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. Author manuscript; available in PMC: 2020 Feb 1.
Published in final edited form as: Cognit Ther Res. 2018 Nov 1;43(1):32–44. doi: 10.1007/s10608-018-9975-9

Resilience and Coping in Cancer Survivors: The Unique Effects of Optimism and Mastery

Matthew W Gallagher 1, Laura J Long 1, Angela Richardson 1, Johann M D’Souza 1
PMCID: PMC6586435  NIHMSID: NIHMS1511362  PMID: 31223177

Abstract

Optimism and mastery are two cognitive traits that involve positive expectations for the future and that have been demonstrated to be important predictors of reduced anxiety as well as superior coping and physical health in many populations, including cancer survivors. There is limited research, however, examining the unique effects of these traits when examined simultaneously. The present cross-sectional study used structural equation modeling to examine the unique effects of optimism and mastery on emotion, coping, and health in 603 adult cancer survivors, and whether results were consistent in men and women. Results indicated that both optimism and mastery were associated with improved emotion, coping, and health and together accounted for a small to moderate amount of variance. Although the effects of optimism were generally greater, mastery also uniquely predicted most dependent variables and there was some evidence that gender influenced these effects, with optimism predicting health control more so in women and mastery predicting health control more so in men. These results demonstrate that it is important to examine both generalized positive expectancies such as optimism and positive expectancies regarding mastery when investigating resilience and emotional well-being in cancer survivors.

Keywords: Optimism, Mastery, Cancer, Coping, Anxiety, Resilience

Cancer affects more than 14 million people a year, making it one of the leading causes of morbidity and the second biggest cause of mortality worldwide (Ferlay et al., 2012; Forouzanfar et al., 2015). New treatments such as immunotherapy and improvements in early detection have led to increased survival rates, but have not alleviated the tremendous cost burden, with a worldwide annual estimate of $1.16 trillion USD (Montani et al., 2015; Pardoll, 2012; Steward & Wild, 2014). Cancer diagnoses can lead to heterogeneous outcomes, but are often accompanied by prolonged illness. Although some benefit from post-traumatic growth, many individuals experience negative psychosocial outcomes such as poorer emotional health, anxiety, and maladaptive health behaviors (Andrykowski, Lykins & Floyd, 2008; Lelorain, Bonnaud-Antignac, & Florin, 2010).

Anxiety and Depression in Cancer Survivors

Many studies have found a higher prevalence of mental illness in cancer patients. A meta-analysis of studies that used structured clinical interviews found the prevalence of mental health disorders in acute care cancer patients to be 31% (Singer, Das-Munshi, & Brähler, 2009), which is higher than the prevalence of mental health disorders in the general population of US (26.2%), the UK (16%), or Germany (20%; Jenkins et al., 2003). Not surprisingly, given the chronic stress that often accompanies a diagnosis of cancer, many studies have also documented a high prevalence of anxiety disorders in cancer patients. For example, a six-year study found that 19.0% of cancer patients in Canada had clinical levels of anxiety (Linden et al., 2012), which is higher than the prevalence of 10.4% reported in European and Anglo countries from a recent meta-analysis (Baxter et al., 2013). Cancer may also lead to symptoms of posttraumatic stress disorder (PTSD), with estimates from a meta-analysis of PTSD after cancer diagnosis indicating an odds ratio of 1.66 as compared with the general population (Swartzman, Booth, Munro, & Sani, 2015). Depression is also a common issue in cancer survivors. A systematic review of major depressive disorder in cancer patients found a prevalence of up to 16% in outpatients, up to 14% in inpatients and up to 49% in palliative care (Walker et al., 2012).

The negative consequences of cancer due to both physical and mental illness can be reduced by certain health-promoting resilience factors. Proposed resilience factors in cancer patients cluster around the categories of positive personality traits, and social support (Friborg, Sørlie, & Rosenvinge, 2005). The former includes coping skills and cognitive traits that represent positive expectations of the future. Fortunately, recent developments in cancer treatment options have led to increases in survivorship rates across many forms of cancer. The identification of factors that promote resilience and quality of life in cancer survivors has therefore become increasingly important. The present study examines the unique effects of optimism and mastery, two cognitive traits that have been found to promote resilience and well-being in many populations, including in cancer survivors (Steward & Yuen, 2011).

Optimism and Mastery as Resilience Factors

Optimism and mastery are both cognitive traits that involve positive expectancies for the future. However, these traits are conceptually and empirically distinct and, in theory, should uniquely contribute to resilience. Optimism is defined as the dispositional tendency to expect more positive outcomes in the future than negative outcomes (Scheier & Carver, 1992). Decades of research have demonstrated that higher levels of optimism are associated with positive outcomes in many domains, including physical health (Carver, Scheier, & Segerstrom, 2010; Rasmussen et al., 2017). In contrast to optimism, which focuses on more globalized, generalized positive expectancies, mastery emphasizes perceived control over outcomes (Pearlin & Schooler, 1978), and is therefore more similar to other forms of positive expectancies such as self-efficacy (Bandura, 1977) and hope (Snyder, 2002) that emphasize the role of personal agency. Both optimism and mastery are conceptualized as protective factors that promote emotional wellbeing, lower levels of anxiety, higher levels of adaptive health behaviors and improved physical health outcomes. There is extensive research demonstrating that these positive expectancies do, in fact, promote positive outcomes across many contexts, including in cancer survivors, although more studies have investigated the effects of optimism than the effects of mastery (Carver et al., 2010). A limiting factor in much of this research, however, is that the potential benefits of optimism and mastery are often examined in isolation, so there is less evidence regarding the unique effects of optimism and mastery when both are examined simultaneously as predictors of resilience or coping. Broadly speaking, optimism is distinct from mastery in its emphasis on an individual’s expectation of positive outcomes, regardless of his or her agency in promoting those outcomes. Since optimism is more generalized than mastery, distinguishing its unique contribution to positive coping and health outcomes will help clinician’s determine whether more general positive expectancy characteristics are more impactful than positive expectancy characteristics specific to the individual’s perceived control over their circumstances.

Optimism and Mastery Promote Coping

A major pathway by which both optimism and mastery are hypothesized to promote resilience in general and specifically in cancer survivors is the influence of these positive expectancy traits on coping strategies and behaviors. Although many models of coping have been proposed, one common distinction that is widely supported is between emotion-focused coping and problem-focused coping. Problem-focused coping involves efforts to change or regulate the stressful situation, while emotion-focused coping involves managing the emotional response one may have towards the situation (see Penley, Tomaka, & Wiebe, 2002). Although both forms of coping may be adaptive in certain contexts, emotion-focused coping is often viewed as more maladaptive, and possibly less effective, than problem-focused coping due to its inclusion of avoidance behaviors (Coyne & Racioppo, 2000). Given that cancer diagnoses and treatment often represent a chronic stressor that can persist for years and the evidence that treatment success in cancer is linked with the ability to cope with the stress and burden caused by the illness and treatment (Chida et al., 2008), it is important to examine the impact of psychological resources on coping behaviors.

Consistent with the theoretical models, both optimism and mastery have been linked to the use of more adaptive coping strategies. For example, optimism has a strong positive association with adaptive coping styles such as problem-focused coping strategies, acceptance, and positive reassessment (Prati & Pietrantoni, 2006), and individuals reporting high levels of optimism consistently choose these adaptive coping styles over time (Billingsley, Waehler, & Hardin, 1993). One meta-analysis found that optimism had a weak to moderate positive association with adaptive approach coping (r = .17) and a moderate negative association (r = − .21) with emotion-focused avoidance coping (e.g., denial, distancing, social withdrawal; Nes & Segerstrom, 2006). The inverse relationship with emotion-focused avoidance coping may indicate that optimism protects against maladaptive forms of emotion-focused coping that have been associated with negative outcomes (Hagger, Koch, Chatzisarantis & Orbell, 2017. Mastery may also facilitate adaptive coping strategies, particularly problem-focused coping, by encouraging internal attribution (Ross & Mirowsky, 2013).

The positive influence of optimism and mastery and coping has also been demonstrated in cancer patients. Higher levels of optimism were associated with less avoidant coping strategies in a sample of individuals with advanced-stage cancer diagnoses (Sumpio, Jeon, Northouse, & Knobf, 2017), and optimism was found to indirectly influence greater quality of life and lower overall distress in cancer patients via adaptive coping strategies (Carver et al., 1993; Friedman et al., 2006). Similarly, in a group of Chinese cancer survivors, higher mastery was positively associated with more active problem solving and reappraisal coping (Tang, Lai, & Chung, 2010). However, there is less research examining how optimism and mastery uniquely predict emotion-focused and problem-focused coping in cancer survivors.

