نقش میانجی تنظیم هیجان در تبیین روابط علّی بین ترومای دوران کودکی و تصویر بدنی در زنان با تجربه جراحی ماستکتومی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری، گروه روانشناسی، واحد تنکابن، دانشگاه آزاد اسلامی، تنکابن، ایران

2 دانشیار، گروه روانشناسی، دانشکده علوم اقتصادی و اجتماعی، دانشگاه بوعلی سینا، همدان، ایران

3 استاد، گروه روانشناسی، دانشکده علوم اقتصادی و اجتماعی، دانشگاه بوعلی سینا، همدان، ایران

چکیده

مقدمه: سرطان پستان شایع‌ترین سرطان زنان است و بازماندگان آن با اضطراب، افسردگی و تصویر بدنی منفی مواجه‌اند. این پژوهش با هدف بررسی رابطه آسیب‌های دوران کودکی با تصویر بدنی زنان ماستکتومی‌شده و نقش میانجی تنظیم هیجان انجام شد.
روش‌ کار: روش پژوهش حاضر از نوع تحقیقات توصیفی- همبستگی، معادلات ساختاری بود. نمونه پژوهش شامل 250 نفر از زنانی بود که در سال‌های 1401-1403 تحت عمل جراحی ماستکنومی قرار گرفتند و به روش نمونه‌گیری هدفمند از واحد شیمی درمانی و رادیوتراپی مرکز ام آر آی مهدیه، بخش جراحی و آنکولوژی بیمارستان بعثت همدان انتخاب شدند. ابزار جمع‌آوری داده‌ها شامل پرسشنامه ترومای دوران کودکی (برنشتاین، 1988)، تصویر بدنی (هوپورد و همکاران، 2001) و تنظیم هیجان (گراس و جان، 2003) بود. تحلیل داده‌ها به‌صورت توصیفی و استنباطی با استفاده از نرم افزار spss-22 و amous-22 انجام شد.
یافته ها: نتایج نشان داد بین ترومای کودکی و تصویر بدنی، همچنین بین تنظیم هیجان و تصویر بدنی، رابطه معناداری وجود دارد (P<0.01). ترومای کودکی اثر مستقیم منفی بر تنظیم هیجان (01/0> P، 302/5-=T، 42/0-=β)و تصویر بدنی (05/0> P، 453/2=T، 289/0=β) داشت. همچنین، تنظیم هیجان به‌طور مستقیم بر تصویر بدنی اثرگذار بود(01/0> P، 13/3-=T، 524/0=β) نقش میانجی‌گری تنظیم هیجان نیز در این رابطه تأیید شد(P<0.01). شاخص‌های برازش مدل نشان‌دهنده برازش مناسب مدل پیشنهادی با داده‌ها بودند.
نتیجه‌گیری: آسیب‌های کودکی می‌تواند تصویر بدنی زنان ماستکتومی‌شده را تضعیف کند و تنظیم هیجان نقش کلیدی در این فرآیند دارد. تقویت تنظیم هیجان می‌تواند به بهبود تصویر بدنی و کیفیت زندگی این بیماران کمک کند.

کلیدواژه‌ها

عنوان مقاله [English]

The Mediating Role of Emotion Regulation in Explaining Causal Relationships Between Childhood Trauma and Body Image in Women with Mastectomy Surgery

نویسندگان [English]

  • Parastou Malekanmehr 1
  • Hossein Mohagheghi 2
  • Abolghasem Yaghoobi 3
1 PhD student, Department of Psychology, To.C., Islamic Azad University, Tonekabon, Iran.
2 Associate Professor of Department of Psychology, Faculty of Economics and Social Sciences, Bu-Ali Sina University, Hamedan, Iran
3 Professor, Department of Psychology, Faculty of Economics and social Sciences, Bu-Ali Sina University, Hamedan, Iran
چکیده [English]

