Previous studies have indicated that cancer patients may have a lower level of subjective well-being (SWB); nevertheless, the underlying factors for this phenomenon remain insufficiently investigated. Based on the characteristics of Chinese breast cancer patients and the unique culture, this study explored the independent contributions of death anxiety, self-esteem, and social support to SWB from the protective and risk perspectives. A cross-sectional survey recruited 514 females with breast cancer and collected participants’ demographic and the above variables. The results found that death anxiety independently predicted SWB in a negative direction (β = −0.36, p < 0.001). In addition, self-esteem (β = 0.38, p < 0.001) and social support (β = 0.14, p < 0.001) also had the unique positive effects on SWB. These findings offer new insights into strengthening breast cancer patients’ SWB, for instance, using relevant interventions to reduce death anxiety and improve self-esteem and social support.
AbrahamsHJGGielissenMFMVerhagenCAHHVM, et al (2018) The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clinical Psychology Review63: 1–11.
2.
ApriliantoELumadiSAHandianFI (2021) Family social support and the self-esteem of breast cancer patients undergoing neoadjuvant chemotherapy. Journal of Public Health Research10(2): 2234–2241.
3.
BadanaANSMarinoVRTemplemanME, et al (2019) Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients. Supportive Care in Cancer27(11): 4245–4252.
4.
BaumeisterRFCampbellJDKruegerJI, et al (2003) Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles?Psychological Science in the Public Interest4(1): 1–44.
5.
BibiAKhalidMA (2020) Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan. Death Studies44(12): 787–792.
6.
BloomJRStewartSLOakley-GirvanI, et al (2012) Quality of life of younger breast cancer survivors: Persistence of problems and sense of well-being. Psycho-Oncology21(6): 655–665.
7.
CarreiraHWilliamsRMüllerM, et al (2018) Associations between breast cancer survivorship and adverse mental health outcomes: A systematic review. Journal of the National Cancer Institute110(12): 1311–1327.
8.
CastADBurkePJ (2002) A theory of self-esteem. Social Forces80(3): 1041–1068.
9.
ChenBLuoLWuX, et al (2021) Are the lower class really unhappy? Social class and subjective well-being in Chinese adolescents: Moderating role of sense of control and mediating role of self-esteem. Journal of Happiness Studies22: 825–843.
10.
ClarkDABeckAT (2010) Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings. Trends in Cognitive Sciences14(9): 418–424.
11.
Cobo-CuencaAIMartín-EspinosaNMRodríguez-BorregoMA, et al (2019) Determinants of satisfaction with life and self-esteem in women with breast cancer. Quality of Life Research28(2): 379–387.
12.
CohenABPierceJDChambersJ, et al (2005) Intrinsic and extrinsic religiosity, belief in the afterlife, death anxiety, and life satisfaction in young Catholics and Protestants. Journal of Research in Personality39(3): 307–324.
13.
CohenSDoyleWJTurnerR, et al (2003) Sociability and susceptibility to the common cold. Psychological Science14(5): 389–395.
14.
ColeBSHopkinsCMTisakJ, et al (2008) Assessing spiritual growth and spiritual decline following a diagnosis of cancer: Reliability and validity of the spiritual transformation scale. Psycho-Oncology17(2): 112–121.
15.
DeimlingGPhelpsEKGilbertM, et al (2019) Life satisfaction among older adult, long-term cancer survivors: A comparison of black with white survivors. Psycho-Oncology28(6): 1335–1341.
DienerEChanMY (2011) Happy people live longer: Subjective well-being contributes to health and longevity. Applied Psychology: Health and Well-Being3(1): 1–43.
18.
DienerEEmmonsRALarsenRJ, et al (1985) The satisfaction with life scale. Journal of Personality Assessment49(1): 71–75.
19.
DienerEGohmCLSuhE, et al (2000) Similarity of the relations between marital status and subjective well-being across cultures. Journal of Cross-Cultural Psychology31(4): 419–436.
20.
DienerEPressmanSDHunterJ, et al (2017) If, why, and when subjective well-being influences health, and future needed research. Applied Psychology: Health and Well-Being9(2): 133–167.
21.
DingRXiaoYMoM, et al (2022) Breast cancer screening and early diagnosis in Chinese women. Cancer Biology and Medicine19(4): 450–467.
22.
Di PaulaACampbellJD (2002) Self-esteem and persistence in the face of failure. Journal of Personality and Social Psychology83(3): 711–724.
23.
DuyBYıldızMA (2019) The mediating role of self-esteem in the relationship between optimism and subjective well-being. Current Psychology38(6): 1456–1463.
