Factors Predicting Psychological Well-being among Survivors of Breast Cancer in A Tertiary Care Hospital, Thailand


  • Nuntana Singtaweesuk Psychiatric and Mental Health Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand / Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
  • Wareerat Thanoi Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
  • Nopporn Vongsirimas Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
  • Sirada Kesornsri Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
  • Piyanee Klainin-Yobas Alice Lee Centre for Nursing Studies, Yoo Loo Lin School of Medicine, 2 National University of Singapore Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore




Breast cancer survivors, Psychological well-being, Resilience, Self-efficacy, Social support, Stress


Objective: The primary aim of this study was to examine predicting the effect of stress, social support, self-efficacy, and resilience on psychological well-being in breast cancer survivors

Materials and Methods: This predictive analysis for the descriptive cross-sectional study was conducted by the theoretical underpinning of resilience and population consisted of eligible breast cancer survivors receiving care at an outpatient clinic within a tertiary hospital setting. The data collecting was proceeded through self-administered questionnaires in line with convenient sampling. The analytical approach encompassed descriptive statistics, Pearson’s correlation coefficient, and multiple linear regression.

Results: Emanating from the study included the recruitment of 123 participants, with stress, social support, and resilience collectively elucidating 43% of the variance in psychological well-being among breast cancer survivors. Notably, resilience emerged as the most influential predictor (β=.33), followed by stress (β=-.27) and social support (β=.26), all of which significantly contributed to the prediction of psychological well-being.

Conclusion: Resilience, stress, and social support were three predictors of psychological well-being among survivors of breast cancer in this study. Recommendations extend to the integration of strategies that foster resilience and social support, while concurrently mitigating stress levels through activities and programs aimed at augmenting the psychological well-being of breast cancer survivors in the future.


International Agency for Research on Cancer. Breast cancer now most common form of cancer: WHO taking action. [Internet]. Available from: https://www.who.int/news/item/03-02-2021-breast-cancer-now-most-common-form-of-cancer-who-taking-action [last accessed on, 2022 May 30]

World Health Organization. Global cancer 2020. [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer [last accessed on, 2022 May 30]

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. C.A. Cancer J Clin. 2021;71(3):209-49.

Zoberi K, Tucker J. Primary Care of Breast Cancer Survivors. Am Fam Physician. 2019;99(6):370-375.

Maass S, Boerman L, Brandenbarg D, Verhaak P, Maduro J, Bock GH, et al. Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care. Breast. 2020;54:133-138.

Byar KL, Berger AM, Bakken SL, Cetak MA. Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum. 2006;33(1):E18-26.

Izci F, Ilgun AS, Fındıkli E, Ozmen V. Psychiatric Symptoms and Psychosocial Problems in Patients with Breast Cancer. J Breast Health. 2016;12(3):94-101.

Nomsang P, Kurat S, Baothong K, Somboonkij D, Supanyabut K, Pasaribut R, et al. Life experiences of breast cancer patients who received chemotherapy. J Prapokklao Hosp Clin Med Educ Cent. 2018;35(2):140-152.

Ryff CD, Keyes CLM. The structure of psychological well-being revisited. J Pers Soc Psychol. 1995;69:719-727.

Casellas-Grau A, Vives J, Font A, Ochoa C. Positive psychological functioning in breast cancer: An integrative review. Breast. 2016;27:136-68.

Henselmans I, Helgeson VS, Seltman H, de Vries J, Sanderman R, Ranchor AV. Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis. Health Psychol. 2010;29(2):160-168.

Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-1272.

Zhang JY, Zhou YQ, Feng ZW, Fan YN, Zeng GC, Wei L. Randomized controlled trial of mindfulness-based stress reduction (MBSR) on posttraumatic growth of Chinese breast cancer survivors. Psychol Health Med. 2017;22(1):94-109.

Ye ZJ, Peng CH, Zhang HW, Liang MZ, Zhao JJ, Sun Z, et al. A biopsychosocial model of resilience for breast cancer: A preliminary study in mainland China. Eur J Oncol Nurs. 2018;36:95-102.

Rottmann N, Dalton SO, Christensen J, Frederiksen K, Johansen C. Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Qual Life Res. 2010;19(6):827-836.

