The associations of self-stigma, social constraints, and sleep among Chinese American breast cancer survivors



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.


The data were based on self-report baseline data (n = 136) from an expressive writing intervention study for Chinese American breast cancer survivors (MTime 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.


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.


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.

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The study was funded by American Cancer Society MRSGT-10-011-01-CPPB (PI: Qian Lu). Trial registration: Identifier: NCT02946619. This manuscript was supported in part by a cancer prevention fellowship for Ivan H.C. Wu, Ph.D., by the Cancer Prevention and Research Institute of Texas grant award, RP170259, Shine Chang, PhD, Principal Investigator and by the MD Anderson Cancer Center Support Grant, CA016672, funded by the National Cancer Institute.

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Correspondence to Ivan H. C. Wu or Qian Lu.

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Wu, I.H.C., Tsai, W., McNeill, L.H. et al. The associations of self-stigma, social constraints, and sleep among Chinese American breast cancer survivors. Support Care Cancer 28, 3935–3944 (2020).

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  • Sleep
  • Oncology
  • Self-stigma
  • Ambivalence over emotional expression
  • Breast cancer survivorship