Introduction: Breast cancer is the most common cancer in women, and its survivors face problems such as anxiety, depression, and negative body image. This study aimed to investigate the relationship between childhood trauma and body image in mastectomized women and the mediating role of emotion regulation.
Methods: The present research method was descriptive-correlational research, structural equations. The research sample consisted of 250 women who underwent mastectomy surgery in 1401-1403 and were selected through purposive sampling from the chemotherapy and radiotherapy unit of Mahdieh MRI Center, and the surgery and oncology department of Besat Hospital, Hamadan. The data collection tools included the Childhood Trauma Questionnaire (Bernstein, 1988), Body Image (Hopford et al., 2001), and Emotion Regulation (Gross and John, 2003). Data analysis was performed descriptively and inferentially using SPSS-22 and Amous-22 software.
Findings: The results showed that there was a significant relationship between childhood trauma and body image, as well as between emotion regulation and body image (P<0.01). Childhood trauma had a direct negative effect on emotion regulation (P<0.01, T=-5.302, β=-0.42) and body image (P<0.05, T=2.453, β=0.289). Also, emotion regulation directly affected body image (P<0.01, T=-3.13, β=0.524). The mediating role of emotion regulation was also confirmed in this relationship (P<0.01). The model fit indices indicated a good fit of the proposed model with the data. Conclusion: Childhood trauma can weaken the body image of mastectomized women, and emotion regulation plays a key role in this process. Strengthening emotion regulation can help improve body image and quality of life in these patients.

کلیدواژه‌ها [English]

  • Childhood trauma
  • emotion regulation
  • body image
  • cancer
  • mastectomy

مراجع

  1. Bettariga F, Galvao DA, Taaffe DR, Bishop C, Lopez P, Maestroni L, Quinto G, Crainich U, Verdini E, Bandini E, Natalucci V. Association of muscle strength and cardiorespiratory fitness with all-cause and cancer-specific mortality in patients diagnosed with cancer: a systematic review with meta-analysis. British Journal of Sports Medicine. 2025 May 1;59(10):722-32.
  2. Osman NT, Khalaf M, Ibraheem S. Assessment of CIP2A and ROCK-I expression and their prognostic value in breast cancer. Polish Journal of Pathology. 2020 Jan 1;71(2):87-98.
  3. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA: a cancer journal for clinicians. 2024 Jan 1;74(1).
  4. Xu Y, Gong M, Wang Y, Yang Y, Liu S, Zeng Q. Global trends and forecasts of breast cancer incidence and deaths. Scientific data. 2023 May 27;10(1):334.
  5. Martín M, Herrero A, Echavarría I. El cáncer de mama. Arbor. 2015 Jun 30;191(773):a234-
  6. Kinkead B, Schettler PJ, Larson ER, Carroll D, Sharenko M, Nettles J, Edwards SA, Miller AH, Torres MA, Dunlop BW, Rakofsky JJ. Massage therapy decreases cancer‐related fatigue: Results from a randomized early phase trial. Cancer. 2018 Feb 1;124(3):546-54.
  7. Rios MC, Pedraza RS. Anxiety and depression disorders in relation to the quality of life of breast cancer patients with locally advanced or disseminated stage. Revista Colombiana de Psiquiatría (English ed.). 2018 Oct 1;47(4):211-20.
  8. Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, Zackrisson S, Senkus E, ESMO Guidelines Committee. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2019 Aug 1;30(8):1194-220.
  9. Mansilla JR, Díaz AS, Sánchez BG, Ramírez-Durán MD, Ardila EM, Sánchez MD, Palomares MJ. Effects of Massage Therapy in Breast Cancer Survivors with Mastectomy: Systematic Review. Cancers. 2025 Jun 17;17(12):2023.

10.Rose L, Mallela T, Waters M, Novice M, Minta A, Akintilo L, Shipp D, Dulmage B. Cosmetic considerations after breast cancer treatment. Archives of dermatological research. 2024 May 24;316(6):223.

11.Donahue PM, MacKenzie A, Filipovic A, Koelmeyer L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast cancer research and treatment. 2023 Jul;200(1):1-4.

