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Relationship between body image and stigma among Chinese breast cancer patients: A chain mediation model
Xiao-Hua He, Bo Zhou, Yang Liu, You-Wen Gong, Hong-Ling Zheng
Xiao-Hua He, Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Xiao-Hua He, Department of Nursing, Zhangjiajie People’s Hospital, Zhangjiajie 427000, Hunan Province, China
Bo Zhou, You-Wen Gong, Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
Yang Liu, School of Nursing, University of South China, Hengyang 421001, Hunan Province, China
Hong-Ling Zheng, Breast Surgery Ward 1, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu 610041, Sichuan Province, China
Co-first authors: Xiao-Hua He and Bo Zhou.
Co-corresponding authors: You-Wen Gong and Hong-Ling Zheng.
Author contributions: He XH and Zhou B contributed equally to this manuscript and are co-first authors. He XH conceived and supervised the study; Zhou B and Liu Y conducted the data analyses; He XH and Gong YW prepared the initial draft; Zheng HL and Zhou B provided critical revisions; Gong YW and Zheng HL jointly organized and finalized the manuscript and shared co-corresponding authorship. All authors reviewed and approved the final version of the manuscript.
AI contribution statement: AI tools (Grammarly) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Supported by Hunan Provincial Natural Science Foundation of China, No. 2025JJ80414; and Health Research Project of Hunan Provincial Health Commission, No. 20253681.
Institutional review board statement: This study was approved by the University of South China’s Ethics Committee (No. CS2023231).
Informed consent statement: Written informed consent was obtained from all participants before they were enrolled in the study.
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: Data associated with this study can be obtained from the corresponding authors upon reasonable request.
Corresponding author: You-Wen Gong, MD, Professor, Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), No. 818 Renmin Road, Changde 415000, Hunan Province, China.
1755144149@qq.com
Received: October 24, 2025
Revised: December 4, 2025
Accepted: February 2, 2026
Published online: June 19, 2026
Processing time: 216 Days and 20.8 Hours
BACKGROUND
Body image disturbance is a common psychosocial issue among patients with breast cancer, leading to stigma that negatively impacts their psychological well-being and quality of life. Resilience and social support are the key protective factors that may buffer this relationship. Previous studies have explored these constructs separately, but little is known about their potential chain-mediating effects on the link between body image and stigma, particularly in the Chinese population with breast cancer. This study examined the association between body image and stigma among Chinese patients with breast cancer by focusing on the sequential mediating roles of resilience and social support.
AIM
To investigate the association between body image and stigma, focusing on the chain-mediating roles of resilience and social support.
METHODS
A cross-sectional survey was conducted among Chinese patients with breast cancer using an electronic questionnaire distributed in Wenjuanxing, China. In total, 298 valid responses were obtained. The participants completed the Body Image After Cancer Questionnaire-Chinese version, the Stigma Scale for Chronic Illness-8, the Connor-Davidson Resilience Scale, and the Perceived Social Support Scale. Chain mediation analysis was performed using the PROCESS macro in Statistical Product and Service Solutions to examine the relationships among body image, resilience, social support, and stigma.
RESULTS
The findings indicated that body image had a significant direct effect on stigma [effect = 0.184; 95% confidence interval (CI): 0.031-0.313]. In addition to this direct effect, three significant indirect pathways were observed: (1) Resilience (effect = 0.250; 95%CI: 0.165-0.363); (2) Social support (effect = 0.129; 95%CI: 0.030-0.237); and (3) A sequential mediation pathway involving both resilience and social support (effect = 0.053; 95%CI: 0.012-0.099). The total indirect effects of the three mediation paths accounted for 43.1% of the relationship between body image and stigmatization.
CONCLUSION
Findings highlight the roles resilience and social support play in mediating the relationship between body image and stigma. Interventions enhancing these variables may reduce stigma and improve patients’ psychological well-being.
Core Tip: Body image disturbance is a prominent psychosocial concern among individuals with breast cancer and is closely associated with increased perceptions of stigma in clinical settings. This study examined whether resilience and social support function as mediating mechanisms that link body image and stigma in a sample of Chinese patients with breast cancer. Given data from a cross-sectional survey, the findings highlighted the crucial roles played by resilience and perceived social support in alleviating the negative impacts of body image disturbances. These results provide valuable insights for developing targeted interventions to strengthen patients’ psychological resources, ultimately reducing stigma and improving their overall well-being.