24.
FaulFErdfelderELangAG, et al (2007) G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods39(2): 175–191.
25.
GrossmanCHBrookerJMichaelN, et al (2018) Death anxiety interventions in patients with advanced cancer: A systematic review. Palliative Medicine32(1): 172–184.
26.
HaslamNWhelanJBastianB (2009) Big Five traits mediate associations between values and subjective well-being. Personality and Individual Differences46(1): 40–42.
27.
HobfollSE (2001) The influence of culture, community, and the nested-self in the stress process: Advancing conservation of resources theory. Psychologie Appliquee50(3): 337–421.
28.
HoganBELindenWNajarianB (2002) Social support interventions: Do they work?Clinical Psychology Review22(3): 383–442.
29.
HongYYuhanLYouhuiG, et al (2022) Death anxiety among advanced cancer patients: A cross-sectional survey. Supportive Care in Cancer30: 3531–3539.
30.
HorleyJLaveryJJ (1995) Subjective well-being and age. Social Indicators Research34(2): 275–282.
31.
JiangSLiCWangZ, et al (2020) The mediating effect of neighbor relationship between community social support and elderly’s subjective well-being in China. Journal of Health Psychology25(6): 780–790.
32.
KarampourSFereidooni-MoghadamMZareaK, et al (2018) The prevalence of death anxiety among patients with breast cancer. BMJ Supportive & Palliative Care8(1): 61–63.
33.
KongFYangKYanW, et al (2021) How does trait gratitude relate to subjective well-being in Chinese adolescents? The mediating role of resilience and social support. Journal of Happiness Studies22(4): 1611–1622.
34.
KongFZhaoJYouX (2013) Self-esteem as mediator and moderator of the relationship between social support and subjective well-being among Chinese university students. Social Indicators Research112(1): 151–161.
35.
LazarusRS (1999) Hope: An emotion and a vital coping resource against despair. Social Research66(2): 653–678.
36.
LeiSZhengRZhangS, et al (2021) Breast cancer incidence and mortality in women in China: Temporal trends and projections to 2030. Cancer Biology and Medicine18(3): 900–909.
37.
LeongSPShenZ-ZLiuTJ, et al (2010) Is breast cancer the same disease in Asian and Western countries?World Journal of Surgery34(10): 2308–2324.
38.
LeungJPachanaNAMcLaughlinD (2014) Social support and health-related quality of life in women with breast cancer: A longitudinal study. Psycho-Oncology23(9): 1014–1020.
39.
LittleRJRubinDB (2002) Statistical Analysis With Missing Data. New York, NY: Wiley Press.
40.
Lorenzo-SevaUCalderonCFerrandoPJ, et al (2019) Psychometric properties and factorial analysis of invariance of the Satisfaction with Life Scale (SWLS) in cancer patients. Quality of Life Research28(5): 1255–1264.
41.
McDonoughMHSabistonCMWroschC (2014) Predicting changes in posttraumatic growth and subjective well-being among breast cancer survivors: The role of social support and stress. Psycho-Oncology23(1): 114–120.
42.
MartelaFRyanRM (2016) The benefits of benevolence: Basic psychological needs, beneficence, and the enhancement of well-being. Journal of Personality84(6): 750–764.
43.
MoosRHSchaeferJA (1993) Coping resources and processes: Current concepts and measures. In: GoldbergerLBreznitzS (eds) Handbook of Stress: Theoretical and Clinical Aspects. New York, NY: Free Press, pp.234–257.
44.
NeimeyerRA (1994) Validity and reliability of the multidimensional. In: NeimeyerRA (ed.) Death Anxiety Handbook: Research, Instrumentation, and Application. Washington, DC: Taylor and Francis, pp.103–119.
45.
NiveauNNewBBeaudoinM (2021) Self-esteem interventions in adults – A systematic review and meta-analysis. Journal of Research in Personality94: 104131.
46.
ParkSSatoYTakitaY, et al (2020) Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer – A randomized controlled trial. Journal of Pain and Symptom Management60(2): 381–389.
47.
PinquartMFröhlichC (2009) Psychosocial resources and subjective well-being of cancer patients. Psychology and Health24(4): 407–421.
48.
RosenbergM (1965) Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press.
49.
RoshaniK (2012) Relationship between religious beliefs and life satisfaction with death anxiety in the elderly. Annals of Biological Research3(9): 4400–4405.
50.
RudazMLedermannTGrzywaczJG (2019) The influence of daily spiritual experiences and gender on subjective well-being over time in cancer survivors. Archive for the Psychology of Religion41(2): 159–171.