  1. Dixon-Douglas J, Loi S. Immunotherapy in early-stage triple-negative breast cancer: where are we now and where are we headed?. Current treatment options in oncology. 2023 Aug;24(8):1004-20.
  2. Wu Y, Zhang C, Wang H, Zeng Z, You S, Fang Q, Fang M. Clinical observational study of gasless endoscope-assisted modified radical mastectomy combined with stage I prosthesis reconstruction through anterior axillary line incision. Current problems in surgery. 2025 Feb 1;63:101702.
  3. Wang R, Yang HX, Chen J, Huang JJ, Lv Q. Best treatment options for occult breast cancer: A meta-analysis. Frontiers in oncology. 2023 May 12;13:1051232.
  4. Jatoi I, Benson JR. Surgical management of the axilla in early breast cancer. Current problems in surgery. 2018 Feb 2;55(2):47-65.
  5. Wang K, Yu Z, Rong X, Tang J, Dang J, Li H, Yang J, Peng H, Yi C. Meta-analysis of the oncological safety of autologous fat grafting after breast cancer on basic science and clinical studies. Aesthetic Plastic Surgery. 2023 Aug;47(4):1245-57.
  6. Si J, Guo R, Lu X, Han C, Xue L, Xing D, Chen C. Decision aids on breast conserving surgery for early stage breast cancer patients: a systematic review. BMC medical informatics and decision making. 2020 Oct 22;20(1):275.
  7. Thakur M, Sharma R, Mishra AK, Gupta B. Body image disturbances among breast cancer survivors: A narrative review of prevalence and correlates. Cancer Research, Statistics, and Treatment. 2022 Jan 1;5(1):90-6.
  8. Rodrigues EC, Neris RR, Nascimento LC, de Oliveira‐Cardoso ÉA, Dos Santos MA. Body image experience of women with breast cancer: A meta‐synthesis. Scandinavian journal of caring sciences. 2023 Mar;37(1):20-36.
  9. Przezdziecki A, Alcorso J, Sherman KA. My Changed Body: Background, development and acceptability of a self-compassion based writing activity for female survivors of breast cancer. Patient Education and Counseling. 2016 May 1;99(5):870-4.
  10. Nargis F, Jauhar AA, Sattar M, Saba N, Riaz S, Waheed A. Understanding body image and sexual dysfunctions among women with breast cancer in Pakistan. Contemporary Journal of Social Science Review. 2025 Mar 20;3(1):1863-75.
  11. Lovelace DL, McDaniel LR, Golden DL. Long-term effects of breast cancer surgery, treatment, and survivor care. J Midwifery Womens Health. 2019;64(6):713–24. 12.
  12. Balkan E, Oskay Ü. Jinekolojik Kanser Hastası ve ailesinin psiko-sosyal Bakımında Sağlık Profesyonelinin Rolü. Bandırma Onyedi Eylül Univ Sağlık Bilim Araş Derg. 2023;5(1):74–83. 13.
  13. Erturhan Türk K, Yılmaz M. The effect on quality of life and body image of mastectomy among breast cancer survivors. Eur J Breast Health. 2018;14:205–10. 14.
  14. Başkaya K. Meme Kanseri Olan Kadınlarda Beden Imajı ve cinsel Uyumun belirlenmesi (Yüksek lisans tezi]. İstanbul: İstanbul Medipol Üniversitesi Sağlık Bilimleri Enstitüsü; 2019. 15.
  15. Yılmaz M, Gürler H. The relationship between body image and sexuality after surgical treatment in women with breast cancer. J Educ Res Nurs. 2020;17(3):244–51.
