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Perceived Stress as a Mediator Between Social Support and Posttraumatic Growth Among Chinese American Breast Cancer Survivors

Yeung, Nelson C.Y. PhD; Lu, Qian MD, PhD

doi: 10.1097/NCC.0000000000000422

Background: Studies have shown that social support is positively associated with posttraumatic growth (PTG) among white cancer survivors. Whether the same relationship holds among Asian American cancer survivors and through what mechanism social support may influence PTG is unclear.

Objective: This study examined the association between social support and PTG among Chinese American breast cancer survivors and proposed perceived stress as a mediator.

Methods: Chinese American breast cancer survivors (n = 118) were recruited from Southern California. Participants’ social support, perceived stress, and PTG were measured in a questionnaire package.

Results: Social support was associated with lower perceived stress (r= −0.34, P<.001) and higher PTG (r=0.44, P<.001). Perceived stress was negatively associated with PTG (r=−0.36, P< .001). Results from structural equation modeling supported the mediation model, with satisfactory model fit indices (χ237= 65.55, comparative fit index= 0.98, Tucker-Lewis Index = 0.97, root-mean-square error of approximation = 0.08). Both the indirect effect from social support to PTG via perceived stress (β = .07, P< .05) and the direct effect from social support and PTG (β= .40, P< .001) were statistically significant, suggesting a partial mediation effect of perceived stress between social support and PTG.

Conclusions: The positive association between social support and Chinese American breast cancer survivors’ PTG was supported. Our findings also suggested that social support may facilitate PTG through reduction of perceived stress.

Implications for Practice: Interventions that help to enhance Chinese American breast cancer survivors’ social support may also facilitate their PTG.

Author affiliations: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong (Dr Yeung); Department of Psychology, University of Houston, Texas (Dr Lu).

This study was supported by the American Cancer Society, MRSGT-10-011-01-CPPB (principal investigator: Qian Lu), and National Cancer Institute, NCI R01CA180896-01A1 (principal investigator: Qian Lu).

The authors have no conflicts of interest to disclose.

Correspondence: Qian Lu, MD, PhD, Department of Psychology, Room 101, Heyne Building, 3695 Cullen Blvd, University of Houston, Houston, TX 77204-5022 (

Accepted for publication May 27, 2016.

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