Mental health in female breast cancer survivors post-mastectomy: A structural model based on Roy's adaptation model

Breast cancer survivors experience significant physical and psychosocial changes after mastectomy, making them vulnerable to mental health challenges such as depression, anxiety, and social dysfunction. This study identifies factors influencing the mental health of breast cancer survivors using Roy's Adaptation Model (RAM), which provides a framework for understanding adaptation processes and their impact on health outcomes.

A cross-sectional structural equation modeling (SEM) study was conducted to develop and validate a hypothetical model based on RAM. Data were collected through an online survey administered from February 1 to 28, 2023, to female breast cancer survivors who had undergone mastectomy at least one year but less than five years before the commencement of the study. A total of 346 participants from an online community of patients with breast cancer were included in the final analysis. Statistical analyses were performed using IBM SPSS 26.0 and AMOS 28.0.

The goodness-of-fit indices for the structural model indicated acceptable fit (goodness-of-fit index [GFI] ​= ​0.82; RMR ​= ​0.05; comparative-fit-index [CFI] ​= ​0.85; root mean square error of approximation [RMSEA] ​= ​0.09). Seven of the eight hypothesized paths were significant. Coping and adaptation processes directly influenced symptom experience, body image, role performance, and social support and indirectly affected mental health. Body image, role performance, and social support collectively explained 88% of the variance in mental health outcomes. Multigroup SEM analysis revealed differences in the structural paths based on breast reconstruction status.

Effective mental health assessment and intervention for breast cancer survivors undergoing mastectomy requires an integrated approach that considers coping processes, body image, role performance, and social support. Nurses should focus on strengthening adaptive coping strategies, fostering a positive body image, managing role-related stress, and enhancing social support systems to improve survivors' overall mental well-being.