Optimism and Mastery Promote Emotional Health

Mastery and optimism are also thought to be important factors in promoting positive emotions and in providing resilience to negative emotions and emotional disorders such as anxiety disorders. Higher levels of optimism and mastery can promote resilience against the experience of anxiety by influencing how individuals respond to uncertainty and threat (Bandura, 1988, Schwarzer, 2014). The individual’s response to uncertainty and threat is considered crucial factor in determining anxiety (Barlow, 2002) and may be particularly relevant in coping with cancer given the uncertainty often involved with prognoses following cancer diagnoses and treatment. The benefits of optimism and mastery in reducing negative affect and anxiety may be reinforced by the impact of promoting positive emotions given evidence that positive emotions lead to an upward spiral that contributes to the individual’s ability to cope with future adversity (Garland, Fredrickson, Kring, Johnson, Meyer, & Penn, 2010), and positive emotions may undo the effects of negative emotions (Fredrickson & Branigan, 2005). Consistent with this, optimism has been repeatedly demonstrated to be associated with higher positive and lower negative emotions, even when controlling for other personality factors such as the big five and hope (Ciarrocchi & Deneke, 2005; Gallagher & Lopez, 2009). A recent meta-analysis found a significant moderate to strong negative association between optimism and anxiety (Alarcon et al., 2013). Mastery also has been shown to be an important predictor of emotional well-being. Higher levels of mastery are associated with reduced depressive symptoms and lower levels of anxiety symptoms across time (Gallagher, Schoemann, & Pressman, 2011; Raeifar, Halkett, Lohman, & Sirey, 2017).

Optimism and mastery also appear to be important predictors of emotional outcomes such as anxiety in cancer populations. Among cancer patients, higher optimism is significantly related to lower levels of anxiety (Allison, Guichard, Fung & Gilain, 2003; Wang, Liu, Shi, & Wang, 2016; Zenger, Borowski, Stolzenburg, & Hinz, 2010). While less research has been conducted regarding the relationship between mastery and anxiety in cancer patients, there is some evidence that mastery predicts lower levels of cancer-related anxiety (Vodermaier, Esplen, & Maheu, 2010). There is also evidence that self-efficacy, a construct closely related to mastery, is a protective factor against anxiety in cancer survivors (Ziner et al., 2012).

Optimism and Mastery Promote Physical Health

Optimism and mastery are also conceptualized to promote physical health both indirectly by promoting emotional well-being and adaptive coping as discussed, but also via directly influencing perceptions of health and perceived control over health. Meta-analytic reviews have demonstrated the robust evidence that positive expectancies are positive correlated with improved health outcomes (Rasmussen, Scheier, & Greenhouse, 2011). Higher levels of mastery are also generally associated with a more positive perception of health status in samples with chronic illness (e.g., multiple sclerosis patients; Krokavcova et al., 2008). One reason for this may be that patients with a greater perceived control over treatment experience greater satisfaction, adherence to treatment, and positive treatment outcomes (Tennstedt, 2000).

Optimism and mastery also predict a variety of improved health outcomes when specifically examining cancer survivors. Dispositional optimism is associated with lower perceived cancer risk (McGregor et al., 2004), better quality of life (Applebaum et al., 2014), and a higher likelihood of survival status one year post cancer diagnosis (Allison, Guichard, Fung, & Gilain, 2003). The positive association between optimism and health outcomes in cancer populations has also been supported in meta-analytic reviews (Rasmussen et al., 2011). Similarly, self-efficacy is associated with lower perceived cancer reoccurrence in breast cancer survivors (Ziner et al., 2012), and cancer patients who believed they could control their cancer experienced lower distress (Barez, Blasco, Fernandez-Castro & Viladrich, 20084), and perceived control predicts behaviors that are protective of cancer risk, (McCaul et al., 1993). As with other outcomes discussed, the majority of this past work has examined the benefits of these cognitive resilience traits in isolation.

The Present Study

Although there is promising evidence that both of these cognitive factors generally influence anxiety and physical health and are also relevant in cancer survivors, there are some important limitations of existing work. Much of the research examining these cognitive processes has examined them in isolation. In addition, more research has been conducted regarding the effects of optimism on well-being, particularly in cancer patients (Allison, Guichard, Fung & Gilain, 2003; Applebaum et al., 2014; Krokavcova et al., 2008) than the effects of mastery. We therefore have promising evidence that mastery and optimism are important sources of resilience when examined in isolation, but there is less clarity regarding their unique effects on anxiety, coping, and perceived health in cancer survivors when examined together. Additionally, given that gender influences the prevalence of different cancer types, levels of anxiety both in general (McLean, Asnaani, Litz, & Hofmann 2011) and in cancer survivors (Bhattacharjee & Banerjee, 2016; Zajac, Klein, & McCaul, 2006), and coping strategies (Tamres, Janicki, & Helgeson, 2002) that may influence emotional and physical health in cancer survivors, it is important to understand the extent to which any resiliency conferred by mastery and optimism is consistent across genders.

The present study therefore examined the unique effects of optimism and mastery on emotional, coping, and physical health in cancer survivors. In doing so, we hoped to demonstrate that optimism and mastery are conceptually and empirically distinct forms of positive thinking that may uniquely contribute to lower levels of anxiety and higher levels of emotional well-being and may therefore be important potential targets of promoting resilience in cancer survivors. More specifically, we expected that greater levels of optimism and mastery would be associated with lower levels of anxiety, higher levels of more adaptive coping styles, better perceived health, and greater levels of PA along with lower levels of NA, and that both optimism and mastery would uniquely contribute to each dependent variable examined. Additionally, we expected that the benefits of optimism and mastery would be largely consistent across gender.

Methods

Procedures

Data from the 3rd wave of the Midlife in the U.S. National Study of Health and Wellbeing (MIDUS) project was utilized for the study. A nationally representative sample of the United States was originally recruited via random digit dialing for the first wave of the MIDUS project. Participants completed a telephone interview followed by a battery of self-report questionnaires that were received by mail across the 3 longitudinal waves of the MIDUS project (1995-1996 for wave 1, 2004-2006 for wave 2, and 2013-2015 for wave 3). Participants could receive a total of $62 at wave 3 after completing both the initial phone interview and self-report questionnaires.

Participants

The current study included 603 adults that indicated that they had been diagnosed with cancer (i.e. answered “yes” to the question “Have you ever had cancer”) when completing the third wave of the MIDUS project. Participant ages ranged from 43-92 (M = 69.21; SD = 10.57), and 45.4% of the sample identified as male. In terms of ethnicity, 4.3% of the sample identified as Hispanic/Latinx. In terms of racial background, the sample was 91.4% White, 2.3% Black/African American, .5% Native American/Alaska Native, 1% Native Hawaiian/Pacific Islander, and 5.1% Other. The most common forms of cancer included skin cancer (n = 247, 48.6% Male), breast cancer (n = 121, 0.9% Male), and prostate cancer (n = 83, 100% Male).

Measures

Optimism was measured using the Life-Orientation Test-Revised (Carver & Scheier, 1994). The LOT-R is based on a unidimensional theory of dispositional optimism, and includes two 3-item subscales measuring optimism, or positive generalized outcome expectancies (e.g., “In uncertain times, usually expect best”) and pessimism, or negative generalized outcome expectancies (e.g., “I Hardly ever expect things to go my way”). Participants respond using a 5-point likert scale, and items were coded so that higher scores represent greater levels of optimism (e.g., pessimism items were reverse coded). The internal consistency was α = .81 for the full LOT-R, α = .70 for the optimism subscale, and α .80 = for the pessimism subscale. The optimism and pessimism subscale showed a strong inverse association (r = −.48).

Mastery was measured using items from Pearlin and Schooler’s (1978) Mastery Scale (e.g. “Whether or not I am able to get what I want is in my own hands,” “I can do just about anything I really set my mind to”) in addition to items developed in the context of the study (Lachman & Weaver, 1998). Participants responded to the four items using a 7-point likert scale, and items were coded so that greater scores were associated with higher levels of mastery. The Pearlin mastery scale is a widely used measure that has demonstrated sufficient construct validity (Korkeila et al 2005; Mausbach et al., 2007; Pearlin, Lieberman, & Menaghan, 1981; Stephens, Dulberg & Joubert, 2000), and the mastery items included in the present study have been utilized in previous research (Ettner & Gryzywacz, 2001; Soederberg Miller & Lackman, 2000; Lachman & Prenda, 2004; Prenda & Lachman, 2001). The internal consistency of the mastery scale was α = .72 in the current study.

