Social support, resilience, and demoralization in patients with breast cancer: a moderated network analysis.
Demoralization is common among individuals with breast cancer, and both social support and resilience are recognized as protective factors. However, the way these two factors interact at the symptom level remains unclear. This study therefore sought to clarify how resilience modifies the association between social support and demoralization at both symptom and construct levels.
In this cross-sectional analysis, a total of 412 patients with breast cancer from the Be Resilient to Breast Cancer (BRBC) program completed the Perceived Social Support Scale (PSSS), the Cancer-Specific Resilience Scale (RS-SC-10), and the Demoralization Scale-II (DS-II). Moderated network analysis, Johnson-Neyman techniques, and response surface analysis were used to examine the moderating role of resilience from both symptom-level (micro) and scale-level (macro) perspectives.
The mean age of participants was 50.8 years, ranging from 28 to 85 years, and 43.2% of them were diagnosed with stage II cancer. Higher social support and resilience were each negatively associated with demoralization. Resilience significantly moderated the associations between social support and demoralization, including the edge between friends' actual assistance and feeling unsupported (β = -0.002, SE = 0.002, p = 0.024), and between others' emotional care and self-undervaluation (β = 0.013, SE = 0.004, p = 0.004). Demoralization was lowest when patients reported concurrently high social support and resilience, and remained relatively low even when patients reported low social support but high resilience (F = 29.18, P < 0.01).
Resilience appears to be associated with an enhanced protective effect of social support on demoralization and, when high, may be associated with lower demoralization even in the context of low external social support. Interventions that concurrently enhance internal resilience and external social support may be promising strategies to reduce demoralization and improve psychological well-being in patients with breast cancer.
In this cross-sectional analysis, a total of 412 patients with breast cancer from the Be Resilient to Breast Cancer (BRBC) program completed the Perceived Social Support Scale (PSSS), the Cancer-Specific Resilience Scale (RS-SC-10), and the Demoralization Scale-II (DS-II). Moderated network analysis, Johnson-Neyman techniques, and response surface analysis were used to examine the moderating role of resilience from both symptom-level (micro) and scale-level (macro) perspectives.
The mean age of participants was 50.8 years, ranging from 28 to 85 years, and 43.2% of them were diagnosed with stage II cancer. Higher social support and resilience were each negatively associated with demoralization. Resilience significantly moderated the associations between social support and demoralization, including the edge between friends' actual assistance and feeling unsupported (β = -0.002, SE = 0.002, p = 0.024), and between others' emotional care and self-undervaluation (β = 0.013, SE = 0.004, p = 0.004). Demoralization was lowest when patients reported concurrently high social support and resilience, and remained relatively low even when patients reported low social support but high resilience (F = 29.18, P < 0.01).
Resilience appears to be associated with an enhanced protective effect of social support on demoralization and, when high, may be associated with lower demoralization even in the context of low external social support. Interventions that concurrently enhance internal resilience and external social support may be promising strategies to reduce demoralization and improve psychological well-being in patients with breast cancer.