Predictive role of family dysfunction on psychological morbidity in breast cancer patients

doi:10.5498/wjp.v16.i2.113887

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Psychiatry. Feb 19, 2026; 16(2): 113887
Published online Feb 19, 2026. doi: 10.5498/wjp.v16.i2.113887

Predictive role of family dysfunction on psychological morbidity in breast cancer patients

Zhi-Juan Li, Liang-Ying Chen, Xiu-Fen Zhuang, Pan-Pan Yang, Yan Fang

Zhi-Juan Li, Xiu-Fen Zhuang, Pan-Pan Yang, Yan Fang, Department of Head and Neck Oncology, Comprehensive Oncology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China

Liang-Ying Chen, Department of Hematology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China

Co-first authors: Zhi-Juan Li and Liang-Ying Chen.

Author contributions: Li ZJ and Chen LY contributed equally to this work as co-first authors. Li ZJ was responsible for study design, data collection, statistical analysis, manuscript drafting, and revision; Chen LY contributed to patient recruitment, psychological assessments, data interpretation, and critical manuscript revision; Zhuang XF participated in family functioning assessments, data management, and literature review; Yang PP assisted with data analysis, figure preparation, and reference management; Fang Y conceived the study, supervised the research process, provided critical intellectual input, and approved the final manuscript. All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Institutional review board statement: This study was approved by the Scientific Research Ethics Committee of the Affiliated Hospital of Jiangsu University (Approval No. KY2025H0923-03). All procedures complied with the Declaration of Helsinki.

Informed consent statement: Written informed consent was waived due to the retrospective design.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: De-identified data and analysis code are available from the corresponding author upon reasonable request and subject to institutional approvals.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yan Fang, Department of Head and Neck Oncology, Comprehensive Oncology, Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang 212001, Jiangsu Province, China. fangy813@163.com

Received: September 28, 2025
Revised: October 29, 2025
Accepted: December 11, 2025
Published online: February 19, 2026
Processing time: 123 Days and 22.3 Hours

Abstract

BACKGROUND

Breast cancer affects over 2.3 million women worldwide annually, with 30%-50% experiencing psychological morbidity, including anxiety and depression. Family functioning plays a crucial role in patients’ psychological adaptation to cancer, yet the specific predictive relationship between family dysfunction dimensions and psychological outcomes remains insufficiently characterized. This study aimed to systematically examine how family dysfunction predicts psychological morbidity in breast cancer patients.

AIM

To explore the predictive role of family dysfunction on psychological morbidity in breast cancer patients and develop a clinical risk prediction model.

METHODS

A retrospective cohort study was conducted among 285 breast cancer patients from June 2022 to March 2025 at a provincial tertiary hospital. Family functioning was assessed using the Family Assessment Device, and psychological health was evaluated using the Hospital Anxiety and Depression Scale. Univariate and multivariate logistic regression analyses were performed to identify predictive factors. A comprehensive risk prediction model was developed and validated.

RESULTS

The overall psychological morbidity rate was 41.5% (n = 118), with anxiety symptoms in 28.1% and depressive symptoms in 31.9% of patients. Family dysfunction was present in 32.8% of patients, with communication dysfunction being most prevalent (41.8%). Pearson correlation analysis revealed significant positive correlations between all family dysfunction dimensions and psychological morbidity indicators, with communication dysfunction showing the strongest correlation (r = 0.542 for anxiety, r = 0.518 for depression, both P < 0.001). Multivariate logistic regression demonstrated that overall family dysfunction was an independent predictor of psychological morbidity (odds ratio = 3.247, 95% confidence interval: 1.832-5.756, P < 0.001), explaining 23.6% of variance (Nagelkerke R² = 0.236).

CONCLUSION

Family dysfunction significantly predicts psychological morbidity in breast cancer patients, with communication dysfunction being the most critical dimension. The developed risk prediction model demonstrates good accuracy for clinical decision-making.

Keywords: Breast cancer; Family dysfunction; Psychological morbidity; Anxiety; Depression; Risk prediction

Core Tip: This study demonstrates that family dysfunction, particularly communication problems, is a strong independent predictor of psychological morbidity in breast cancer patients. Using the Family Assessment Device and the Hospital Anxiety and Depression Scale, we developed and validated a clinical risk prediction model with good accuracy. Early identification of family dysfunction allows timely psychological support and family-centered interventions, which may improve mental health outcomes and treatment adherence in breast cancer care.