Physical health dependent variables included a single item to assess self-rated global health as well three items that were used to specific a latent variable of perceived control over health. Perceived health was measured with the following item, “Using a scale from 0 to 10 where 0 means ‘the worst possible health’ and 10 means ‘the best possible health,’ how would you rate your health these days?” Perceived control over health was measured using three items developed within the context of the study: “Keeping healthy depends on things that I can do,” “There are certain things that I can do for myself to reduce the risk of getting cancer,” and “I work hard at trying to stay healthy.” Participants responded to items using a 7-point likert scale, with higher scores associated with greater perceived control over health. The internal consistency of items measuring perceived control over health was α = .70.

Emotional health dependent variables included positive and negative affect as well as symptoms of generalized anxiety disorder. Positive and Negative affect were measured using 12 items from the Negative and Positive Affect Scale (NAPAS; Mroczek , 2004; Mroczek & Kolarz, 1998), which was created in the context of the MIDUS study and was based off of commonly used instruments assessing affect. Frequency of experiencing different forms of positive and negative affect during the previous 30 days was recorded using a 5-point likert scale. Items were coded so that high scores represented a greater frequency of positive or negative affect. Internal consistencies were .90 for positive affect items and .83 for negative affect items.

Generalized Anxiety Disorder was assessed using 10 items based off of criteria from the revised third edition of the Diagnostic and Statistical Manual (DSM-III-R; 1987) and was operationalized in screening versions of the World Health Organization’s “Composite International Diagnostic Interview,” version 10 (CIDI; WHO, 1990; Kessler et al., 1998). CIDI diagnoses have demonstrated validity and test-retest reliability (Blazer et al, 1994; Wittchen, 1994). Generalized anxiety disorder symptoms were assessed when participants answered that they worried “a lot more” than most people, that they either worried “just about every day” or “most days,” and that they worried about either “more than one thing” or have different worries “at the same time.” Participants responded to the 10 items on a 4-point likert scale, with higher scores associated with greater generalized anxiety. The internal consistency of the 10 GAD items was .73.

Coping was measured using items from the COPE Inventory (Carver, Scheier, & Weintraub 1989). Problem-focused coping was assessed using three subscales: Positive Reappraisal (α = .77), Active Coping (α = .73), and Planning (α = .81), each included 4 items. Problem-focused coping was assessed using three subscales: Focus on and Venting Emotions (α = .82), Denial (α = .71), and Behavioral Disengagement (α = .69), which also included 4 items each. Items for each subscale were rated using a 4-point likert scale, and responses were coded so that higher scores were associated with greater usage of a particular coping style. The mean of item responses for each associated subscale was calculated in order to assess problem- and emotion- focused coping.

Analytic Plan

Descriptive statistics were calculated using IBM SPSS version 24.0 and Mplus version 7.4 (Muthén & Muthén, 1998-2012). Means and standard deviations of study variables were calculated for the total sample as well as by gender. Correlations were also calculated to characterize the relationships between latent variables included in the study (i.e. optimism, mastery, emotion-focused coping, problem-focused coping, NA, and PA) as well as mental and physical health.

Study hypotheses were tested with structural equation modeling in Mplus version 7.4 (Muthén & Muthén, 1998-2012). Confirmatory factor analysis (CFA) was used to examine the measurement models of each latent construct and to identify latent correlations among all constructs. The latent construct of optimism was modeled using three parcels (Little, Cunningham, Shahar, & Widaman, 2002) that each consisted one item from the optimism subscale and one reverse coded item from the pessimism subscale. Positive affect and negative affect were each modeled using three parcels consisting of the means of pairs of scale items. GAD was similarly modeled using 5 parcels. The latent construct of mastery was identified by specifying the four individual items as indicators. Model fit was deemed acceptable if Root Mean Square Error (RMSEA) < .06, and both the Comparative Fit Index (CFI) and the Tucker-Lewis Index (TLI) > .90. Afterwards, the structural models were used to examine the unique effects of optimism and mastery on health, coping strategies, and emotion latent variables. First, the direct effects of both optimism and mastery on perceived health, perceived control over health, positive affect, negative affect, GAD symptoms, problem-focused coping, and emotion-focused coping was examined (Figure 1). The same SEM analysis was then examined separately in the male and female subsamples to examine whether the effects of optimism and mastery are consistent across gender. In all models, all constructs other than the global health rating were specified as latent variables and results were interpreted based on the completely standardized effects as well as the 95% confidence intervals of those effects. Missing data was handled using robust maximum likelihood estimation.

Figure 1.

Figure 1.

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Structural Equation Model of Optimism and Mastery Predicting Coping, Emotional Health, and Physical Health

Note: Latent variables are represented as ovals and manifest variables are represented as rectangles.

Results

Latent Associations

The associations between optimism, mastery, and all dependent variables were examined first using CFA. The model fit for the CFA in the full sample demonstrated acceptable to good fit (χ2 (df = 315) = 606.99, p > .05, RMSEA = 0.04, TLI = .94, CFI = .93) and the latent correlations from this CFA are reported in table 1. As expected, optimism and mastery demonstrated a large, positive association with one another and both optimism and mastery demonstrated moderate to large latent correlations with emotion focused coping and problem focused coping in the hypothesized directions. For the emotional latent constructs, optimism appeared to generally have a stronger relationship with positive affect, negative affect, and GAD symptoms than mastery, although mastery was statistically significantly correlated with both positive and negative affect as well in the hypothesized directions. Finally, both optimism and mastery demonstrated moderate positive latent correlations (rs > .28) with both the latent variable of health control and the manifest global rating of perceived health.

Table 1.

Latent correlations between optimism, mastery, coping, emotional health, and physical health in CFA model in full sample (n = 603)

Optimism Mastery Emotional
coping		 Problem
Coping		 Positive
Affect		 Negative
Affect		 GAD Health
Control		 Health
Rating
Optimism 1
Mastery .51* 1
Emotional coping −.47* −.32* 1
Problem Coping .43* .43* −.28* 1
Positive Affect .51* .35* −.22* .27* 1
Negative Affect −.52* −.24* .42* −.16* −.64* 1
GAD −.21 .04 .01 −.13 −.02 .07 1
Health Control .33* .38* −.13 .31* .30* −.21* −.18 1
Health Rating .29* .28* −.20* .09 .32* −.41* −.10 .47* 1
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Note:

*

p < .01.

Unique Effects of Optimism and Mastery

We next examined the unique effects of optimism and mastery on emotion, coping, and health using SEM (see Figure 1). The model fit for the SEM in the full sample demonstrated acceptable to good fit (χ2 (df = 315) = 606.99, p > .05, RMSEA = 0.04, TLI = .94, CFI = .93) and the completely standardized beta coefficients (with 95% CI) and R2 for each latent construct from this SEM are reported in table 2. As expected, both optimism and mastery were associated with higher levels of perceived health and the latent variable of health control. The magnitude of the effects of optimism and mastery were similar for perceived health and slighter higher for mastery than optimism for health control, although the effects were not statistically significantly different based on the confidence intervals. Combined, optimism and mastery predicted a small to moderate amount of variance in perceived health (R2 =.11) and health control (R2 =.17). These results suggest that both optimism and mastery are relevant and uniquely contribute to the prediction of health in cancer survivors.

Table 2.

Unique Effects of Optimism and Mastery on Coping, Emotional, and Health in SEM analyses for overall sample, women, and men.