51.
RuiniCVescovelliFAlbieriE (2013) Post-traumatic growth in breast cancer survivors: New insights into its relationships with well-being and distress. Journal of Clinical Psychology in Medical Settings20(3): 383–391.
52.
SalsmanJMPustejovskyJESchuellerSM, et al (2019) Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect. Journal of Cancer Survivorship13(6): 943–955.
53.
SchreiberJABrockoppDY (2012) Twenty-five years later—What do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review. Journal of Cancer Survivorship6(1): 82–94.
54.
SheldonKMCorcoranMPrenticeM (2019) Pursuing eudaimonic functioning versus pursuing hedonic well-being: The first goal succeeds in its aim, whereas the second does not. Journal of Happiness Studies20: 919–933.
55.
SheldonKMCorcoranMTitovaL (2021) Supporting one’s own autonomy may be more important than feeling supported by others. Motivation Science7(2): 176–186.
56.
SherbourneCDStewartAL (1991) The MOS social support survey. Social Science & Medicine (1967)32(6): 705–714.
SiedleckiKLSalthouseTAOishiS, et al (2014) The relationship between social support and subjective well-being across age. Social Indicators Research117(2): 561–576.
59.
SoleimaniMABahramiNAllenKA, et al (2020) Death anxiety in patients with cancer: A systematic review and meta-analysis. European Journal of Oncology Nursing48: 101803.
60.
SoleimaniMAYaghoobzadehABahramiN, et al (2016) Psychometric evaluation of the Persian version of the Templer’s Death Anxiety Scale in cancer patients. Death Studies40(9): 547–557.
61.
SungHFerlayJSiegelRL, et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians71(3): 209–249.
62.
TaghiabadiMKavosiAMirhafezSR, et al (2017) The association between death anxiety with spiritual experiences and life satisfaction in elderly people. Electronic Physician9(3): 3980–3985.
63.
TanJJXKrausMWCarpenterNC, et al (2020) The association between objective and subjective socioeconomic status and subjective well-being: A meta-analytic review. Psychological Bulletin146(11): 970–1020.
64.
TaylorSE (1983) Adjustment to threatening events: A theory of cognitive adaptation. The American Psychologist38(11): 1161–1173.
65.
TaylorSE (2011) Social support: A review. In: FriedmanHS (ed.) The Oxford Handbook of Health Psychology. New York, NY: Oxford University Press, pp.189–214.
66.
TemplerDI (1970) The construction and validation of a death anxiety scale. The Journal of General Psychology82(2): 165–177.
67.
TianQ (2016) Intergeneration social support affects the subjective well-being of the elderly: Mediator roles of self-esteem and loneliness. Journal of Health Psychology21(6): 1137–1144.
68.
WangYHuangYZhengR, et al (2023) Intern nursing students’ perceived barriers to providing end-of-life care for dying cancer patients in a death taboo cultural context: A qualitative study. Asia-Pacific Journal of Oncology Nursing10(4): 100210.
69.
WatsonDClarkLATellegenA (1988) Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology54(6): 1063–1070.
70.
WillsTA (1991) Social support and interpersonal relationships. In: ClarkMS (ed.) Prosocial Behavior. Newbury Park, CA: Sage Publications, pp.265–289.
71.
WitterRAOkunMAStockWA, et al (1984) Education and subjective well-being: A meta-analysis. Educational Evaluation and Policy Analysis6(2): 165–173.
72.
YouJLuQ (2014) Sources of social support and adjustment among Chinese cancer survivors: Gender and age differences. Supportive Care in Cancer22: 697–704.
73.
ZainalNZBoothSHuppertFA (2013) The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: A meta-analysis. Psycho-Oncology22(7): 1457–1465.
74.
ZamanianHAmini-TehraniMJalaliZ, et al (2021) Perceived social support, coping strategies, anxiety and depression among women with breast cancer: Evaluation of a mediation model. European Journal of Oncology Nursing50: 101892.
75.
ZhangLLiWYeY, et al (2023) Being grateful every day will pay off: A daily diary investigation on relationships between gratitude and well-being in Chinese young adults. The Journal of Positive Psychology18: 853–865.
76.
ZhangSSunKZhengR, et al (2021) Cancer incidence and mortality in China, 2015. Journal of the National Cancer Center1(1): 2–11.
77.
ZhengRSGuoQHDongFQ, et al (2015) Chinese oncology nurses’ experience on caring for dying patients who are on their final days: A qualitative study. International Journal of Nursing Studies52(1): 288–296.
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