| Objective:The diagnosis of breast cancer not only poses a threat to the life of the patient,it also causes a heavy burden to the patient`s family.Although China is a country with a low incidence of breast cancer,the incidence and mortality of breast cancer have been on the rise in recent years with the aging of the population,social and economic development,lifestyles and the ecological environment changed.The 1-year observed survival rate of patients with breast cancer was over 90%,and the 5-year relative survival rate was 73.0%?71.2%-74.9%?.Economic losses and the burden caused by the disease are becoming increasingly serious.The special effects caused by breast cancer,and the physiological and psychological characteristics of women,caused the most intense emotional trauma experience among breast cancer patients.The diagnosis of cancer also makes women face the dual pressures of life threatening and social discrimination,so breast cancer patients have the highest level of depressive symptoms in all cancer patients.Research indicated that the prevalence of depression among breast cancer patients in China was 63.4%,the prevalence of major depression was 34.3%.However,cancer diagnosis is not entirely a devastating event,some patients could even get positive changes from the course of treatment after cancer diagnosis,that is,the post-traumatic growth?PTG?.About 60%-90%of patients after cancer diagnosis got positive psychological changes.At present,most studies of mental health in patients with breast cancer were to explore the negative psychological outcome of cancer?depressive symptoms?,while the research on the positive psychological outcome?PTG?caused by cancer was rather limited.In addition,effects of influence factors on the mental health of breast cancer patients were inconsistent.Therefore,evaluating the negative psychological outcome?depressive symptoms?and positive psychological outcome?PTG?in patients with breast cancer,and exploring the factors that influenced the mental health of female breast cancer patients were necessary.Among the factors related to mental health,social support was the most widely studied.Studies have shown that social support is beneficial to the physical and mental health of breast cancer patients.Social support not only can effectively buffer a series of negative effects caused by cancer,but also helps to promote the PTG.In addition,the diagnosis and treatment of breast cancer will cause serious harm to women`s body image,which could cause serious secondary blow to the mental health of female cancer patients.And a large number of studies have shown that psychological stress is not only one of the risk factors of breast cancer,but also cause serious harm to the mental health of breast cancer patients.In addition,positive psychological resources may also play protective roles in the mental health among breast cancer patients.With the rise of positive psychology research,positive psychological resources have gradually become the focus of psycho-oncology.Hope,self-esteem,resilience and optimism play important and positive roles in improving the quality of life and mental health of cancer patients.However,most of the researches on positive psychological resources focused on a single psychological resource at present.Therefore,it is important to explore and determine the effects of overall positive psychological resources on the mental health of breast cancer patients and the mechanism.An important prerequisite for carrying out positive psychological resources research and clinical positive psychological intervention is to explore the antecedent variables of positive psychological resources.At present,the research on antecedent variables of patients`positive psychological resources was relatively inadequate.The antecedent variables and positive psychological resources of patients are different due to different diseases.So exploring the antecedent variables of women`s positive psychological resources is of great significance.Based on these above concerns,this study explored the antecedent variables of positive psychological resources?hope,self-esteem,resilience,optimism?among breast cancer patients from the perspective of female cancer patients and the specific injury caused by breast cancer;explored the impact of positive psychological resources and social support,body image and psychological stress on the mental health?depressive symptoms,PTG?of breast cancer patients based on positive psychology,psychosocial oncology and stress theory;and put forward and clarifies mediating/moderating effects caused by the positive psychological resources on relationships between social support,body image,psychological stress and depressive symptoms,PTG.This study could provid a theoretical basis for clinical positive psychological intervention,and ultimately achieved the purpose of improving the positive psychological resources stock of breast cancer patients,and promoting the mental health among breast cancer patients.Methods:During the period from December 2015 to August 2017,the research team continuously collected breast cancer patients from Department of Breast Surgery,First Affiliated Hospital of China Medical University,and finally obtained a total of 458 cases of breast cancer patients.After deleted the unqualified and non-compliance criteria,a total of 424 patients were included in the study,the effective rate was 92.58%.In this study,self-contained questionnaires with the same design were used to collect individual characteristics,clinical characteristics and social psychological factors of breast cancer patients.After obtaining informed consent from the patient,the individual characteristics and psychosocial factors were filled in by patients and the clinical characteristics were filled in by doctors.In this study,Epidata 3.1 software was used for the double entry of data.SPSS 17.0 was used for statistical analysis and model construction.Descriptive analysis,T-test,one-way analysis of variance?ANOVA?,reliability test,Pearson correlation analysis,multiple regression analysis,and asymptotic-resampling test were used in this study.All statistical tests were two-sided??