The role of emotional regulation and interpersonal support in grief, depression, and markers of inflammation in Hispanic women with breast cancer

**Loss, grief, and emotion regulation in the context of the cancer experience: a proposed model to understand the link between depression and systemic inflammation: **The proposed supplement parts from wide literature in the affective neuroscience field, in which studies have identified seven primary emotion neurological pathways (SEEKING, LUST, CARE, PLAY, RAGE, FEAR, and PANIC/GRIEF). 53,54 When the PANIC/GRIEF system is activated, studies in animal models have shown that rats make a call after separation to seek help and thus, prevent danger. The PANIC/GRIEF system’s main function is to maintain social bonds as they convey security.53,54 As grief has been identified as the first reaction after an interpersonal loss (separation), the despair caused by the activation of the PANIC/GRIEF system has been linked to the reason why depression hurts.52 Panksepp and Watt conceptualize grief as the despair feeling caused after an interpersonal loss, and according to animal studies, prolonged sustained activity of the grief neurological pathway leads (by an unknown mechanism) to inhibition of the seeking-reward system.52 Inhibition of the seeking-reward systems in rat studies manifests as surrender and defeat in different tasks (used to measured depression phenotype), which Panksepp and Watt conceptualized as anhedonia, one of the primary symptoms of Major Depression Disorder (MDD).52 As interpersonal loss has been identified as a predictor of phenotypic expressions of depression symptomatology using animal models; likewise, Slavish and Irwin have stated a Social Signal Transduction Theory of Depression linking early trauma and chronic stress (including interpersonal loss and social rejection) as a high predictor of MDD.17 The authors conceptualize stressful events as triggers for MDD and associate them with the onset or exacerbation of other major inflammatory health conditions that involve inflammatory processes (rheumatoid arthritis, chronic pain, obesity, diabetes, and cardiovascular disease). This theory suggests that exposure to psychosocial trauma and thus, the inability to cope with loss could be linked to risk factors that are important in understanding the repercussions on health, both psychological and physical. However, there is a gap in literature regarding non-death-related losses and how they affect the context of the cancer diagnosis. The different types of losses a cancer patient faces after a diagnosis could imply loss of security. Different types of perceived non-death-related losses could imply concerning repercussions on health, therefore investigating the relationship between non-death-related losses, grief, and depression as well as potential protective factors that are key to improving quality of life for BC patients as this information can contribute to targeted psychological treatments. The study team hypothesizes that emotion regulation and social support are potential protective coping mechanisms in grief management, depression symptoms, and upregulation of proinflammatory factors associated with BC tumor progression after non-death-related losses.
Files and variables· phq9: PHQ-9 which measures depression symptomatology and severity.
· fssi: Frequency of Suicide Ideation Inventory which measures suicide ideation
· mpss: Multidimensional Scale Of Perceived Social Support which measures perceived
· social support. It is composed of three subscales.
· anps: The PANIC/GRIEF system was measured using its respective subscale from the Affective Neuroscience Personality Scale.
· bhi: the Beck Hopelessness Inventory was used to measure hopelessness
· ders: the Dificulty with Emotion Regulation Scale was used to measure emotion regulation difficulties
· ddpg:the Grief Diagnostic Instrument For General Practice was used to assess type of losses experienced related to the the breast cancer diagnosis.
SoftwareIBM SPSS version 29

癌症背景下的丧失、哀伤与情绪调节：解析抑郁与全身性炎症关联的拟议模型：
本研究的补充内容源自情感神经科学领域的广泛文献，该领域已识别出七种核心情绪神经通路（SEEKING、LUST、CARE、PLAY、RAGE、FEAR及PANIC/GRIEF）53,54。当PANIC/GRIEF通路被激活时，动物模型研究显示大鼠会在分离后发出叫声以寻求帮助、规避危险。该通路的核心功能是维系社会联结并传递安全感53,54。由于哀伤被认定为人际丧失（分离）后的首种反应，PANIC/GRIEF通路激活引发的绝望感与抑郁的致病机制相关联52。Panksepp与Watt将哀伤概念化为人际丧失后产生的绝望情绪，且根据动物研究，哀伤神经通路的长时间持续激活会通过未知机制抑制寻求-奖赏系统52。在大鼠研究中，寻求-奖赏系统的抑制表现为不同任务中的屈服与挫败（用于评估抑郁表型），Panksepp与Watt将此概念化为快感缺失——重度抑郁症（Major Depression Disorder, MDD）的核心症状之一52。
人际丧失已通过动物模型被证实为抑郁症状表型表达的预测因子；同样，Slavish与Irwin提出的抑郁社会信号转导理论将早期创伤与慢性应激（包括人际丧失与社交排斥）列为MDD的高风险预测因素17。该理论将应激事件定义为MDD的触发因素，并将其与其他涉及炎症过程的主要炎症性健康状况（类风湿关节炎、慢性疼痛、肥胖、糖尿病及心血管疾病）的发作或加重相关联。此理论表明，暴露于心理社会创伤以及无法应对丧失，可能与影响身心健康的风险因素存在关联。然而，现有文献尚未涉及非死亡性丧失及其对癌症诊断场景的影响。癌症患者在确诊后面临的各类丧失可能意味着安全感的丧失。不同类型的感知性非死亡性丧失可能对健康产生不良影响，因此探究非死亡性丧失、哀伤与抑郁之间的关联，以及对改善乳腺癌（Breast Cancer, BC）患者生活质量至关重要的潜在保护因素，具有重要意义——相关研究结果可为针对性心理治疗提供依据。本研究团队提出假设：在非死亡性丧失发生后，情绪调节与社会支持是哀伤管理、抑郁症状缓解，以及抑制与乳腺癌肿瘤进展相关的促炎因子上调的潜在保护性应对机制。

数据集与变量：
· phq9：患者健康问卷9项量表（PHQ-9），用于评估抑郁症状及其严重程度。
· fssi：自杀意念频率量表（Frequency of Suicide Ideation Inventory），用于测量自杀意念水平。
· mpss：多维感知社会支持量表（Multidimensional Scale Of Perceived Social Support），用于评估感知到的社会支持，该量表包含三个子维度。
· anps：采用情感神经科学人格量表（Affective Neuroscience Personality Scale）的对应子维度，用于测量PANIC/GRIEF通路状态。
· bhi：贝克无望感量表（Beck Hopelessness Inventory），用于评估无望感水平。
· ders：情绪调节困难量表（Difficulty with Emotion Regulation Scale），用于测量情绪调节困难程度。
· ddpg：全科医生哀伤诊断工具（Grief Diagnostic Instrument For General Practice），用于评估与乳腺癌诊断相关的各类丧失类型。

软件：IBM SPSS 29版本