Abstract
The aim of the current work was to improve understanding of factors associated with
distress in women at increased risk of breast cancer because of their family history of
the disease. Levels of distress have been described in this population although few
studies have attempted to investigate causes of variation in distress. A number of
anecdotal reports and qualitative studies have highlighted that women's experiences
of breast cancer in their family is related to distress. The first study in this thesis
aimed to assess women's experiences in a quantitative manner and demonstrated
associations with general and cancer specific distress.
Applying theoretical perspectives from health psychology enables us to consider how
these experiences may influence psychological response to genetic risk. Using
Leventhal's SelfRegulatory Model (SRM) (Leventhal et al. 1980) a theoretical
model was developed for use in this thesis. This model proposed that perceptions of
breast cancer mediate the impact of experiences of the disease in the family on
psychological well-being. A large cross-sectional questionnaire study of women at
increased risk of breast cancer and women in the general population was conducted
in order to systematically explore this model. As there were no measures available to
assess perceptions of breast cancer in healthy populations an existing generic
measure was adapted and evaluated in the current samples. The mediation model was
then systematically explored in a series of analyses.
The results confirmed a number ofhypotheses. Women at increased risk of breast
cancer showed higher levels of cancer specific distress and held different perceptions
ofbreast cancer than women with no experience of the disease. Analysis indicated
that experience of breast cancer in the family was associated with levels of distress
and perceptions of the disease and that both experience ofbreast cancer and illness
perceptions predicted distress in women at increased risk. Some support for the
mediation model was found.
This thesis has shown that the SRM can be successfully applied to women at
increased risk of breast cancer. Further work is required to explore additional aspects
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of illness perceptions in healthy individuals at increased risk of disease and to test the
causality of relations revealed in this thesis. Utilising theoretical models to
understand response to risk in this clinical context is likely to provide implications
for the development and evaluation of interventions aimed at improving
psychological well-being.