Full Sample (n = 603) Women (n=329) Men (n=274)
Dependent
Variable		 Opt B (95% CI) Mast B (95% CI) R2 Opt B (95% CI) Mast B (95% CI) R2 Opt B (95% CI) Mast B (95% CI) R2
Problem Coping .28 (.17 :.39) .29 (.17 : .42) .25 .34 (.19 : .50) .28 (.12 : .45) .30 .20 (.04 : .36) .32 (.13 : .52) .21
Emotion Coping −.42 (−.59 : −.25) −.11 (−.27 :.05) .23 −.43 (−.70 : −.17) −.04 (−.27 : .18) .21 −.43 (−.67 : −.19) −.15 (−.40 : .11) .27
Positive Affect .46 (.35 : .56) .12 (−.00 : .23) .27 .43 (.30 : .57) .23 (.08 : .38) .34 .48 (.32 : .64) −.01 (−.19 : .17) .23
Negative Affect −.53 (−.64 : −.43) .03 (−.09 : .14) .27 −.54 (−.68 : −.40) −.01 (−.17 : .15) .30 −.50 (−.66 : −.34) .06 (−.12 : .24) .22
GAD −.31 (−.57 : −.05) .20 (−.09 : .48) .07 −.37 (−.68 : −.06) .19 (−.17 : .54) .10 −.22 (−.71 : .27) .43 (−.15 : 1.00) .14
Health Rating .20 (.09 : .32) .18 (.05 : .30) .11 .22 (.07 : .38) .16 (−.00 : .32) .11 .16 (−.01 : .32) . 21 (.00 : .42) .10
Health Control .19 (.03 : .34) .29 (.10 : .48) .17 .40 (.21 : .59) .22 (−.05 : .48) .30 −.09 (−.29 : .12) .42 (.17 : .67) .15
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Note: Results represent completely standardized beta coefficients from SEM analyses. Effects in bold are statistically significant atp < .05

Findings were more mixed when examining the unique effects of optimism and mastery on problem focused and emotion focused coping. Both optimism and mastery predicted higher levels of problem focused coping as expected, and the magnitude of the completely standardized effects of optimism and mastery on problem focused coping were almost identical. In contrast, only optimism was found to be a statistically significant predictor of lower levels of emotion focused coping and the magnitude of the optimism effect was greater than mastery based on the confidence intervals of the beta coefficients. Combined, optimism and mastery predicted a small to moderate amount of variance in problem focused coping (R2 =.25) and emotion focused coping (R2 =.23). These results suggest that both optimism and mastery are relevant and uniquely contribute to problem focused coping, but that optimism is a better predictor of emotion focused coping.

Findings were also more mixed when examining the unique effects of optimism and mastery on emotional latent constructs of positive affect, negative affect, and GAD symptoms. Optimism, but not mastery, was found to be a statistically significant predictor of higher levels of positive affect and lower levels of negative affect and GAD symptoms. The magnitude of the optimism effects was also greater than mastery based on the confidence intervals of the beta coefficients for all three emotional latent constructs. Combined, optimism and mastery predicted a small to moderate amount of variance in positive affect (R2 =.27) and negative affect (R2 =.27), but just a small amount of variance in GAD symptoms (R2 =.07). These results suggest that optimism is a better predictor than mastery of both anxiety disorder symptoms and of more global emotional constructs of positive and negative affect, but that the impact of optimism may be greater for more global emotional health variables.

Influence of Gender

We next examined differences in positive thinking by gender and whether the benefits of optimism and mastery varied by gender. Comparisons of mean levels by gender revealed that men had higher levels of optimism (d =0.05; 95% CI −0.11 : 0.21) and mastery (d = 0.09; 95% CI −0.07 : 0.25) than women, although the magnitude of the effect size differences was very small and not statistically significant. CFA models were then specified to examine the latent correlations among latent constructs within each gender. The model fit for the CFAs both the male (χ2(df = 315) = 506.00, p > .05, RMSEA = 0.05, TLI = .91, CFI = .90) and female (χ2 (df = 315) = 488.67, p > .05, RMSEA = 0.04, TLI = .94, CFI = .93) subsamples demonstrated acceptable to good fit. The latent correlations from the CFAs in males/females are reported in table 2. The pattern of associations was largely consistent across genders in terms of directionality of associations, although the magnitude of latent correlations for both optimism and mastery with dependent variables was often larger in women than men.

Finally, we examined the unique effects of optimism and mastery on emotion, coping, and health using SEM within men and women. Results were largely consistent in both genders when examining perceived health as the dependent variable, but varied significantly for men and women when examining the prediction of the health control latent variable. Only optimism was a statistically significant positive predictor of health control for women, whereas only mastery was a statistically significant positive predictor of health control for men, and the amount of variance explained by the two positive thinking factors was doubled in women (R2 = .30 ) vs men (R2 = .15). For coping, both optimism and mastery were both moderate positive predictors of higher levels of problem focused coping in both men and women, but only optimism was a statistically significant predictor of lower levels of emotion focused coping in both men and women. There were also gender differences when examining the prediction of emotional health. Optimism was again the more consistent predictor and predicted higher levels of positive affect and lower levels of negative affect in both men and women. Mastery was only a statistically significant predictor of higher levels of positive affect in women and appeared unrelated to negative affect in women or positive or negative affect in men. The amount of variance in positive and negative affect predicted by optimism and mastery was roughly 10% higher in women than men. Finally, the only statistically significant relationship with GAD symptoms was optimism as a negative predictor of GAD in women.

Discussion

Optimism, Mastery and Physical Health

The present study examined the unique effects of optimism and mastery on coping, emotional health, and physical health in cancer survivors. Optimism and mastery both uniquely contributed to greater control over health and, to a slightly lesser degree, perceived physical health in the full sample. However, for male cancer survivors, only mastery was associated with greater perceived control over physical health, demonstrating a moderate effect size. Conversely, optimism predicted a greater amount of perceived control over health among female cancer survivors, demonstrating a moderate effect size, while mastery was not significantly associated with either physical health construct. So while our findings suggest that the relative contribution of different forms of positive thinking may vary by gender, our results are largely consistent with previous work demonstrating that, broadly speaking, positive thinking influences physical health across gender (Khallad 2013; Cabras & Mondo, 2018). Studies conducted with cancer survivors have similarly found that mastery and optimism were associated with less self-reported pain and fatigue, and the strength of this relationship was similar for both forms of positive thinking (Allison, Guichard, & Gilain, 2000; Kurtz, Kurtz, Given, & Given, 2008). Our study extends this work, demonstrating that this relationship is consistent across gender among cancer survivors as well.

Fewer studies have examined the link between positive thinking and perceptions of control over health. Some have demonstrated a link between optimism and greater health internal locus of control, as well as lower levels of cancer worry among cancer survivors (Pinquart & Frohlich, 2009; Hodges & Winstanley, 2012). A link between optimism and health locus of control has also been demonstrated among other patient populations and older adults (Gruber-Baldinia, Yea, Anderson, Shulmanb, 2009; Kostka & Jachimowicz, 2010). Similarly, mastery is associated with greater internal health locus of control in cancer survivors as well as patients with chronic illness (Park & Kim, 2015; Younger, Marsh, & Grap, 1995). Furthermore, self-efficacy, which also emphasizes personal agency, has been found to be associated with health internal locus of control as well (Wu, Tang & Kwok; 2004). Our results extend this work by examining the influence of gender, suggesting that optimism is a stronger predictor of health control among female cancer survivors, while mastery is more relevant for male cancer survivors.

Optimism, Mastery and Emotional Health

When considering emotional health, optimism was a comparatively stronger predictor than mastery and was associated with positive functioning. These included greater levels of positive affect as well as lower levels of negative affect and GAD in the full sample, demonstrating medium-to-large effect sizes. Mastery did not predict a significant amount of variance in any of the emotional health dependent variables for the full sample. Positive thinking predicted more variance in the global emotional latent constructs compared to the more specific mental health dependent variable of GAD. Our findings are consistent with other research that has demonstrated a relationship between optimism and superior emotional functioning among cancer survivors, including less anxiety regarding care seeking, reduced pre-op anxiety, improved psychological adjustment, and greater positive affect (Ai, Wink, & Shearer, 2012, Carver et al., 2005; Lauver & Tak, 1995; Pinquart & Frohlich, 2009; Taber, Klein, Ferrer, Kent & Harris, 2016). While other studies have found a link between mastery and distress among cancer survivors (Hinnen, Ranchor, Baas, Sanderman & Hedorn, 2009), our results indicate that optimism is a stronger predictor of positive emotional health when both forms of positive thinking are examined concurrently.

Furthermore, positive thinking explained a greater amount of variance in emotions for women compared to men. While the relationship of optimism with the global emotional latent constructs was consistent across genders, optimism was associated with lower levels of GAD only among female cancer survivors. Furthermore, mastery was associated with greater positive affect among female cancer survivors as well. Positive thinking may predict more variance in emotions for women because woman demonstrate more variance in emotional experience in general (e.g. frequency, range, intensity; Brody & Hall, 2008; Fischer & Manstead, 2000; Grossman & Wood, 1993; Fujita et al., 1991) and the well documented gender disparity in the prevalence of anxiety and depressive disorders (McLean et al., 2011).

