When words reveal risk: a mixed-method study on autobiographical narratives of breast biopsy results disclosure as early markers of psychological distress

Background: Autobiographical memory theory suggests that how stressful events are encoded and recalled, particularly in terms of centrality to identity, emotional intensity, and retrieval frequency, can influence mental health. In breast cancer care, the disclosure of biopsy results may represent a psychologically impactful moment, regardless of diagnosis type.Objectives: This mixed-method study aimed to determine whether and how narrative features of breast biopsy result disclosure, analysed by both content (what was said) and form (how it was said), are associated with psychological distress one month later.Method: Sixty-eight participants were interviewed ≥7 days after receiving a breast biopsy result. Psychological distress was assessed one month later using the Distress Thermometer (non-specific distress) and the Impact of Event Scale–Revised (post-traumatic stress symptoms; PTSS). Narratives were coded using a theory-driven framework assessing centrality, emotional intensity, and recall frequency, applied separately to content and form.Results: While controlling for self-reported dissociation, linear regressions showed that for content, centrality and emotional intensity were significantly associated with PTSS, whereas only emotional intensity was significantly associated with non-specific distress. No substantial evidence of an association was found between frequency and any psychological outcome. In terms of form, all three dimensions were significantly associated to PTSS, while frequency and emotional intensity were significantly associated with non-specific distress. Early narrative markers following breast biopsy result disclosure were associated with psychological distress one month later.Conclusions: These findings highlight how memory processes associated with medical stressors can shape psychological outcomes and support their potential as screening tools for early identification of at-risk individuals.