  16. Jin R, Xie T, Zhang L, Gong N, Zhang J. Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study. European Journal of Oncology Nursing. 2021 Jun 1;52:101972.
  17. Jakobsen K, Magnus E, Lundgren S, Reidunsdatter RJ. Everyday life in breast cancer survivors experiencing challenges: A qualitative study. Scandinavian journal of occupational therapy. 2018 Jul 4;25(4):298-307.
  18. Amini‐Tehrani M, Zamanian H, Daryaafzoon M, Andikolaei S, Mohebbi M, Imani A, Tahmasbi B, Foroozanfar S, Jalali Z. Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model. Journal of Advanced Nursing. 2021 Aug;77(8):3412-23.
  19. Sebri V, Pravettoni G. Tailored psychological interventions to manage body image: an opinion study on breast cancer survivors. International Journal of Environmental Research and Public Health. 2023 Feb 8;20(4):2991.
  20. Pino O, Cadena RT, Poli D. A comprehensive review on multifaceted mechanisms involved in the development of breast cancer following adverse childhood experiences (ACEs). International journal of environmental research and public health. 2022 Oct 2;19(19):12615.
  21. Senaratne DN, Thakkar B, Smith BH, Hales TG, Marryat L, Colvin LA. The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis. BMC medicine. 2024 Aug 15;22(1):315.
  22. Ranallo L. Feasibility Study of Adverse Childhood Experiences, Treatment-Related Sequelae, and Inflammatory Markers in Breast Cancer Survivors. Number 6/November 2024. 2024 Nov 1;51(6):516-28.
  23. McLennan JD, Gonzalez A, MacMillan HL, Afifi TO. Routine screening for adverse childhood experiences (ACEs) still doesn't make sense. Child abuse & neglect. 2024 Feb 22:106708.
  24. Hinnen C, Von Haeseler E, Tijssens F, Mols F. Adverse childhood events and mental health problems in cancer survivors: a systematic review. Supportive Care in Cancer. 2024 Jan;32(1):80.
  25. Abouelmagd ME, AbdelMeseh M, Elrosasy A, Eldeeb HA, Nabil Y. Adverse childhood experiences and risk of late-life dementia: a systematic review and meta-analysis. Social psychiatry and psychiatric epidemiology. 2025 May;60(5):1087-98.
  26. Daníelsdóttir HB, Aspelund T, Shen Q, Halldorsdottir T, Jakobsdóttir J, Song H, Lu D, Kuja-Halkola R, Larsson H, Fall K, Magnusson PK. Adverse childhood experiences and adult mental health outcomes. JAMA psychiatry. 2024 Jun 1;81(6):586-94.
  27. Sher-Censor E, Makarov M, Shai A. The impact of adverse childhood experiences on pain and subjective cognitive decline in patients treated for localized breast cancer: The mediating role of sense of coherence, sense of danger and psychosocial distress and danger. The Breast. 2025 Apr 1;80:103884.
  28. Bower JE, Asher A, Garet D, Petersen L, Ganz PA, Irwin MR, Cole SW, Hurvitz SA, Crespi CM. Testing a biobehavioral model of fatigue before adjuvant therapy in women with breast cancer. Cancer. 2019 Feb 15;125(4):633-41.