Chaooichai W, Pothiban L, Chintanawat R. Factors Related to Psychological Well-being in Older Patients with Cancer Receiving Chemotherapy. Nurs J CMU. 2019;46:13-22.

Gochett, CG. Psychological Wellbeing Among Breast Cancer Survivors: Factors That Influence Transition from Primary Treatment to Early Survivorship. UKnowledge. 2015;16:1-80.

Kordan Z, Azimi Lolaty H, Mousavinasab S, Fard J. Relationship between psychological well-being and social capital and resilience among cancer patients. J Nurs Midwifery Sci. 2019;6:131-137.

Selye H. The stress of life. New York, NY, U.S.: McGraw-Hill; 1956.

Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471.

Park CL, Lechner SC. Measurement Issues in Assessing Growth Following Stressful Life Experiences. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research & practice. Mahwah, NJ, U.S.: Lawrence Erlbaum Associates Publishers; 2006:47-67.

Golden-Kreutz DM, Thornton LM, Wells-Di Gregorio S, Frierson GM, Jim HS, Carpenter KM, et al. Traumatic stress, perceived global stress, and life events: prospectively predicting quality of life in breast cancer patients. Health Psychol. 2005;24(3):288-96.

Groarke A, Curtis R, Kerin M. Cognitive-behavioural stress management enhances adjustment in women with breast cancer. Br J Health Psychol. 2013;18(3):623-641.

Musarezaie A, Esfahani HN, Momeni T, Karimian J, Ebrahimi A. The Relationship between spiritual well-being and stress, anxiety, and depression in patients with breast cancer. J Isfahan Med Sch. 2012;30(195):1-10.

Brandt PA, Weinert C. PRQ: Psychometric update unpublished manuscript. University of Washington, School of Nursing, Washington DC; 1985.

Stuifbergen AK, Seraphine A, Roberts G. An explanatory model of health promotion and quality of life in chronic disabling conditions. Nurs Res. 2000;49(3):122-129.

Solikhah S, Perwitasari DA, Irham LM, Matahari R. Social Support in Quality of Life among Breast Cancer Patients after Diagnosis: A Bibliometric Analysis. Siriraj Med J. 2023;75(7):529-537.

Bandura A. Self-efficacy: The exercise of control. New York, NY, U.S.: WH Freeman/Times Books/ Henry Holt & Co; 1997.

Foster C, Breckons M, Cotterell P, Barbosa D, Calman L, Corner J, et al. Cancer survivors' self-efficacy to self-manage in the year following primary treatment. J Cancer Surviv. 2015;9(1):11-19.

Tu PC, Yeh DC, Hsieh HC. Positive psychological changes after breast cancer diagnosis and treatment: The role of trait resilience and coping styles. J Psychosoc Oncol. 2020;38(2):156-170.

Golberg HE. A guide to promote resilience in children: Strengthening the human spirit. Netherlands: Bernard Van Lee Foundation; 1995.

Hiew CC, Mori T, Shimizu M, Tominaga M. Measurement of resilience development: Preliminary results with a state-trait resilience inventory. Journal of Learning and Curriculum Development. 2000;1:111-117.

Samantarath P, Kesornsri S, Jittayanont S, Kanchanapongkul S. Predictors of psychological wellbeing among adolescents receiving cancer chemotherapy. Nurs Sci J Thail. 2022;40(2):124-139.

Phuca W, Vongsirimas N, Thanoi W. Factors correlated with psychological well-being in patients receiving hemodialysis. Nurs Sci J Thail. 2020;38(1):73-85.

Kumpfer KL. Factors and processes contributing to resilience: The resilience framework. Resilience and development: Positive life adaptations. Longitudinal research in the social and behavioral sciences. Dordrecht, Netherlands: Kluwer Academic Publishers; 1999:179-224.

Baeda AG, Nurwahyuni E. Impact of Resilience on Psychological well-being in Breast Cancer Patients Undergoing Chemotherapy. J Kep Padjadiaran. 2022;10(1):37-44.

Brain rehabilitation group. Brain function test (Thai). Siriraj Hosp Gaz. 1993;45(6):359-374.

Phuangwarin N, Thongtaeng O, Asantachai P, Praditsuwan R, Thephasadin Na Ayudhya W, Sukatungka K, et al. Thai geriatric depression scale in the Thai elderly. Siriraj Hosp Gaz. 1994;46(1):1-9.

