Study on the Pathway Mechanism of Social Support and Quality of Life Between Self-Disclosure and Stigma Among Breast Cancer Patients During Recovery.

BACKGROUND: Breast cancer comprehensive therapies often cause body image changes, triggering stigma that impairs mental health and quality of life. Existing studies lack an integrated model to reveal the underlying mechanisms between these variables. METHODS: A cross-sectional survey was conducted among 292 breast cancer patients selected via convenience sampling from 5 hospitals in Guangdong Province between March 2021 and March 2022. The Distress Disclosure Index (DDI), Consumer Experiences of Shame Questionnaire (CESQ), Functional Assessment of Cancer Therapy-Breast (FACT-B), and Multidimensional Scale of Perceived Social Support (PSSS) scales were administered. Pearson correlation analysis explored variable relationships, structural equation modeling (SEM) constructed the chain mediating model, the Bootstrap method tested mediating effects, and subgroup associations with stigma were analyzed. RESULTS: Breast cancer patients had self-disclosure and stigma scores of 38.17 ± 0.54 and 13.74 ± 0.42, respectively. Stigma was significantly negatively correlated with self-disclosure, social support, and quality of life (all p < 0.01). Self-disclosure was directly associated with lower stigma (β = -0.52, p < 0.001) and indirectly mediated by two pathways: the independent pathway through "better quality of life" (11.6% of total effect) and the chain pathway through "higher social support and better quality of life" (5.4% of total effect). Subgroup analysis indicated that patients with a bachelor's degree or above were more significantly associated with low stigma (OR = 0.42, 95% CI: 0.17-0.96), while introverted patients showed a stronger association with high stigma than extroverted ones (OR = 2.90, 95% CI: 1.57-5.56). CONCLUSION: Breast cancer patients exhibit relatively low self-disclosure and moderate-to-low stigma. Higher self-disclosure is associated with lower stigma directly or indirectly via the chain mediation of social support and quality of life. Enhancing psychological counseling, social support, and quality of life, paired with targeted interventions for education and personality subgroups, facilitates physical and mental recovery and social reintegration.