The effects of physical functioning and public stigma on psychological distress as mediated by cognitive and social factors among Korean survivors of childhood cancer.

摘要

The overall purpose of this dissertation is to examine cognitive and social mediators of psychological distress in Korean childhood cancer survivors. The four specific research aims are (1) to examine the overall prevalence of psychological distress and to compare the profile of cancer survivors with and without significant levels of psychological distress, (2) to examine perceived physical functioning and perceived public stigma as potential risk factors for psychological distress, taking into account possible sociodemographic and cancer-related correlates, (3) to test a model of the effects of perceived physical functioning and perceived public stigma on psychological distress as mediated through three cognitive and social factors, and (4) to examine gender differences within the mediated effects of perceived physical functioning and perceived public stigma on psychological distress.;Participants consisted of 223 cancer survivors diagnosed before the age of 19 years and currently residing in the community in Korea. Participants were recruited through Korean advocacy foundations and support groups for adolescent and young adult survivors of childhood cancer. Structured questionnaires were collected from June 2010 to November 2010 either by mail or email. The overall goodness of the structural model was tested and then total and specific indirect effects were tested by using bootstrap procedures in Mplus 6.12.;The primary results showed an overall prevalence rate of approximately 20% for psychological distress. Perceived poorer physical functioning and higher levels of perceived public stigma were strong risk factors for psychological distress, while controlling for age, economic status, cancer type, and time since diagnosis. There was a significant mediated effect of perceived physical functioning on psychological distress through social support availability. There was also a significant mediated effect of perceived public stigma on psychological distress through internalized shame or social support availability, or through a chain of two mediators—self-disclosure and internalized shame. The mediated effect of perceived public stigma on psychological distress differed by gender. A greater understanding of the factors influencing the levels of psychological well-being could potentially help social workers and other professionals identify childhood cancer survivors in greater needs of psychosocial services and provide them with appropriate resources and interventions.