Optimism, Mastery and Coping

Optimism and mastery both predicted greater levels of problem focused coping, demonstrating comparable small-to-medium effect sizes. However, optimism was a stronger predictor of emotion-focused coping. Greater optimism was also associated with less emotion focused coping, demonstrating a moderate effect size, while mastery did not predict a significant amount of variance in emotion focused coping. These relationships were largely consistent across gender. The present findings are consistent with previous research indicating a robust relationship between optimism and adaptive forms of approach coping such as problem-focused coping, as well as an inverse relationship between optimism and emotion-focused coping strategies (Nes & Segerstrom, 2006). While mastery has demonstrated similar relationships with coping (Pearlin & Bierman, 2013; Folkman, 1984; Fleishman, 1984; Parker, Jimmieson, Walsh & Loakes, 2015; Tan, Tang, Ng, Ho, & Ho, 2015), the findings from this study suggest that optimism contributes to a comparatively larger amount of variance in emotion-focused coping in cancer survivors.

Study Strengths and Limitations

A strength of the current study is that the sample of cancer survivors were identified from a large, nationally representative sample of adults in the United States. However, the cross-sectional nature of the data limits conclusions regarding causality and the reliance on self-report measures may have artificially inflated or biased results. Furthermore, because this data was collected within the context of an ongoing longitudinal study, the available measure of GAD was based on the DSM-III-R in order to remain consistent with previous waves. Furthermore, information about symptoms of generalized anxiety disorder was only available for approximately one fourth of the current sample due to the screening methodology that was employed within the context of the larger MIDUS study. In addition, we aimed to examine gender differences in coping as well as emotional and physical functioning among cancer survivors. However, the results may have been confounded by cancer type given that two of the most common types of cancer among the sample, breast and prostate cancer, disproportionally effect females and males, respectively. Finally, we were not able to distinguish between individuals who are actively fighting cancer versus those who are in remission. The acute stressors encountered by individuals diagnosed with cancer vary across time as individual adjust to an initial diagnosis, progress through treatment, and hopefully achieve remission and we were not able to distinguish how optimism and mastery influence anxiety and coping across the different stages of diagnosis, treatment, and recovery.

Future Directions and Clinical Implications

The results of the current study indicate that optimism and mastery promote resilience and healthy coping in the context of cancer populations that face significant stressors and for whom negative cognitive processes often confer an elevated risk of developing anxiety and other emotional disorders. Future studies may want to examine these processes within a sample of cancer survivors that endorse high levels of anxiety and determine whether they are consistent across individuals with different types of cancer. Future research should also examine how factors such as cancer stage, time since diagnosis, and remission status may influence resilience in cancer survivors. It will also be important to examine further whether there are some circumstances in the process of coping with cancer in which optimism and mastery are either not helpful or even potentially maladaptive as it may be the case that sometimes acceptance or other cognitive strategies are more beneficial than positive thinking. In addition, future studies may benefit from using multi-method approaches to examining optimism and mastery, such as behavioral or objective measures in addition to questionnaires and examining whether optimism and mastery interact such that high levels of both confer additional benefits. Furthermore, previous research suggests that adaptive coping may mediate the relationship between positive thinking and superior mental and physical health outcomes (Carver & Scheier, 2010). Longitudinal studies will help clarify the mechanisms underlying this relationship.

Finally, the results suggest that optimism and mastery may be fruitful targets for intervention for this population. Future research may examine these forms of positive thinking as mechanisms of change within the context of interventions to promote emotional well-being and reduce mental illness among cancer survivors. Our results provide promising additional evidence of the potential benefits of positive thinking in the form of optimism and mastery in promoting adaptive coping, higher levels of emotional well-being, and lower levels of anxiety. It will therefore be important to build upon these findings to understand whether promoting optimism and mastery in the aftermath of a cancer diagnosis may help to minimize the development of anxiety disorders and promote resilience.

Table 3.

Latent correlations between optimism, mastery and emotion, coping, and health latent constructs in CFA model in women (n = 329 and men (n = 274) subsamples

Optimism Mastery Emotional
coping		 Problem
Coping		 Positive
Affect		 Negative
Affect		 GAD Health
Control		 Health
Rating
Optimism 1 .50* −.51* .36* .48* −.47* −.01 .13 .26*
Mastery .51* 1 −.37* .42* .23* −.19 .32 .38* .29*
Emotional coping −.46* −.27* 1 −.19 −.22 .41* −.23 −.01 −.18
Problem Coping .49* .46* −.36* 1 .23* −.05 .01 .26* .06
Positive Affect .55* .45* −.22 .31* 1 −.52* .05 .18 .26*
Negative Affect −.55* −.29* .42* −.27* −.75* 1 −.14 .00 −.38*
GAD −.28 .00 .06 −.15 −.06 .17 1 −.26 .00
Health Control .51* .42* −.21 .36* .40* −.38* −.24 1 .29*
Health Rating .30* .27* −.22* .13 .37* −.44* −.14 .56* 1
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Note:

*

p < .01. Correlation in women are below the diagonal, correlation in men are above the diagonal