40.Bower JE, Wiley J, Petersen L, Irwin MR, Cole SW, Ganz PA. Fatigue after breast cancer treatment: Biobehavioral predictors of fatigue trajectories. Health Psychology. 2018 Nov;37(11):1025.

41.Bower JE, Crosswell AD, Slavich GM. Childhood adversity and cumulative life stress: risk factors for cancer-related fatigue. Clinical Psychological Science. 2014 Jan;2(1):108-15.

  1. Kanzawa-Lee GA, Knoerl R, Williams DA, Clauw DJ, Bridges CM, Harte SE, Kolarik E, Houghtby J, Smith EM. Childhood trauma predicts cancer treatment–related pain in breast cancer survivors. Cancer nursing. 2020 Jul 1;43(4):E207-16.
  2. Sebri V, Durosini I, Mazzoni D, Pravettoni G. Breast cancer survivors’ motivation to participate in a tailored physical and psychological intervention: a qualitative thematic analysis. Behavioral Sciences. 2022 Aug 7;12(8):271.
  3. Kovač A, Tovilović S, Bugarski-Ignjatović V, Popović-Petrović S, Tatić M. The role of cognitive emotion regulation strategies in health related quality of life of breast cancer patients. Vojnosanitetski pregled. 2020;77(10):1032-40.
  4. Supriati L, Sudiana IK, Nihayati HE, Rodli M. Emotional Regulation Intervention for Reducing Distress Psychologist in Breast Cancer Woman: Systematic Review. Journal of International Dental & Medical Research. 2021 Jul 1;14(3).
  5. Harris RE, Ichesco E, Cummiford C, Hampson JP, Chenevert TL, Basu N, Zick SM. Brain connectivity patterns dissociate action of specific acupressure treatments in fatigued breast cancer survivors. Frontiers in Neurology. 2017 Jun 23;8:298.
  6. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology. 2003 Aug;85(2):348.
  7. Li L, Yang Y, He J, Yi J, Wang Y, Zhang J, Zhu X. Emotional suppression and depressive symptoms in women newly diagnosed with early breast cancer. BMC women's health. 2015 Oct 24;15(1):91.
  8. McRae K. Cognitive emotion regulation: A review of theory and scientific findings. Current Opinion in Behavioral Sciences. 2016 Aug 1;10:119-24.
  9. Fritzson E, Bellizzi KM, Zhang N, Park CL. Effects of resilience and emotion regulation on perceptions of positive and negative life changes in Cancer survivors: a longitudinal study. Annals of Behavioral Medicine. 2024 Apr 1;58(4):253-63.
  10. Sebri V, Policardo GR, Pravettoni G. How to improve emotional regulation in breast cancer survivors? A psychological intervention. Frontiers in Psychology. 2024 Sep 13;15:1443635.
  11. Karimzadeh Y, Rahimi M, Goodarzi MA, Tahmasebi S, Talei A. Posttraumatic growth in women with breast cancer: emotional regulation mediates satisfaction with basic needs and maladaptive schemas. European journal of psychotraumatology. 2021 Jan 1;12(1):1943871.
  12. Ebrahimi H, Dejkam M, Seghatoleslam T. Childhood Traumas and Suicide Attempt in adulthood . IJPCP 2014; 19 (4) :275-282
  13. Arbab, H., Mirzahosini, H., Monirpoor, N. Predicting the Substance Use Relapse according to Childhood Trauma: Mediating Role of Object Relations Alienation, Borderline Personality Organization & Depression. Journal of Clinical Psychology, 2020; 11(4): 1-12. doi: 10.22075/jcp.2020.19478.1806
  14. Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. European journal of cancer. 2001 Jan 1;37(2):189-97.
  15. Rajabi G, Kaveh Farsani Z, Fadaei Dehcheshmeh H, Jelodari A. Psychometric Properties of the Persian version Scale of Body Image among Patients with Breast Cancer. ijbd 2015; 8 (2) :66-74
  16. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology. 2003 Aug;85(2):348.
  17. Wang Y, Wang S, Tong L, Zhuang J, Xu Y, Wu Y, Chen L. Relationships between body image, dyadic coping and post-traumatic growth in breast cancer patients: a cross-sectional study. Frontiers in Psychology. 2024 May 9;15:1368429.
  18. Rossi E, Cassioli E, Maggi M, Ricca V, Castellini G. Childhood Sexual Abuse and Psychopathology. InEmotional, Physical and Sexual Abuse: Impact on Individuals, Couples, Children and Minorities 2024 Feb 25 (pp. 189-211). Cham: Springer International Publishing.
  19. Berberoğlu Z, Hocaoğlu Ç. The relationship between childhood trauma and body image, self-esteem and eating attitudes in patients undergoing bariatric surgery. Turkish Journal of Psychiatry. 2023 Oct 12;35(2):116.
  20. Råman L, Scheffers M, Moeijes J, Jeronimus BF. Childhood abuse and neglect and adult body attitude. European Journal of Psychotraumatology. 2025 Dec 31;16(1):2439652.
  21. Wu Q, Zhou N, He J, Lin X, Cao H. Childhood emotional maltreatment and emerging adults’ body dissatisfaction: Self-compassion and body surveillance as explanatory mechanisms. Body Image. 2024 Dec 1;51:101799.
  22. Abdel-Fadeel NA, Zanaty MM, Kamal AM, Hassan MA, Taha M. Childhood psychological trauma and psychiatric comorbidity in patients with breast cancer. The Egyptian Journal of Hospital Medicine. 2022 Jul 1;88(1):2788-94.
  23. Hajiyousef H, Dehestani M, Darvish Molla M. The mediating role of emotion regulation difficulties in the relationship between abuse experiences and body image dissatisfaction among adolescent girls. Journal of Applied Psychological Research. 2022 May 22;13(1):327-44.
مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
دوره 68، شماره 6
بهمن-اسفند1404
بهمن و اسفند 1404
صفحه 1725-1735

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