Abstract
OBJECTIVES: According to the personality five-factor theory (FFT), this study explored a structural equation model for women with breast cancer involving variables, including extraversion and neuroticism, post-breast-cancer stress, demoralization, sleep disturbances, and psychological well-being (PWB). METHODS: A total of 351 women with breast cancer were recruited from mid-Taiwan for the cross-sectional questionnaire survey. RESULTS: In this model, extraversion had direct effects on demoralization (-0.21), sleep disturbances (-0.16), and PWB (0.36); neuroticism had direct effects on post-breast-cancer stress (0.28), demoralization (0.12), and sleep disturbances (0.19); post-breast-cancer stress had direct effects on demoralization (0.71) and PWB (0.38); demoralization had direct effects on sleep disturbances (0.33) and PWB (-0.75). Accordingly, extraversion had a higher direct influence on demoralization than neuroticism (-0.21 vs. 0.12); however, neuroticism correlated with demoralization more than extraversion with demoralization (0.36 vs. -0.28). Neuroticism had a higher direct influence on sleep disturbances than extraversion on sleep disturbances. With regards to indirect influences, post-breast-cancer stress partially mediated the path from neuroticism to demoralization. Demoralization completely mediated the path from post-breast-cancer stress to sleep disturbances and partially mediated the path from extraversion to sleep disturbances. Moreover, demoralization and post-breast-cancer stress together completely mediated the path from neuroticism to PWB. Furthermore, a suppression effect occurred, making the influence from post-breast-cancer stress to PWB positive, which seemed to characterize post-traumatic growth; meanwhile, the suppression enforced the negative effect of demoralization on PWB. CONCLUSIONS: Post-breast-cancer stress and demoralization play important roles in clinical counseling for survivors of women with breast cancer.