{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:55:22Z","timestamp":1781762122934,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Resilience showed a weak positive association with social support (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.04) and significant negative associations with anxiety, depression, and fear of illness progression (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f\u22120.18 to \u22120.24,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Multiple linear regression showed standardized\n                      <jats:italic>\u03b2<\/jats:italic>\n                      coefficients of \u22120.26 for resilience and \u22120.08 for social support after adjustment for age, explaining 22.3% of the variance in mental distress (\n                      <jats:italic>F<\/jats:italic>\n                      (3, 1,048)\u202f=\u202f100.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Significant differences in the mental distress composite were observed across the four quadrants (\n                      <jats:italic>F<\/jats:italic>\n                      (3, 1,048)\u202f=\u202f565.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.62).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1796977","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:34:26Z","timestamp":1781760866000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Relationship between resilience, social support, and mental health in breast cancer patients based on the four-quadrant health model"],"prefix":"10.3389","volume":"14","author":[{"given":"Shuangrui","family":"Sui","sequence":"first","affiliation":[{"name":"Breast Disease Diagnosis and Treatment Center","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weicong","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Allergy","place":["Tangshan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihui","family":"Tan","sequence":"additional","affiliation":[{"name":"Breast Disease Diagnosis and Treatment Center","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Feng","sequence":"additional","affiliation":[{"name":"Breast Disease Diagnosis and Treatment Center","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weitao","family":"Yan","sequence":"additional","affiliation":[{"name":"Breast Disease Diagnosis and Treatment Center","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueying","family":"Su","sequence":"additional","affiliation":[{"name":"Breast Disease Diagnosis and Treatment Center","place":["Qinhuangdao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/S0140-6736(17)33326-3","article-title":"Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37,513,025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries","volume":"391","author":"Allemani","year":"2018","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.3390\/ijerph19063547","article-title":"Factors related to anxiety, depressive symptoms and quality of life in breast cancer","volume":"19","author":"C\u00e1ceres","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1136\/bmj.38343.670868.D3","article-title":"Depression and anxiety in women with early breast cancer: five year observational cohort study","volume":"330","author":"Burgess","year":"2005","journal-title":"BMJ"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1007\/s11764-013-0272-z","article-title":"Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies","volume":"7","author":"Simard","year":"2013","journal-title":"J Cancer Surviv"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"6440","DOI":"10.1200\/JCO.2005.02.3259","article-title":"Emotional distress: the sixth vital sign in cancer care","volume":"23","author":"Bultz","year":"2005","journal-title":"J Clin Oncol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2101","DOI":"10.1001\/archinte.160.14.2101","article-title":"Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence","volume":"160","author":"DiMatteo","year":"2000","journal-title":"Arch Intern Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1176\/ajp.137.5.535","article-title":"The clinical application of the biopsychosocial model","volume":"137","author":"Engel","year":"1980","journal-title":"Am J Psychiatry"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1001\/jama.1995.03520250075037","article-title":"Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes","volume":"273","author":"Wilson","year":"1995","journal-title":"JAMA"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1136\/bmj.332.7549.1080","article-title":"The cost of dichotomising continuous variables","volume":"332","author":"Altman","year":"2006","journal-title":"BMJ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1037\/1082-989x.7.1.19","article-title":"On the practice of dichotomization of quantitative variables","volume":"7","author":"MacCallum","year":"2002","journal-title":"Psychol Methods"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1002\/da.10113","article-title":"Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC)","volume":"18","author":"Connor","year":"2003","journal-title":"Depress Anxiety"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"208","DOI":"10.3389\/fpsyt.2019.00208","article-title":"Resilience in cancer patients","volume":"10","author":"Seiler","year":"2019","journal-title":"Front Psych"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.cpr.2017.11.002","article-title":"Intervention studies to foster resilience - a systematic review and proposal for a resilience framework in future intervention studies","volume":"59","author":"Chmitorz","year":"2018","journal-title":"Clin Psychol Rev"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol Bull"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1037\/0278-6133.15.2.135","article-title":"Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research","volume":"15","author":"Helgeson","year":"1996","journal-title":"Health Psychol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1002\/pon.574","article-title":"The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment","volume":"11","author":"Stanton","year":"2002","journal-title":"Psychooncology"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1471-2407-13-6","article-title":"Differences in the symptom experience of older versus younger oncology outpatients: a cross-sectional study","volume":"13","author":"Cataldo","year":"2013","journal-title":"BMC Cancer"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"19","DOI":"10.2224\/sbp.2007.35.1.19","article-title":"Factor analysis and psychometric evaluation of the Connor-Davidson resilience scale (CD-RISC) with Chinese people","volume":"35","author":"Yu","year":"2007","journal-title":"Soc Behav Pers"},{"key":"ref20","first-page":"98","article-title":"The theoretical basis and research application of social support rating scale","volume":"4","author":"Xiao","year":"1994","journal-title":"J Clin Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1908","DOI":"10.1111\/j.1365-2702.2008.02736.x","article-title":"A psychometric evaluation of the Chinese version of the hospital anxiety and depression scale in patients with coronary heart disease","volume":"18","author":"Wang","year":"2009","journal-title":"J Clin Nurs"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1038\/sj.bjc.6604952","article-title":"Hospital anxiety and depression scale cutoff scores for cancer patients in acute care","volume":"100","author":"Singer","year":"2009","journal-title":"Br J Cancer"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"274","DOI":"10.13109\/zptm.2006.52.3.274","article-title":"Fear of progression in breast cancer patients: validation of the short form of the fear of progression questionnaire (FoP-Q-SF)","volume":"52","author":"Mehnert","year":"2006","journal-title":"Z Psychosom Med Psychother"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"5","DOI":"10.16460\/j.issn1008-9969.2018.07.005","article-title":"Reliability and validity of Chinese version of fear of progression questionnaire-short form in women with breast cancer","volume":"25","author":"Cai","year":"2018","journal-title":"J Nurs"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1002\/1097-0142(20001001)89:7<1634::aid-cncr29>3.0.co;2-v","article-title":"Assessing symptom distress in cancer patients: the M.D. Anderson symptom inventory","volume":"89","author":"Cleeland","year":"2000","journal-title":"Cancer"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.clbc.2013.02.014","article-title":"The validity and utility of the M. D. Anderson symptom inventory in patients with breast cancer: evidence from the symptom outcomes and practice patterns data from the eastern cooperative oncology group","volume":"13","author":"Mendoza","year":"2013","journal-title":"Clin Breast Cancer"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"330","DOI":"10.2307\/2332579","article-title":"On the comparison of several mean values: an alternative approach","volume":"38","author":"Welch","year":"1951","journal-title":"Biometrika"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"113","DOI":"10.2307\/1164979","article-title":"Pairwise multiple comparison procedures with unequal n's and\/or variances: a Monte Carlo study","volume":"1","author":"Games","year":"1976","journal-title":"J Educ Stat"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1002\/pon.3353","article-title":"Positive psychology interventions in breast cancer: a systematic review","volume":"23","author":"Casellas-Grau","year":"2014","journal-title":"Psychooncology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3119","DOI":"10.1200\/JCO.2012.47.5210","article-title":"Randomized controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer","volume":"31","author":"Carlson","year":"2013","journal-title":"J Clin Oncol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1002\/cncr.29133","article-title":"Experiencing reproductive concerns as a female cancer survivor is associated with depression","volume":"121","author":"Gorman","year":"2015","journal-title":"Cancer"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1796977\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:34:28Z","timestamp":1781760868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1796977\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":32,"alternative-id":["10.3389\/fpubh.2026.1796977"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1796977","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"article-number":"1796977"}}