Current Psychology

, Volume 38, Issue 5, pp 1310–1317 | Cite as

Does Marital Adjustment Mediate Type C Personality-Depressive Symptoms Relation? A Comparison between Breast Cancer Patients and Cancer-Free Women

  • Özlem Bozo
  • Yagmur ArEmail author
  • Dilay Eldoğan


The purpose of this study was to investigate the relation between Type C personality and depressive symptoms in breast cancer patients, and to examine if marital adjustment mediates this relation. The data was collected from 98 married breast cancer patients undergoing post-operative chemotherapy treatment. Also, 97 married cancer-free women were included in the study as the comparison group to test whether the proposed relationship is typical only to breast cancer patients. Regression analyses indicated that marital adjustment partially mediated Type C personality-depressive symptoms relation in breast cancer patients. However, this mediation was not found in cancer-free women. Findings of the study were discussed in relation to current literature and cultural context of Turkey.


Type C personality Marital adjustment Depression Breast cancer 



This study was not funded by any institution.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amenmends or comprable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Allan, S., & Gilbert, P. (2007). Submissive behavior and psychopathology. British Journal of Clinical Psychology, 36(4), 467–488. Scholar
  2. Al Ghazal, S.K., Fallowfield, L., & Blamey, R.W. (2002). Comparison of psychological aspects andpatient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. European Journal of Cancer, 36(15), 1938–1943.Google Scholar
  3. 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(6), 1173–1182.CrossRefPubMedGoogle Scholar
  4. Beck, A. T. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571.CrossRefPubMedGoogle Scholar
  5. Blum, J. S., & Mehrabian, A. (1999). Personality and temperament correlates of marital satisfaction. Journal of Personality, 67(1), 93–125. Scholar
  6. Bowlby, J. A. (1988). Secure base: Clinical applications of attachment theory. London: Tavistock/Routledge.Google Scholar
  7. Bozo, Ö., Gündoğdu, E., & Büyükaşık-Çolak, C. (2009). The moderating role of different sources of perceived social support on the dispositional optimism-posttraumatic growth relationship in postoperative breast cancer patients. Journal of Health Psychology, 14(7), 1009–1020. Scholar
  8. Bozo, Ö., Yılmaz, T., & Tathan, E. (2012). Adaptation, reliability and validity study of Type C behavior scale. Anatolian Journal of Psychiatry, 13, 145–150.Google Scholar
  9. Burgess, C., Cornelius, V., Love, S., Graham, J., Richards, M., & Ramirez, A. (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ: British Medical Journal, 330(7493), 702–705.Google Scholar
  10. Carlson, L. E., Bultz, B. D., Speca, M., & St Pierre, M. (2000). Partners of cancer patients: Part I. impact, adjustment, and coping across the illness trajectory. Journal of Psychosocial Oncology, 18(2), 39–62.CrossRefGoogle Scholar
  11. Classen, C., Koopman, C., Angell, K., & Spiegel, D. (1996). Coping styles with psychological adjustment to advanced breast cancer. Health Psychology, 15(6), 434–437.CrossRefPubMedGoogle Scholar
  12. Eysenck, H. J. (1994). Cancer, personality and stress: Prediction and prevention. Advances in Behavior Therapy and Research, 31, 167–215.CrossRefGoogle Scholar
  13. Fernandez-Ballesteros, R., Ruiz, M. A., & Garde, S. (1998). Emotional expression in healthy women and those with breast cancer. British Journal of Health Psychology, 3(1), 41–50.Google Scholar
  14. Fışıloğlu, H., & Demir, A. (2000). Applicability of the dyadic adjustment scale for measurement of marital quality with Turkish couples. European Journal of Psychological Assessment, 16(3), 214–218.CrossRefGoogle Scholar
