Relationship between resilience, social support, and mental health in breast cancer patients based on the four-quadrant health model

Bibliographic Data

ID22091268
AuthorsShuangrui Sui (Breast Center), Weicong Ma (Department of Allergy), Zhihui Tan (Breast Center, corresponding author), Kai Feng (0000-0002-1099-2352, Breast Center, corresponding author), Weitao Yan (0000-0002-2561-9673, Breast Center), Xueying Su (Breast Center)
Year2026
Volume14
Pages1796977-1796977
Publication date2026-06-18
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1796977
PMID42395276
OpenAlexW7165201431
LanguageEN
References cited31

Background Breast cancer is a major public health problem that exposes patients to persistent physical symptoms and psychological distress across diagnosis, treatment, and follow-up. Objective: This study explored the associations of resilience and social support with mental health indicators among individuals with breast cancer and examined whether a Four-Quadrant Health Model could distinguish clinically meaningful physical-psychological risk profiles. Methods This secondary cross-sectional analysis used baseline data from a parent breast cancer care-management project. A convenience sample of 1,052 breast cancer inpatients and follow-up patients was analyzed. Measures included the Connor-Davidson Resilience Scale, Social Support Rating Scale, Hospital Anxiety and Depression Scale, Fear of Progression Questionnaire, and MD Anderson Symptom Inventory-Breast Cancer module. Primary analyses retained continuous scores for correlation and regression models. The four-quadrant classification was used as an additional clinical stratification framework based on physical symptom burden and HADS-defined psychological status. Pearson correlations, hierarchical multiple linear regression, and one-way ANOVA with robustness checks were used for statistical analysis. Results Resilience showed a weak positive association with social support ( r = 0.04) and significant negative associations with anxiety, depression, and fear of illness progression ( r = −0.18 to −0.24, p < 0.001). Multiple linear regression showed standardized β coefficients of −0.26 for resilience and −0.08 for social support after adjustment for age, explaining 22.3% of the variance in mental distress ( F (3, 1,048) = 100.3, p < 0.001). Significant differences in the mental distress composite were observed across the four quadrants ( F (3, 1,048) = 565.8, p < 0.001, η 2 = 0.62). Conclusion Higher resilience and stronger social support were independently associated with lower psychological distress among breast cancer patients, with resilience showing the stronger association. The Four-Quadrant Health Model distinguished clinically meaningful risk profiles and may support psychosocial triage when used alongside continuous assessment. Because this was a secondary cross-sectional analysis based on convenience sampling from one tertiary hospital, the findings should be interpreted as associations and confirmed in longitudinal, multi-center studies

Anxiety · Breast cancer · Distress · Mental health · Multilevel model · Psychological resilience · Social support · Cancer survivorship and care · Childhood Cancer Survivors' Quality of Life · Family Support in Illness

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