Manne, S.L., Winkel, G., Rubin, S., Edelson, M., Rosenblum, N., Bergman, C., . . . Rocereto, T. (2008). Mediators of a coping and communication-enhancing intervention and a supportive counseling intervention among women diagnosed with gynecological cancers. Journal of Consulting and Clinical Psychology, 76, 1034–1045.

To implement two psychological interventions to evaluate the effects of coping and communication-enhancing intervention (CCI) and supportive counseling (SC) on depressive symptoms.

Subjects were randomized into three groups based on Beck Depression Inventory (BDI) baseline score. CCI and SC groups consisted of six individual sessions of one-hour each plus one telephone session one week after the sixth individual session. There was a pre-intervention baseline questionnaire, and measures were repeated three times—at three months, six months, and nine months. Data were collected over six years, but each participant was involved for only the nine months of repeated measures.

• N = 353
• MEAN AGE = 55 years (SD = 11.4 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Diagnosed with primary gynecologic cancers
• OTHER KEY SAMPLE CHARACTERISTICS: Most of the women (89.5%) were white. More than 70% were married, and 49% were working full- or part-time. More than 52% held a college degree.

• SITE: Multi-site
• SETTING TYPE: Outpatient and home setting
• LOCATION: Northeastern United States

• PHASE OF CARE: Active treatment

• Stratified, randomized clinical trial with repeated measures

• BDI for depressive symptoms
• Six subscales of the COPE (The acronym was not defined.)
• Emotional Expressivity Questionnaire—general expressivity with three subscales: positive, emotion, and intimacy
• Emotional Processing Scale—cancer-related emotional expression. This is a four-item scale.
• Rosenberg Self-Esteem Inventory—a Guttman scale to measure self-acceptance

There were no significant differences in depressive symptoms in any group over time or at any point in time. Depressive symptoms declined in all groups over time. Compared with UC, people in the CCI group showed significant effect interventions on BDI (p = .037). There was a significant effect of the SC intervention on depressive symptoms compared with the UC condition (p = .0169). People in the CCI group also showed mixed results of association with the measures of COPE and emotional expression. The SC condition significantly was associated with higher levels of cancer-related emotional expression, emotional processing, positive reappraisal, and seeking instrumental support. Acceptance, positive reappraisal, self-esteem, cancer-related emotional expression, and expression of positive emotion significantly were related to depressive symptoms.

Neither of the treatments showed a significant impact on cancer-specific distress.

• Primarily white, well-educated, income-earning women were included in the study.
• Study participants were significantly younger and more likely to be married than were study refusers, and participants who completed more than one study survey were younger than participants who completed only one survey.
• These differences may have biased the results of this study.
• Many of the measures, such as self-esteem, were not cancer-specific.

This was a complex study but indicated a clearly positive impact of CCI and SC on depressive symptoms over time when compared to the UC group. A model depicting variables, mediators, and their strengths of association would help to clarify the actions, impacts, and interactions discovered in this study.