References

  1. Ai AL, Wink P, & Shearer M (2012). Fatigue of survivors following cardiac surgery: Positive influences of preoperative prayer coping. British Journal of Health Psychology, 17(4), 724–742. doi: 10.1111/j.2044-8287.2012.02068.x [DOI] [PubMed] [Google Scholar]
  2. Alarcon GM, Bowling NA and Khazon S, 2013. Great expectations: A meta-analytic examination of optimism and hope. Personality and Individual Differences, 54(7), pp.821–827. [Google Scholar]
  3. Allison PJ, Guichard C, & Gilain L (2000). A prospective investigation of dispositional optimism as a predictor of health-related quality of life in head and neck cancer patients. Quality Of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 9(8), 951–960. doi: 10.1023/A:1008931906253 [DOI] [PubMed] [Google Scholar]
  4. Allison PJ, Guichard C, Fung K, Gilain L (2003). Dispositional optimism predicts survival status 1 year after diagnosis in head and neck cancer patients. Journal of Clinical Oncology, 21(3), 543–548. [DOI] [PubMed] [Google Scholar]
  5. American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edition. Washington, DC: American Psychiatric Association. [Google Scholar]
  6. Applebaum AJ, Stein EM, Lord-Bessen J, Pessin H, Rosenfeld B, & Breitbart W (2014). Optimism, social support, and mental health outcomes in patients with advanced cancer. Psycho-Oncology, 23, 299–306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bárez M, Blasco T, Fernández-Castro J, & Viladrich C (2009). Perceived control and psychological distress in women with breast cancer: A longitudinal study. Journal of Behavioral Medicine, 32(2), 187. [DOI] [PubMed] [Google Scholar]
  8. Baxter AJ, Scott KM, Vos T, & Whiteford HA (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological medicine, 43(5), 897–910. [DOI] [PubMed] [Google Scholar]
  9. Bhattacharjee A, & Banerjee A (2016). State and trait anxiety among cancer patients: A comparative analysis. Journal of Psychosocial Research, 11(2), 427–436. [Google Scholar]
  10. Billingsley KD, Waehler CA, & Hardin SL (1993). Stability of optimism and choice of coping strategy. Perceptual and Motor Skills, 76, 91–97. [DOI] [PubMed] [Google Scholar]
  11. Blazer DG, Kessler RC, McGonagle KA, & Swartz MS (1994). The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. American Journal of Psychiatry, 151, 979–986. [DOI] [PubMed] [Google Scholar]
  12. Bradburn NM (1969). The structure of psychological well-being. Chicago: Aldine. [Google Scholar]
  13. Brody LR, & Hall JA (2008). Gender and emotion in context In Lewis M, Haviland-Jones JM, Barrett LF, (Eds.), Handbook of emotions (pp. 395–408). New York, NY, US: Guilford Press. [Google Scholar]
  14. Cabras C & Mondo (2018). Coping strategies, optimism, and life satisfaction among first-year university students in Italy: gender and age differences. Higher Education, 75, 643–654. doi: 10.1007/s10734-017-0161-x [DOI] [Google Scholar]
  15. Carver CS, Pozo C, Harris SD, Noriega V, Scheier MF, Robinson DS, … Clark KC (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65(2), 375–390. doi: 10.1037/0022-3514.65.2.375 [DOI] [PubMed] [Google Scholar]
  16. Carver CS, Scheier MF, & Segerstrom SC (2010). Optimism. Clinical Psychology Review, 30(7), 879–889. doi: 10.1016/j.cpr.2010.01.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Carver CS, Scheier MF & Weintraub JK (1989). Assessing coping strategy: A theoretical based approach. Journal of Personality and Social Psychology, 56, 267–283. [DOI] [PubMed] [Google Scholar]
  18. Carver CS, Smith RG, Antoni MH, Petronis VM, Wiss S, & Derhagopan RP (2005). Optimistic personality and psychosocial well-being during treatment predict psychosocial wellbeing among long-term survivors of breast cancer. Health Psychology, 24, 508–516. [DOI] [PubMed] [Google Scholar]
  19. Ciarrocchi JW, & Deneke E, 2005. Hope, optimism, pessimism, and spirituality as predictors of well-being controlling for personality. Research in the Social Scientific Study of Religion, 16, 161–183. [Google Scholar]
  20. Coyne JC, & Racioppo MW (2000). Closing the gap between coping research and clinical intervention research. American Psychologist, 55, 655–664. [DOI] [PubMed] [Google Scholar]
  21. Crawford JR, & Henry JD (2004). The positive and negative affect schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 43, 245–265. [DOI] [PubMed] [Google Scholar]
  22. Chida Y, Hamer M, Wardle J, & Steptoe A (2008). Do stress-related psychosocial factors contribute to cancer incidence and survival?. Nature Reviews Clinical Oncology, 5(8), 466. [DOI] [PubMed] [Google Scholar]
  23. Ettner SL & Gryzywacz JS (2001). Worker’s perception of how jobs affect health: A Social ecological perspective. Journal of Occupational Health Psychology, 6, 101–113. [PubMed] [Google Scholar]
  24. Fallowfield L (1997). Truth sometimes hurts but deceit hurts more. Annals New York Academy of Sciences, 809(1), 525–536. doi: 10.1111/j.1749-6632.1997.tb48115.x [DOI] [PubMed] [Google Scholar]
  25. Fazio AF (1977). A concurrent validational study of the NCHS General Well-Being Schedule. Vital and Health Statistics, 2(73), 1–53. [PubMed] [Google Scholar]
  26. Fischer AH, Rodriguez Mosquera PM, Van Vianen AE, & Manstead AS (2004). Gender and culture differences in emotion. Emotion, 4, 87–94. [DOI] [PubMed] [Google Scholar]
  27. Fleishman JA (1984). Personality characteristics and coping patterns. Journal of Health And Social Behavior, 25(2), 229–244. doi: 10.2307/2136671 [DOI] [Google Scholar]
  28. Folkman S (1984). Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and Social Psychology, 46, 839–852. [DOI] [PubMed] [Google Scholar]
  29. Fredrickson BL, & Branigan C (2005). Positive emotions broaden the scope of attention and thought-action repertoires. Cognition & emotion, 19(3), 313–332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Friborg O, Sørlie T, & Rosenvinge JH (2005). Breast cancer: A manual for a proposed group treatment integrating evidence based resilience factors. Psychological Reports, 97(1), 77–97. [DOI] [PubMed] [Google Scholar]
  31. Friedman LC, Kalidas M, Elledge R, Chang J, Romero C, Husain I, … Liscum KR (2006). Optimism, social support and psychosocial functioning among women with breast cancer. Psycho-Oncology, 15(7), 595–603. doi: 10.1002/pon.992 [DOI] [PubMed] [Google Scholar]
  32. Fujita F, Diener E, & Sandvik E (1991). Gender differences in negative affect and wellbeing: the case for emotional intensity. Journal of Personality and Social Psychology, 61, 427–434. [DOI] [PubMed] [Google Scholar]
  33. Gallagher MW, & Lopez SJ (2009). Positive expectancies and mental health: Identifying the unique contributions of hope and optimism. The Journal of Positive Psychology, 4(6), 548–556. doi: 10.1080/17439760903157166 [DOI] [Google Scholar]
  34. Gallagher MW, Schoemann A, & Pressman S (2011). Mastery beliefs and intraindividual variability of anxiety. Cognitive Therapy and Research, 35(3), 227–231. doi: 10.1007/s10608-010-9327-x [DOI] [Google Scholar]
  35. Garland EL, Fredrickson B, Kring AM, Johnson DP, Meyer PS, & Penn DL (2010). Upward spirals of positive emotions counter downward spirals of negativity: Insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology. Clinical Psychology Review, 30(7), 849–864. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Giltay EJ, Kamphuis MH, Kalmijn S, Zitman FG, Kromhout D (2006). Dispositional optimism and the risk of cardiovascular death: The zutphen elderly study. Archives of Internal Medicine, 166(4), 431–436. [DOI] [PubMed] [Google Scholar]
  37. Grossman M, & Wood W (1993). Sex differences in intensity of emotional experience: a social role interpretation. Journal of Personality and Social Psychology, 65, 1010–1022. [DOI] [PubMed] [Google Scholar]
  38. Gruber-Baldini AL, Ye J, Anderson KE, & Shulman LM (2009). Effects of optimism/pessimism and locus of control on disability and quality of life in Parkinson's disease. Parkinsonism & Related Disorders, 15(9), 665–669. doi: 10.1016/j.parkreldis.2009.03.005 [DOI] [PubMed] [Google Scholar]
  39. Hagger MS, Koch S, Chatzisarantis ND, & Orbell S (2017). The common sense model of self-regulation: Meta-analysis and test of a process model. Psychological Bulletin, 143(11), 1117–1154. doi: 10.1037/bul0000118 [DOI] [PubMed] [Google Scholar]
  40. Hart SL, Vella L, & Mohr DC (2008). Relationships among depressive symptoms, benefit- finding, optimism and positive affect in multiple sclerosis patients after psychotherapy for depression. Health Psychology, 27(2), 230–238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Harrison J, & Maguire P (1994). Predictors of psychiatric morbidity in cancer patients. British Journal of Psychiatry, 165, 593–598. [DOI] [PubMed] [Google Scholar]
  42. Hinnen C, Ranchor AV, Baas PC, Sanderman R, & Hagedoorn M (2009). Partner support and distress in women with breast cancer: The role of patients’ awareness of support and level of mastery. Psychology & Health, 24(4), 439–455. doi: 10.1080/08870440801919513 [DOI] [PubMed] [Google Scholar]
