When body image and fear collide: a fuzzy-set qualitative comparative (fsQCA) and mediation analysis of sufficient pathways to post-traumatic stress in breast cancer survivors

Background: Breast cancer survivors frequently experience significant posttraumatic stress symptoms (PTSS). Using the Conservation of Resources (COR) theory as a framework, this study aimed to investigate the configurational patterns and underlying psychological associations linked to high PTSS in post-operative patients. Methods: A cross-sectional study was conducted with 172 post-operative breast cancer patients. Participants completed measures for PTSS, resilience, perceived social support (PSS), self-efficacy, fear of progression (FoP), body image disturbance (BID), and shared decision-making (SDM). The analysis employed fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify sufficient combinations of factors associated with high PTSS. This was followed by mediation analysis to test interrelationships among the identified core conditions. Results: The prevalence of PTSS was 89.5%. fsQCA identified five sufficient configurations for high PTSS. The combination of high BID and high FoP emerged as a core condition across these patterns. Mediation analysis demonstrated that FoP was associated with the link between BID and PTSS, and linked PSS to PTSS. Conclusion: High FoP and high BID are central factors correlated with PTSS in breast cancer survivors, operating within a COR-based "loss spiral." Low SDM functions as a conditional factor related to resource obstruction. Findings suggest a need for stratified interventions targeting these specific resource depletions.