{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T17:28:35Z","timestamp":1787074115545,"version":"build-2736575974"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Breast cancer is the most common cancer among women. The treatment process can lead to various physical and psychological challenges. Furthermore, breast cancer treatment can evoke a range of emotions due to changes in body image, including feelings of shame and guilt. This study aims to identify how feelings of shame and guilt mediate the impact of psychological distress on body image difficulties through comprehensive model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>This cross-sectional study, conducted in Tehran, Iran in 2023, recruited 210 breast cancer patients (mean age of 44.50; range 22\u201375) through convenience sampling. Data were collected using demographic information, the Depression, Anxiety, and Stress Scales (DASS), body image Scale (BICI), shame and guilt Scales (SSGS). A mediation model was examined within a path analysis framework by testing the indirect effect of psychological distress on body image difficulties through shame and guilt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A mediation analysis showed that patients with psychological distress have difficulties in body image perception. All indirect effects were statistically significant, except for the anxiety and stress scales. This model accounted for 48% of the variance for body image and 29% of shame (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.29) and 21% of guilt (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.21).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>The findings of this study are expected to advance our theoretical understanding of body image disturbance and provide practical implications for clinical interventions to improve patient\u2019s general health and emotional well-being.<\/jats:p>\n                  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