  43. Hodges K, & Winstanley S (2012). Effects of optimism, social support, fighting spirit, cancer worry and internal health locus of control on positive affect in cancer survivors: A path analysis. Stress and Health: Journal of the International Society for the Investigation of Stress, 28(5), 408–415. doi: 10.1002/smi.2471 [DOI] [PubMed] [Google Scholar]
  44. Jenkins R, Bebbington P, Brugha TS, Farrell M, Lewis G, & Meltzer H (1998). British psychiatric morbidity survey. British Journal of Psychiatry, 173, 4–7. [DOI] [PubMed] [Google Scholar]
  45. Jenkins R, Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, & Meltzer H (2003). The National Psychiatric Morbidity Surveys of Great Britain--initial findings from the household survey. International Review of Psychiatry, 15(1-2), 29–42. [DOI] [PubMed] [Google Scholar]
  46. Kessler RC (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the united states: Results from the national comorbidity survey. Archives of General Psychiatry, 51(1), 8–29. [DOI] [PubMed] [Google Scholar]
  47. Kessler RC, Andrews A, Mroczek D, Ustun B, & Wittchen HU (1998). The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7, 171–185. doi: 10.1002/mpr.47 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, & Wittchen HU (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169–184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Khallad Y (2013). Dispositional optimism and physical wellbeing: The relevance of culture, gender, and socioeconomic status. International Journal of Psychology, 48(5), 978–985. doi: 10.1080/00207594.2012.695795 [DOI] [PubMed] [Google Scholar]
  50. Kissane DW, Clarke DM, Ikin J, Bloch S, Smith GC, Vitetta L, & McKenzie DP (1998). Psychological morbidity and quality of life in australian women with early-stage breast cancer: A cross-sectional survey. Medical Journal of Australia, 169(4), 192–196. [DOI] [PubMed] [Google Scholar]
  51. Korkeila JA, Kovess V, Dalgard O, Madianos M, Salize H, & Lehtinen V (2007). Piloting mental health indicators for Europe. Journal Of Mental Health, 16(3), 401–413. doi: 10.1080/09638230701299152 [DOI] [Google Scholar]
  52. Kostka T, & Jachimowicz V (2010). Relationship of quality of life to dispositional optimism, health locus of control and self-efficacy in older subjects living in different environments. Quality Of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 19(3), 351–361. doi: 10.1007/s11136-010-9601-0 [DOI] [PubMed] [Google Scholar]
  53. Krokavcova M, Nagyova I, van Dijk JP, Rosenberger J, Gavelova M, Middel B, … Groothoff JW (2008). Mastery, functional disability and perceived health status in patients with multiple sclerosis. European Journal of Neurology, 15, 1237–1244. [DOI] [PubMed] [Google Scholar]
  54. Kurtz ME, Kurtz JC, Given CW, & Given BA (2008). Patient optimism and mastery—Do they play a role in cancer patients' management of pain and fatigue?. Journal of Pain and Symptom Management, 36(1), 1–10. doi: 10.1016/j.jpainsymman.2007.08.010 [DOI] [PubMed] [Google Scholar]
  55. Lachman ME, & Prenda Firth KM (2004). The adaptive value of feeling in control during midlife In Brim OG, Ryff CD & Kessler RC (Eds.), How healthy are we?: A national study of wellbeing at midlife, (pp. 320 – 349). Chicago: Univ. of Chicago Press. [Google Scholar]
  56. Lachman ME, & Weaver SL (1998). The sense of control as a moderator of social class differences in health and well-being. Journal of Personality and Social Psychology, 74, 763–773. [DOI] [PubMed] [Google Scholar]
  57. Lauver D, & Tak Y (1995). Optimism and coping with a breast cancer symptom. Nursing Research, 44(4), 202–207. doi: 10.1097/00006199-199507000-00003 [DOI] [PubMed] [Google Scholar]
  58. Lee MS, Love SB, Mitchell JB, Parker EM, Rubens RD, Watson JP, … Hayward JL (1992). Mastectomy or conservation for early breast cancer: Psychological morbidity. European Journal of Cancer, 28A, 1340–1344. doi: 10.1016/0959-8049(92)90514-3 [DOI] [PubMed] [Google Scholar]
  59. Lelorain S, Bonnaud-Antignac A, & Florin A (2010). Long term posttraumatic growth after breast cancer: Prevalence, predictors and relationships with psychological health. Journal of Clinical Psychology in Medical Settings, 17(1), 14–22. [DOI] [PubMed] [Google Scholar]
  60. Little TD, Bovaird JA, & Card NA (Eds.). (2007). Modeling contextual effects in longitudinal studies. Mahwah, N.J: Lawrence Erlbaum Associates. [Google Scholar]
  61. Little TD, Cunningham WA, Shahar G, & Widaman KF (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural equation modeling, 9(2), 151–173. [Google Scholar]
  62. Linden W, Vodermaier A, MacKenzie R, & Greig D (2012). Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. Journal of affective disorders, 141(2), 343–351. [DOI] [PubMed] [Google Scholar]
  63. Macmillan AM (1957). The Health Opinion Survey: Technique for estimating prevalence of psychoneurotic and related types of disorder in communities. Psychological Reports, 3, 325–339. https://doi.Org/10.2466/PR0.3..325-339 [Google Scholar]
  64. Madrigal L, Gill DL, & Willse JT (2017). Gender and the relationships among mental toughness, hardiness, optimism and coping in collegiate athletics: A structural equation modeling approach. Journal of Sport Behavior, 40(1), 68–86. [Google Scholar]
  65. Mausbach BT, Patterson TL, Von Känel R, Mills PJ, Dimsdale JE, Ancoli-Israel S, & Grant I (2007). The attenuating effect of personal mastery on the relations between stress and Alzheimer caregiver health: A five-year longitudinal analysis. Aging & Mental Health, 11(6), 637–644. doi: 10.1080/13607860701787043 [DOI] [PubMed] [Google Scholar]
  66. McCaul KD, Sandgren AK, O'Neill HK, & Hinsz VB (1993). The value of the theory of planned behavior, perceived control, and self-efficacy expectations for predicting health-protective behaviors. Basic and Applied Social Psychology, 74(2), 231–252. [Google Scholar]
  67. McGregor BA, Bowen DJ, Ankerst DP, Andersen MR, Yasui Y, & McTiernan A (2004). Optimism, perceived risk of breast cancer, and cancer worry among a community-based sample of women. Health Psychology, 23(4), 339–344. [DOI] [PubMed] [Google Scholar]
  68. McLean CP, Asnaani A, Litz BT, & Hofmann SG (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatry Research, 45, 1027–1035. doi: 10.1016/j.jpsychires.2011.03.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Merz EL, Malcarne VL, Roesch SC, Ko CM, Emerson M, Roma VG, & Sadler GR (2013). Psychometric properties of Positive and Negative Affect Schedule (PANAS) original and short forms in an African American community sample. Journal of Affective Disorders, 757(3), 942–949. doi: 10.1016/j.jad.2013.08.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Montani F, Marzi MJ, Dezi F, Dama E, Carletti RM, Bonizzi G, … & Spaggiari L (2015). miR-Test: a blood test for lung cancer early detection. JNCI: Journal of the National Cancer Institute, 107(6), 1–5. [DOI] [PubMed] [Google Scholar]
  71. Mroczek DK (2004). Positive and negative affect at midlife In Brim OG, Ryff CD & Kessler RC (Eds.), How healthy are we?: A national study of well-being at midlife. (pp. 205 – 226). Chicago: Univ. of Chicago Press. [Google Scholar]
  72. Mroczek DK, & Kolarz CM (1998). The effect of age on positive and negative affect: A developmental perspective on happiness. Journal of Personality and Social Psychology, 75(5), 1333–1349. https://doi.Org/10.1037/0022-3514.75.5.1333 [DOI] [PubMed] [Google Scholar]
  73. Murphy LK, Bettis AH, Gruhn MA, Gerhardt CA, Vannatta K, & Compas BE (2017). Resilience in adolescents with cancer: Association of coping with positive and negative affect. Journal of Developmental & Behavioral Pediatrics, 38(8), 646–653. [DOI] [PubMed] [Google Scholar]
  74. Muthén BO, Muthén LK, & Asparouhov T (Eds.). (2016). Regression and mediation analysis using Mphis. Los Angeles, CA: Muthén & Muthén. [Google Scholar]
  75. Nes LS, & Segerstrom SC (2006). Dispositional optimism and coping: A meta-analytic review. Personality and Social Psychology Review, 10(3), 235–251. 10.1207/s15327957pspr1003_3 [DOI] [PubMed] [Google Scholar]
  76. Pardoll DM (2012). Immunology beats cancer: a blueprint for successful translation. Nature Immunology, 13(12), 1129–1132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Park E, & Kim J (2015). Predictors of sexual adjustment in cancer patients receiving chemotherapy. Journal of Psychosocial Oncology, 33(5), 488–503. doi: 10.1080/07347332.2015.1067278 [DOI] [PubMed] [Google Scholar]
  78. Parker J, & Endler N (1992). Coping with coping assessment: A critical review. European Journal of Personality, 6(5), 321–344. [Google Scholar]
  79. Parker SL, Jimmieson NL, Walsh AJ, & Loakes JL (2015). Trait resilience fosters adaptive coping when control opportunities are high: Implications for the motivating potential of active work. Journal of Business and Psychology, 30(3), 583–604. doi: 10.1007/s10869-014-9383-4 [DOI] [Google Scholar]
  80. Pearlin LI, & Bierman A (2013). Current issues and future directions in research into the stress process In Aneshensel CS, Phelan JC, Bierman A, Aneshensel CS, Phelan JC, Bierman A (Eds.), Handbook of the sociology of mental health (pp. 325–340). New York, NY, US: Springer Science + Business Media, doi: 10.1007/978-94-007-4276-5_16 [DOI] [Google Scholar]
