Relationship between resilience, social support, and mental health in breast cancer patients based on the four-quadrant health model

BackgroundBreast cancer is a major public health problem that exposes patients to persistent physical symptoms and psychological distress across diagnosis, treatment, and follow-up. Objective: This study explored the associations of resilience and social support with mental health indicators among individuals with breast cancer and examined whether a Four-Quadrant Health Model could distinguish clinically meaningful physical-psychological risk profiles.MethodsThis secondary cross-sectional analysis used baseline data from a parent breast cancer care-management project. A convenience sample of 1,052 breast cancer inpatients and follow-up patients was analyzed. Measures included the Connor-Davidson Resilience Scale, Social Support Rating Scale, Hospital Anxiety and Depression Scale, Fear of Progression Questionnaire, and MD Anderson Symptom Inventory-Breast Cancer module. Primary analyses retained continuous scores for correlation and regression models. The four-quadrant classification was used as an additional clinical stratification framework based on physical symptom burden and HADS-defined psychological status. Pearson correlations, hierarchical multiple linear regression, and one-way ANOVA with robustness checks were used for statistical analysis.ResultsResilience showed a weak positive association with social support (r = 0.04) and significant negative associations with anxiety, depression, and fear of illness progression (r = −0.18 to −0.24, p < 0.001). Multiple linear regression showed standardized β coefficients of −0.26 for resilience and −0.08 for social support after adjustment for age, explaining 22.3% of the variance in mental distress (F(3, 1,048) = 100.3, p < 0.001). Significant differences in the mental distress composite were observed across the four quadrants (F(3, 1,048) = 565.8, p < 0.001, η2 = 0.62).ConclusionHigher resilience and stronger social support were independently associated with lower psychological distress among breast cancer patients, with resilience showing the stronger association. The Four-Quadrant Health Model distinguished clinically meaningful risk profiles and may support psychosocial triage when used alongside continuous assessment. Because this was a secondary cross-sectional analysis based on convenience sampling from one tertiary hospital, the findings should be interpreted as associations and confirmed in longitudinal, multi-center studies.