  15. Figueiredo, M., Fries, E., & Ingram, K. (2004). The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients. Psycho-Oncology, 13, 96–105. Scholar
  16. Frazier, P. A., Tix, A. P., & Barnett, C. L. (2003). The relational context of social support: Relationship satisfaction moderates the relations between enacted support and distress. Personality and Social Psychology Bulletin, 29(9), 1133–1146. Scholar
  17. Gross, J. (1989). Emotional expression in cancer onset and progression. Social Science and Medicine, 28, 1239–1248.CrossRefPubMedGoogle Scholar
  18. Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.CrossRefPubMedGoogle Scholar
  19. Grossarth-Maticek, R., Bastiaans, J., & Kanazir, D. (1985). Psychosocial factors as strong predictors of mortality from cancer, ischaemic heart disease and stroke: The Yugoslav prospective study. Journal of Psychosomatic Research, 29(2), 167–176.CrossRefPubMedGoogle Scholar
  20. Grossarth-Maticek, R., Eysenck, H. J., Pfeiffer, A., Schmidt, P., & Koppel, G. (1997). The specific action of different personality risk factors on cancer of the breast, cervix, corpus uteri and other. Types of cancer: A prospective investigation. Personality and Individual Differences, 23(6), 949–960.CrossRefGoogle Scholar
  21. 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 most? Journal of Health Psychology, 19(3), 274–282.  10.10371/0278-6133.19.3.274.CrossRefGoogle Scholar
  22. Hegelson, V., & Cohen, S. (1996). Social support and adjustment to cancer: Reconciling descriptive, correlational and interventional research. Journal of Health Psychology, 15(2), 135–148.CrossRefGoogle Scholar
  23. Hisli, N. (1988). Beck depresyon envanterinin geçerliği üzerine bir çalışma. Turkish Psychology Journal, 6, 118–126.Google Scholar
  24. Hünler, O. S., & Gençöz, T. (2003). Submissive behaviours and marital satisfaction relation: mediator role of perceived marital problem solving. Turkish Psychology Journal, 18(51), 99–108.Google Scholar
  25. Iwamitsu, Y., Shimoda, K., Abe, H., Tani, T., Kodama, M., & Okawa, M. (2003). Differences in emotional distress between breast tumor patients with emotional inhibition and those with emotional expression. Psychiatry and Clinical Neurosciences, 57, 289–294.CrossRefPubMedGoogle Scholar
  26. Iwamitsu, Y., Shimoda, K., Abe, H., Tani, T., Okawa, M., & Buck, R. (2005). The relation between negative emotional suppression and emotional distress in breast cancer diagnosis and treatment. Journal of Health Communication, 18(3), 201–215.CrossRefGoogle Scholar
  27. Jackson, C. W., & Jackson, K. H. (2007). Comorbid depression in adult oncology. Journal of Pharmacy Practice, 20(5), 360–367. Scholar
  28. John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and lifespan development. Journal of Personality, 72, 1301–1334.CrossRefPubMedGoogle Scholar
  29. Jones, P. S. (1995). Paying respect: care of elderly parents by Chinese and Filipino American women. Health Care for Women International, 16(5), 385–398. Scholar
  30. Kudel, I., Edwards, R., Raja, S., Haythornthewaite, J., & Heinberg, L. J. (2008). The association of perceived partner-related social support with self-reported outcomes in women post-mastectomy. Journal of Health Psychology, 13(8), 1030–1039. Scholar
  31. Kulu, I. (1990). Husbands as decision-makers in relation to family size: East-West regional differentials in Turkey. Nufusbil Dergisi, 12, 41–64.Google Scholar
  32. Kurrass, J. (2004). Type C Behavior Scale: Development and validation. Nashville: Southeastern Psychological Association.Google Scholar
  33. Kutlu, R., Çivi, S., Börüban, M. C., & Demir, A. (2011). Depression and factors affecting the quality of life in cancer patients. Selçuk University Medicine Journal, 27(3), 149–153.Google Scholar