=0.05?.Results:1.The results showed that the resilience of married/cohabiting group among breast cancer patients was higher than divorced/single group;patients received college or above education and with monthly income over 5,000 yuan had highest levels of self-esteem;smoking patients had lower degree of optimism;patients with exercise habits had a higher level of self-esteem;patients whose continuous sitting time less than 1 hour had a significantly higher level of resilience than whose continuous sitting time more than 3hours;new onset patients had higher levels of hope and resilience than recurrence patients;patients with metastatic disease had a lower level of hope;patients without accompany symptoms had more optimism than the patients with accompany symptoms,p<0.05.Social support played an important role in developing hope,self-esteem,resilience and optimism.Among them,support from friends played a positive role in promoting hope and resilience.Support from significant others played important protective roles in hope,self-esteem,resilience and optimism.Body image made significant negative impacts on hope,self-esteem and resilience.Perceived psychological stress could reduce the level of resilience.All results were statistically significant.2.According to the Center for Epidemiological Survey Depression Scale,88.4%of breast cancer patients had depressive symptoms in this present study,at the same time,the total score of Post-traumatic Growth Inventory?PTGI?among breast cancer patients was68.99?17.02?,indicating that the depressive symptoms and PTG of breast cancer patients in our country were at higher levels.Results showed that married/cohabitation breast cancer patients had higher levels of PTG,relating to others,new possibilities,personal strength,spiritual changes;patients with college degrees or above had less depressive symptoms,and higher levels of PTG,new possibilities,spiritual changes than patients with junior high school or below;patients had less than 3000 yuan a month had more depressive symptoms than those made 3000-5000 yuan or 5000 yuan a month;patients with exercise habits hade a lower level of depressive symptoms,and more PTG,new possibilities and spiritual changes;recurrence patients had less PTG,relating to others,new possibilities,personal strength and spiritual changes;patients with T0/Tis/T1a/T1b had the highest scores for new possibilities and spiritual changes;patients who receiving chemotherapy had less depressive symptoms;patients receiving endocrine therapy had a higher level of appreciation of life;patients with cancer metastasis had lower levels of personal strength and spiritual changes.The differences were statistically significant?p<0.05?.Social support?support from significant others?,self-esteem and resilience played significant roles in alleviating depressive symptoms.Body image and psychological stress could promote depressive symptoms.And the explanatory power of psycho-social factors was 43.6%-43.7%.Social support?support from friends and significant others?,hope,resilience had protective effects on the PTG,and the body image played significant negative roles in PTG,the explanatory power of psycho-social factors was 44.3%.Social support?support from friends and family?and hope made positive effects on relating to others,and the explanatory power of psycho-social factors was 39.0%-39.3%.Social support?support from friends and significant others?,hope and resilience had significant positive effects on new possibilities,body image has a significant negative effect on new possibilities,the explanatory power of psycho-social factors was 33.0%-33.5%;social support?support from friends and significant others?,hope and optimism made positive effects on the appreciation of life,the explanatory power of psycho-social factors was 25.8%-25.9%.Social support?support from friends and significant others?,hope and resilience played positive roles in personal strength,body image played a significant negative role on personal strength,and the explanatory power of psycho-social factors was 41.6%-42.1%.Social support?support from friends and significant others?,hope,resilience and optimism made positive effects on spiritual changes,and body image made a significant negative effect on spiritual changes.The explanatory power of psycho-social factors was 37.5%.3.According to the mediating effect of positive psychological resources among social support and depression,the proportion of total effect of positive psychological resources was 73.3%,the proportions of mediating roles of self-esteem and resilience were 18.9%and 42.4%,self-esteem and resilience completely mediated the relationship between social support and depressive symptoms.According to the mediating effect of positive psychological resources among body image and depressive symptoms,the proportion of total effect of positive psychological resources was 18.2%,the proportion of mediating role of resilience was10.3%,resilience partially mediated the relationship between body image and depressive symptoms.According to the mediating effect of positive psychological resources among psychological stress and depression symptoms,the proportion of total effect of positive psychological resources was 11.6%,the proportion of mediating role of resilience was7.5%,resilience partially mediated the relationship between psychological stress and depressive symptoms.According to the mediating effect of positive psychological resources among social support and PTG,the proportion of total effect of positive psychological resources was 52.3%,the proportions of mediating roles of hope and resilience were 39.7%and 13.7%,hope and resilience partially mediated the relationship between social support and PTG.According to the mediating effect of positive psychological resources among body image and PTG,the proportion of total effect of positive psychological resources was 72.1%,the proportions of mediating roles of hope and resilience were 49.7%and 22.0%,hope and resilience completely mediated the relationship between body image and PTG.In addition,hope and self-esteem moderated the relationship between social support and PTG.Conclutions:?1?The influencing factors of positive psychological resources?hope,self-esteem,resilience,optimism?of patients with breast cancer were different,social support was an important antecedent variable of positive psychological resources,support from friends and significant others were important protective factors.Body image made significant negative effects on hope,self-esteem and resilience.Psychological stress could reduce the level of resilience.The individual and clinical characteristics of breast cancer patients also have varying degrees of positive psychological resources.Doctors and nurses could increase the stock of positive psychological resources of breast cancer patients by increasing social support,reducing the psychological stress and the negative effect of body image.2.Breast cancer patients had high levels of depressive symptoms and PTG.Education,exercise,marriage,type of diagnosis,monthly income,chemotherapy,cancer stage,and endocrine therapy affected the mental health of breast cancer patients.Social support?support from significant others?,body image and resilience were important influencing factors for mental health among breast cancer patients.Psychological stress,self-esteem played important roles in depressive symptoms,while support from friends and hope were positively correlated with PTG.3.Self-esteem and resilience completely mediated the relationship between social support and depressive symptoms;resilience played a partial mediating role in the relationship between body image and depressive symptoms;resilience played a partial mediating role in the relationship between psychological stress and depressive symptoms.Hope and resilience partially mediated the relationship between social support and PTG;hope and resilience played completed mediating roles in the relationship between body image and PTG.In addition,hope and self-esteem played moderating roles between social support and PTG. |
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