Klainin-Yobas P, Thanoi W, Vongsirimas N, Ying L. Evaluating the English and Thai-Versions of the Psychological Wellbeing Scale across Four Samples. Psychology. 2020;11:71-86.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385-396.

Wongpakaran N, Wongpakaran T. The Thai version of the PSS-10: An Investigation of its psychometric properties. Biopsychosoc Med. 2010;4:6.

Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. Journal Pers Assess. 1988;52:30-41.

Boonyamalik P. Epidemiology of adolescent suicidal ideation: roles of perceived life

stress, depressive symptoms, and substance use [dissertation]. Baltimore (M.D.): Johns Hopkins University; 2005:422.

Schwarzer R, Jerusalem M. Generalized Self-Efficacy scale. In J. Weinman, S.

Wright, & M. Johnston. Measures in health psychology: A user’s portfolio. Causal and control beliefs. Windsor, UK: NFER-NELSON; 1995:35-37.

Sukmak W, Sirisoontorn A, Meena P. Validity of the questionnaire Self-efficacy. J Psychiatr Assoc Thailand. 2002;47(1):31-37.

Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.

Vongsirimas N, Thanoi W, Klainin-Yobas P. Evaluating psychometric properties of the Connor-Davidson Resilience Scale (10-item CD-RISC) among university students in Thailand. J Nurs Sci. 2017;35(3):25-35.

McDonough MH, Sabiston CM, Wrosch C. Predicting changes in posttraumatic growth and subjective well-being among breast cancer survivors: the role of social support and stress. Psychooncology. 2014;23(1):114-120.

Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psycho. 1989;57:1069-1081.

Fong AJ, Scarapicchia TMF, McDonough MH, Wrosch C, Sabiston CM. Changes in social support predict emotional well-being in breast cancer survivors. Psychooncology. 2017;26(5):664-671.

Caplan, G. Support systems and community mental health. New York: Behavioral Publication; 1974.

House, JS. Work stress and social support. California: Addison-Wesley Publishing Company; 1981.

Foster C, Breckons M, Cotterell P, Barbosa D, Calman L, Corner J, et al. Cancer survivors' self-efficacy to self-manage in the year following primary treatment. J Cancer Surviv. 2015;9(1):11-19.

Loibl S, Andre F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Onco. 2024;35(2):159-182.

Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.

Ye ZJ, Liang MZ, Qiu HZ, Liu ML, Hu GY, Zhu YF. Effect of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), on female breast cancer survivors in mainland China-A randomized, controlled, theoretically-derived intervention trial. Breast Cancer Res Treat. 2016;158(3):509-522.

Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer. 2011;11(6):364-368.

Lu Q, Chen L, Shin LJ, Wang C, Moultin LD, Chu Q, et al. Improvement in quality of life and psychological well-being associated with a culturally based psychosocial intervention for Chinese American breast cancer survivors. Support Care Cancer. 2021;29:4565-4573.

Hu J, Wang X, Guo S, Chen F, Wu YY, Ji JJ, et al. Peer support interventions for breast cancer patients: a systematic review. Breast Cancer Res Treat. 2019;174:325–341.

Park E, Yoon J, Choi Ek, Kim IR, Kang D, Lee SK, et al. A train the trainer program for healthcare professionals tasked with providing psychosocial support to breast cancer survivors. BMC Cancer. 2018;18:45.

Li Y, Zhang X, Zhang L, Wang W. Effects of evidence-based nursing on psychological well-being, postoperative complications and quality of life after breast cancer surgery. Am J Transl Res. 2021;13(5):5165-5173.

Kapoor A, Nambisan P, Baker E. Mobile applications for breast cancer survivorship and self-management: A systematic review. Health Inform J. 2020;26(4):2892-2905.



How to Cite

Singtaweesuk, N. ., Thanoi, W., Vongsirimas, N., Kesornsri, S., & Klainin-Yobas , P. (2024). Factors Predicting Psychological Well-being among Survivors of Breast Cancer in A Tertiary Care Hospital, Thailand. Siriraj Medical Journal, 76(5), 244–254. https://doi.org/10.33192/smj.v76i5.267634



Original Article