackgroundEslamijouybari, M., Patidar, V., Mudgal, S. K., Gaur, R., Marznaki, Z. H., Fournier, A., Hakimi, M. H., & Khosravi, S. (2025) · BMC Women s Health · doi:10.1186/s12905-025-03853-6 · Cited by 1 · see citing works
Begovich, E., Demyanov, S. V., & Demyanov, G. V. (2024) · Реабилитология. · doi:10.17749/2949-5873/rehabil.2024.20 · Cited by 1 · see citing works
Yang, L., Liu, X., Xu, H., & Li, J.-Y. (2025) · Psycho-Oncologie · doi:10.18282/po3650
Lin, X., Wang, Y., Miao, X., Huang, Z., Cheng, X., Cheng, L., He, J., & Xia, S. (2025) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2025.100800
Ye, Y., Song, R., Zhao, F., & Chen, L. (2026) · BMC Cancer · doi:10.1186/s12885-026-16375-7
“Most existing studies focused on the effects of stigma on sleep quality instead of the opposite pathway in cancer patients [48, 49].”
- Authors
- Wu, I. H. C., Tsai, W., McNeill, L. H., & Lu, Q.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- New York University (US)
- Corresponding author
- Wu, Ivan H. C.
- Venue
- Supportive Care in Cancer
- Published
- 2019-12-19
- Volume
- 28
- Issue
- 8
- Pages
- 3935-3944
- ISSN
- 0941-4355 (ISSN-L)
- 1433-7339
- OpenAlex
- W2994990046
- Cited by
- 29
- References
- 67
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 4 · 2022: 6 · 2021: 3 · 2020: 3
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Supportive Care in Cancer (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Cancer Society (MRSGT-10-011-01-CPPB)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- self-stigma, ambivalence over emotional expression, sleep quality, sleep aids, daytime sleepiness, emotional expression
- MeSH terms
- Cancer Survivors, Affect, Asian, Breast Neoplasms, Emotions, Female, Humans, Middle Aged, Quality of Life, Surveys and Questionnaires, Self Concept, Sleep, Social Behavior, Dyssomnias, Social Stigma
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
