Women at high risk for breast cancer oftentimes also experience psychological vulnerably related to experiences of cancer in their family, high bereavement rates and their own uncertainties regarding if and when they may develop the disease. This research sought to evaluate psychological adjustment and examine reattendance among a sample of women adhering to regular breast cancer surveillance, with a specific focus on daughters of breast cancer patients. The study described in Chapter 2 longitudinally profiled anxiety and depressive symptoms among these high-risk daughters across three consecutive surveillance appointments, and also evaluated the effects of a set of hypothesized predictors on change in symptomatology. The results showed an overall decrease in anxiety over the course of the three surveillance visits, as well as a marginally significant decrease in depressive symptoms. When the effects of moderating variables on symptom change were examined, results demonstrated that some subgroups of daughters differentially benefited from the high-risk program, with daughters whose mothers died who were older at the time of their mother’s diagnosis being the only group that did not appear to experience decreases in symptomatology. The study presented in Chapter 3 investigated psychosocial correlates of reattendance at the high-risk clinic, again focusing on daughters of breast cancer patients. Results showed that greater likelihood of reattendance was associated with hypothesized predictors, including older age, lower depressive symptoms and maternal loss to breast cancer. Moreover, mother’s survival status was found to moderate the effect of perceived risk on likelihood of reattendance such that higher perceived risk predicted increased reattendance for daughters whose mothers survived, but not those whose mothers died. Additionally, results indicated that the association between anxiety and likelihood of reattendance was non-linear in nature (inverted “U”); reattendance was more likely among daughters with moderate anxiety compared to those with low or high anxiety. Findings from these studies contribute to a greater understanding of psychological adjustment and screening adherence of women at high-risk for breast cancer and may inform the development of targeted interventions to promote screening adherence and psychosocial wellbeing among this and other vulnerable high-risk populations.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Arechiga, Adam

Second Advisor

Ahmed, Kauser

Third Advisor

Vermeersch, David

Fourth Advisor

Wellisch, David

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Breast Neoplasms; Breast cancer; Depression;

Subject - Local

Breast cancer; Depression; Family communication; Reattendance; High-risk daughters



Page Count

66 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses & Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives