Perceived social support and coping style as mediators between resilience and health-related quality of life in women newly diagnosed with breast cancer: a cross-sectional study

Abstract

Background: Breast cancer may impair health-related quality of life (HRQoL). We examined the mediating roles of perceived social support (PSS) and coping style (CS) in the relationship between resilience and HRQoL in newly diagnosed breast cancer patients.

Methods: Following a cross-sectional design, 431 patients completed a survey at two hospitals in Shaanxi Province, China. Four validated self-report measures assessed HRQoL, psychological resilience, PSS, and CS. A one-sample t-test analyzed differences between resilience, PSS, and CS in breast cancer patients and the corresponding norm. Multivariate linear regression analyzed the independent predictors of HRQoL. The mediating roles of PSS and CS between resilience and HRQoL were investigated using structural equation modeling (SEM).

Results: Participants had significantly lower scores for resilience and PSS, and higher scores for the avoidance and resignation CSs than their corresponding norm. SEM analysis showed resilience had significant direct effects on PSS (Bs: 0.59, 95% CI 0.49, 0.68, P = 0.003), CS (confrontation: 0.53 (0.44, 0.62), P = 0.001; resignation: - 0.66 (- 0.74, - 0.57), P = 0.002), and HRQoL (Bs range from 0.44 to 0.63, P < 0.05). Resilience had significant indirect effects (Bs range from 0.09 to 0.27), and PSS and CS had significant direct effects on HRQoL (P < 0.05).

Conclusions: Newly diagnosed breast cancer patients had lower resilience and PSS, and higher negative CSs, suggesting that PSS and CS mediated the influence of resilience on HRQoL. A multimodal intervention program focusing on PSS and CS might improve the positive influences of resilience on HRQoL in breast cancer patients.

Keywords: Breast cancer; Coping style; Health-related quality of life; Perceived social support; Resilience.

Fig. 1

Theoretical framework of the mediating factor model regarding health-related quality of life based on the Neuman Systems Model

Fig. 2

Mediator roles of perceived social support and coping style between resilience and health-related quality of life. Indirect effect: Model (a): B = 0.15, 95% CI [0.08, 0.23], P = 0.002; Model (b): B = 0.09, 95% CI [0.03, 0.15], P = 0.005; Model (c): B = 0.27, 95% CI [0.19, 0.36], P = 0.002. Total effect of each of the three models: B = 0.72, 95% CI [0.65, 0.78], P = 0.002. (AGFI: adjusted goodness-of-fit index; reference value: ≥ 0.90. RMSEA: root mean square error of approximation; reference value: < 0.08. χ² value (desired significance P > 0.05). 95% CI 95% confidence interval. B: standardized regression weights.)