Supplementary file 1_When body image and fear collide: a fuzzy-set qualitative comparative (fsQCA) and mediation analysis of sufficient pathways to post-traumatic stress in breast cancer survivors.docx

BackgroundBreast cancer survivors frequently experience significant posttraumatic stress symptoms (PTSS). Using the Conservation of Resources (COR) theory as a framework, this study aimed to investigate the configurational patterns and underlying psychological associations linked to high PTSS in post-operative patients.
MethodsA cross-sectional study was conducted with 172 post-operative breast cancer patients. Participants completed measures for PTSS, resilience, perceived social support (PSS), self-efficacy, fear of progression (FoP), body image disturbance (BID), and shared decision-making (SDM). The analysis employed fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify sufficient combinations of factors associated with high PTSS. This was followed by mediation analysis to test interrelationships among the identified core conditions.
ResultsThe prevalence of PTSS was 89.5%. fsQCA identified five sufficient configurations for high PTSS. The combination of high BID and high FoP emerged as a core condition across these patterns. Mediation analysis demonstrated that FoP was associated with the link between BID and PTSS, and linked PSS to PTSS.
ConclusionHigh FoP and high BID are central factors correlated with PTSS in breast cancer survivors, operating within a COR-based “loss spiral.” Low SDM functions as a conditional factor related to resource obstruction. Findings suggest a need for stratified interventions targeting these specific resource depletions.