  34. Manne, S. I., Taylor, K. L., Dougherty, J., & Kemeny, N. (1997). Supportive and negative responses in the partner relationship: Their association with psychological adjustment among individuals with cancer. Journal of Behavioral Medicine, 20(2), 101–125.CrossRefPubMedGoogle Scholar
  35. Massie, M. J. (2004). Prevalence of depression in patients with cancer. Journal of the National Cancer Institute Monographs, 32, 57–71. Scholar
  36. McKenna, M. C., Zevon, M. A., Corn, B., & Rounds, J. (1999). Psychosocial factors and the development of breast cancer: A meta-analysis. Health Psychology, 18, 520–531.CrossRefPubMedGoogle Scholar
  37. 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(4), 383–391.CrossRefPubMedGoogle Scholar
  38. Meyerowitz, B. E. (1980). Psychosocial correlates of breast cancer and its treatments. Psychological Bulletin, 87(1), 108–131. Scholar
  39. Payne, D. K., Hoffman, R. G., Theodoulou, M., Dosik, M., & Massie, M. J. (1999). Screening for anxiety and depression in women with breast cancer. Psychosomatics, 40(1), 64–69.CrossRefPubMedGoogle Scholar
  40. Reis, H., Collins, W. A., & Berscheid, E. (2000). The relationship context of human behavior and development. Psychological Bulletin, 126, 896–909.CrossRefGoogle Scholar
  41. Schlatter, M. C., & Cameron, L. D. (2010). Emotional suppression tendencies as predictors of symptoms, mood, and coping appraisals during ac chemotherapy for breast cancer treatment. Annals Behavioral Medicine, 40(15), 15–29. Scholar
  42. Servaes, P., Vingerhoets, A. J. J. M., Vreugdenhil, G., Keuningn, J. J., & Broekhuijsen, A. M. (1999). Inhibition of emotional expression in breast cancer patients. Behavioral Medicine, 25(1), 23–27.CrossRefPubMedGoogle Scholar
  43. Shapiro, S. L., Lopez, A. M., Schwartz, G. E., Bootzin, R., Figueredo, A. J., Braden, C. J., & Kurker, S. F. (2001). Quality of life and breast cancer: Relationship to psychosocial variables. Journal of Clinical Psychology, 57(4), 501–519.CrossRefPubMedGoogle Scholar
  44. Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28.CrossRefGoogle Scholar
  45. Stanton, A. L., Donoff-Burg, S., Swarowski, L. A., Collins, C. A., Rodriguez-Honley, B., et al. (2002). Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology, 20(20), 4160–4168. Scholar
  46. Şener, Ş., Günel, N., Akçalı, Z., Şenol, S., & İlden-Koçkar, A. (1999). A study about psychological and social impacts of breast cancer. Clinical Psychiatry, 2, 254–260.Google Scholar
  47. Tegin, B. (1980). Depresyonda bilişsel süreçler: Beck modeline göre. Unpublished Doctorate Thesis. Ankara: Hacettepe University.Google Scholar
  48. Temoshok, L. (1987). Personality, coping style, emotion and cancer: Toward an integrative model. Cancer Surveys, 6, 837–857.Google Scholar
  49. Triandis, H. C., & Suh, E. M. (2002). Cultural influences on personality. Annual Review of Psycholology, 53, 133–160.CrossRefGoogle Scholar
  50. Vahdaninia, M., Omidvari, S., & Montazeri, A. (2010). What do predict anxiety and Depression in breast cancer patients? A follow up study. Social Psychiatry Epidemiology, 45, 355–361.CrossRefGoogle Scholar
  51. Watson, M., Greer, S., Rowden, L., Gorman, C., Robertson, B., Bliss, J. M., & Tunmore, R. (1991). Relationships between emotional control, adjustment to cancer and depression and anxiety in breast cancer patients. Psychological Medicine, 21(1), 51–70.CrossRefPubMedGoogle Scholar
  52. Wimberly, S. R., Carver, C. S., Laurenceau, J., Harris, 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(2), 300–211. Scholar
  53. Yang, H., & Schuler, M. A. (2008). Marital quality and survivorship. Cancer, 115(1), 217–228. Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of PsychologyMiddle East Technical University UniversityAnkaraTurkey
  2. 2.Başkent UniversityAnkaraTurkey

Personalised recommendations