  81. Pearlin LL, Menaghan EG, Lieberman MA, & Mullan JT (1981). The stress process. Journal Of Health And Social Behavior, 22(4), 337–356. doi: 10.2307/2136676 [DOI] [PubMed] [Google Scholar]
  82. Pearlin LI, & Schooler C (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21. 10.2307/2136319. [DOI] [PubMed] [Google Scholar]
  83. Penley JA, Tomaka J, & Wiebe JS (2002). The association of coping to physical and psychological health outcomes: A meta-analytic review. Journal of Behavioral Medicine, 25(6), 551–603. [DOI] [PubMed] [Google Scholar]
  84. Pinquart M, & Fröhlich C (2009). Psychosocial resources and subjective well-being of cancer patients. Psychology & Health, 24(4), 407–421. doi: 10.1080/08870440701717009 [DOI] [PubMed] [Google Scholar]
  85. Prati G, & Pietrantoni L (2009). Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. Journal of loss and trauma, 14(5), 364–388. [Google Scholar]
  86. Prenda KM, & Lachman ME (2001). Planning for the future: A life management strategy for increasing control and life satisfaction in adulthood. Psychology and Aging, 16, 206–216. [PubMed] [Google Scholar]
  87. Radloff LS (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. 10.1177/014662167700100306 [DOI] [Google Scholar]
  88. Raeifar E, Halkett A, Lohman MC, & Sirey J (2017). The relationship between mastery, anticipated stigma and depression among older adults in a primary care setting. The Journal of Nervous and Mental Disease, 205(10), 801–804. [DOI] [PubMed] [Google Scholar]
  89. Rasmussen HN, O’Byrne KK, Vandamente M, and Cole BP (2017). Hope and Physical Health In Gallagher MW & Lobes S (Eds.), The oxford handbook of hope. (pp. 159–168). New York, NY, US: Oxford University Press. [Google Scholar]
  90. Ross CE, & Mirowsky J (2013). The sense of personal control: Social structural causes and emotional consequences In Aneshensel CS, Phelan JC, & Bierman A (Eds.), Handbook of the sociology of mental health pp. 379–402). Dordrecht, Netherlands: Springer, 10.1007/978-94-007-4276-5_19. [DOI] [Google Scholar]
  91. Scheier MF, & Carver CS (1992). Effects of optimism on psychological and physical wellbeing: Theoretical overview and empirical update. Cognitive therapy and research, 16(2), 201–228. [Google Scholar]
  92. Scheier MF, Carver CS & Bridges MW (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the life orientation test. Journal of Personality and Social Psychology, 67(6), 1063–1078. [DOI] [PubMed] [Google Scholar]
  93. Schwarzer R (2014). Self-efficacy: Thought control of action. Taylor & Francis. [Google Scholar]
  94. Singer S, Das-Munshi J, & Brähler E (2009). Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis. Annals of Oncology, 21(5), 925–930. [DOI] [PubMed] [Google Scholar]
  95. Soederberg Miller LM & Lachman ME (2000). Cognitive performance and the role of control beliefs in midlife. Aging, Neuropsychology, and Cognition, 7: 69–85. [Google Scholar]
  96. Spencer SM, & Patrick JH (2009). Social support and personal mastery as protective resources during emerging adulthood. Journal of Adult Development, 76(4), 191–198. [Google Scholar]
  97. Stanton AL, & Franz R (1999). Focusing on emotion: An adaptive coping strategy? In Synder CR (Eds.), Coping: The psychology of what works (pp. 90_118). New York: Oxford University Press. [Google Scholar]
  98. Stark DPH, & House A (2000). Anxiety in cancer patients. British journal of cancer, 83(10), 1261–1267. doi: 10.1054/bjoc.2000.1405 [DOI] [PMC free article] [PubMed] [Google Scholar]
  99. Stephens T, Dulberg C, Joubert N (1999). Mental health of the Canadian population: A comprehensive analysis. Chronic Diseases in Canada, 20(3), 118–126. [PubMed] [Google Scholar]
  100. Stewart DE, & Yuen T (2011). A systematic review of resilience in the physically ill. Psychosomatics, 52(3), 199–209. [DOI] [PubMed] [Google Scholar]
  101. Sumpio C, Jeon S, Northouse LL, & Knobf MT (2017). Optimism, symptoms distress, illness appraisal, and coping in patients with advanced-stage cancer diagnoses undergoing chemotherapy treatment. Oncology Nursing Forum, 44(3), 384–392. doi: 10.1188/17.ONF.384-392 [DOI] [PubMed] [Google Scholar]
  102. Swartzman S, Booth JN, Munro A, & Sani F (2017). Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis. Depression and Anxiety, 34(4), 327–339. [DOI] [PubMed] [Google Scholar]
  103. Taber JM, Klein WP, Ferrer RA, Kent EE, & Harris PR (2016). Optimism and spontaneous self-affirmation are associated with lower likelihood of cognitive impairment and greater positive affect among cancer survivors. Annals of Behavioral Medicine, 50(2), 198–209. doi: 10.1007/s12160-015-9745-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  104. Tamres LK, Janicki D, & Helgeson VS (2002). Sex differences in coping behavior: A meta-analytic review and an examination of relative coping. Personality and Social Psychology Review, 6(1), 2–30. doi: 10.1207/S15327957PSPR0601_1 [DOI] [Google Scholar]
  105. Tang CS, Lai BPY, & Chung TKH (2010). Influences of mastery, spousal support, and adaptive coping on sexual drive and satisfaction among Chinese gynecologic cancer survivors. Archive of Sexual Behavior, 39, 1191–1200. [DOI] [PubMed] [Google Scholar]
  106. Tan SH, Tang C, Ng WN, Ho CH, & Ho RM (2015). Determining the quality of life of depressed patients in Singapore through a multiple mediation framework. Asian Journal of Psychiatry, 18, 22–30. doi: 10.1016/j.ajp.2015.10.010 [DOI] [PubMed] [Google Scholar]
  107. Taylor JA (1963). A personality scale of manifest anxiety In Shoben EJ & Ruch FL (Eds.), Perspectives in psychology (pp. 68–74). Glenview: Scott, Foresman & Co; 10.1037/14156-007 [DOI] [Google Scholar]
  108. Taylor SE, Lichtman RR, & Wood JV (1984). Attributions, beliefs about control, and adjustment to breast cancer. Journal of personality and social psychology, 46(3), 489–502. doi: 10.1037/0022-3514.46.3.489 [DOI] [PubMed] [Google Scholar]
  109. Tennstedt SL (2000). Empowering older patients to communicate more effectively in the medical encounter. Clinics in geriatric medicine, 16(1), 61–70. [DOI] [PubMed] [Google Scholar]
  110. Van der Velden PG, Kleber RJ, Fournier M, Grievink L, Drogendijk A, Gersons BP (2007). The association between dispositional optimism and mental health problems among disaster victims and a comparison group: a prospective study. Journal of Affective Disorders, 102, 35–45. [DOI] [PubMed] [Google Scholar]
  111. Walker J, Holm Hansen C, Martin P, Sawhney A, Thekkumpurath P, Beale C, … & Sharpe M (2012). Prevalence of depression in adults with cancer: A systematic review. Annals of Oncology, 24(4), 895–900. [DOI] [PubMed] [Google Scholar]
  112. Wang PS, Berglund P, & Kessler RC (2000). Recent care of common mental disorder in the United States: Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15: 284–292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  113. Wang Z, Liu L, Shi M, & Wang L (2016). Exploring correlations between positive psychological resources and symptoms of psychological distress among hematological cancer patients: A cross-sectional study. Psychology, Health, & Medicine, 21(5), 571–582. doi: 10.1080/13548506.2015.1127396 [DOI] [PubMed] [Google Scholar]
  114. Watson D, Clark LA, & Tellegen A (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of personality and social psychology, 54(6), 1063. [DOI] [PubMed] [Google Scholar]
  115. Wittchen HU (1994). Reliability and validity studies of the WHO Composite International Diagnostic Interview (CIDI): A critical review. Psychiatric Research, 28, 57–84. [DOI] [PubMed] [Google Scholar]
  116. World Health Organization (1990). Composite International Diagnostic Interview, CIDI, Version 10. Geneva: World Health Organization. [Google Scholar]
  117. Wu AS, Tang CS, & Kwok TY (2004). Physical and Psychosocial Factors Associated with Health-promoting Behaviors among Elderly Chinese with Type-2 Diabetes. Journal of Health Psychology, 9(6), 731–740. doi: 10.1177/1359105304045371 [DOI] [PubMed] [Google Scholar]
  118. Younger J, Marsh KJ, & Grap MJ (1995). The relationship of health locus of control and cardiac rehabilitation to mastery of illness-related stress. Journal of Advanced Nursing, 22(2), 294–299. doi: 10.1046/j.1365-2648.1995.22020294.x [DOI] [PubMed] [Google Scholar]
  119. Zajac LE, Klein WP, & McCaul KD (2006). Absolute and Comparative Risk Perceptions as Predictors of Cancer Worry: Moderating Effects of Gender and Psychological Distress. Journal of Health Communication, 11(Suppl1), 37–49. doi: 10.1080/10810730600637301 [DOI] [PubMed] [Google Scholar]
  120. Zenger M, Brix C, Borowski J, Stolzenburg JU, & Hinz A (2010). The impact of optimism on anxiety, depression and quality of life in urogenital cancer patients. Psycho-Oncology, 19(8), 879–886. [DOI] [PubMed] [Google Scholar]
  121. Ziner KW, Sledge GW, Bell CJ, Johns S, Miller KD, & Champion VL (2012). Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis. Oncology Nursing Forum, 39(3), 287–295. [DOI] [PMC free article] [PubMed] [Google Scholar]

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