Perceived stress and post-traumatic growth in breast cancer patients: a moderated mediation model

PURPOSE: While the negative correlation between perceived stress and post-traumatic growth (PTG) in breast cancer patients is well-documented, the underlying mechanisms remain unclear. This study explores a moderated mediation model to investigate whether anxiety mediates this relationship and whether benefit finding (BF) moderates the mediation process. METHODS: A total of 1,135 breast cancer patients completed questionnaires assessing PTG, perceived stress, BF, and anxiety. The General Situation Table, The Simplified Chinese Version of the PTG Inventory (C-PTGI), The Chinese Version of the Perceived Stress Scale (CPSS), The Benefits Finding Scale (BFS), and The Hospital Anxiety and Depression Scale (HADS) for breast cancer patients were included in this study. Descriptive statistics, t-tests, one-way analysis of variance, and Pearson’s correlation analyses were used. The effect of moderated mediation was tested by the PROCESS macro (Models 4 and 14) for SPSS 27.0 by Hayes using 5000 bootstrap samples. RESULTS: A total of 1,135 valid questionnaires were collected (effective response rate: 94.58%). The mean scores for perceived stress, PTG, anxiety, and BF were 37.84 ± 6.799, 46.37 ± 19.910, 8.24 ± 4.135, and 52.15 ± 14.041, respectively. Pearson’s correlation analysis showed that anxiety and perceived stress were negatively correlated with both PTG and benefit-finding, while BF was positively correlated with PTG. Mediation analysis revealed that perceived stress not only predicts PTG directly but also indirectly through the mediating effect of anxiety. The results of the moderated mediation model test indicated that BF moderated the mediation effect, particularly in patients with low to moderate levels of BF, where the conditional indirect effect was significant. CONCLUSION: This study clarifies the dual role of anxiety and BF in the stress-post-traumatic growth relationship among breast cancer patients. In clinical practice, healthcare teams can use mindfulness-based therapy to help patients relieve stress, while conducting targeted interventions on patients’ BF levels through cognitive behavioral therapy. By adjusting patients’ cognitive patterns and behavioral habits, they can guide patients to actively identify positive aspects throughout the disease course, ultimately facilitating the improvement of their post-traumatic growth levels.