Relationship between multifaceted body image and negative affect
among women undergoing mastectomy for breast cancer:
a longitudinal study
Received: 3 October 2017 / Accepted: 16 May 2018
Springer-Verlag GmbH Austria, part of Springer Nature 2018
The purpose of the current study was to investigate how post-surgery multifaceted body image predicts negative affect (NA)
6 months post-surgery among women undergoing mastectomy. In total, 310 Chinese women undergoing mastectomy were
recruited from a hospital in the Hunan province between 2012 and 2013. Upon enrollment (T1), all women were administered
the Chinese version of Body Image after Breast Cancer Questionnaire (BIBCQ) (BIBCQ-C), NA subscale of Positive and
Negative Affect Schedule (PANAS), Multidimensional Scale of Perceived Social Support (MSPSS), Hamilton Anxiety Scale
(HAMA), and Hamilton Depression Scale (HAMD). Two weeks later, BIBCQ-C was re-administered. Six months later (T2), the
NA subscale was administered again. We first evaluated the psychometric properties of BIBCQ-C, and then investigated the
long-term impact of different aspects of body image on NA using forced entry hierarchical regression analyses. The BIBCQ-C
scores demonstrated acceptable internal consistency (all Cronbach’s α > 0.70) and test–retest reliability (all ICC > 0.86).
Confirmatory factor analysis supported the six-factor model (CFI = 0.93, TLI = 0.94, RMSEA = 0.04). Regression analysis
showed that two dimensions of body image, vulnerability (β = 0.217) and body concern (β = 0.119) at T1, significantly predict
NA at T2 (all p < 0.05). BIBCQ-C was a good instrument for measuring multifaceted body image. Improvement of vulnerability
and body concern, two aspects of body image, may reduce post-surgery NA among Chinese women undergoing mastectomy.
Keywords Multifaceted body image
Breast cancer is a major cancer that usually occurs in women
and is a primary cause of death due to cancer for females (Siegel
et al. 2015). Currently, about 30 to 80% of women with breast
cancer received mastectomy, a primary surgery treatment,
across different countries (Chen et al. 2012; Fallbjörk et al.
2013; Agarwal et al. 2014). Inevitably, mastectomy is done
through removing either one or both breasts. This breaks body
integrity and, even worse, may cause disturbed body image,
which is defined as the disturbed subjective mental representa-
tion of the body. Hence, research attention to disturbed body
image as well as its possible consequences among women un-
dergoing mastectomy is very essential.
Many studies have addressed the relationship between dis-
turbed body image and negative emotions (Przezdziecki et al.
2013; Rosenberg et al. 2013). For example, Cash (2000)first
proposed that self-attitude of body elicits corresponding emo-
tions among individuals. Later studies have supported this
point and consistently found significant positive correlations
between disturbed body image and anxiety and depression
symptoms (Przezdziecki et al. 2013; Rosenberg et al. 2013).
In addition to anxiety and depression symptoms, previous
* Xiongzhao Zhu
Medical Psychological Center, The Second Xiangya Hospital,
Central South University, Changsha, Hunan 410011, China
Medical Psychological Institute of Central South University,
Changsha, Hunan 410011, China
Department of Medical Psychology, Public Health Institute of Harbin
Medical University, Harbin, China
The First Affiliated Hospital, Wenzhou Medical College,
Archives of Women's Mental Health