# Relationships for Women with Breast Cancer Among Extraversion and Neuroticism Personality, Stress, Demoralization, Sleep Disturbance, and Psychological Well-Being: A Structural Equation Model

## TL;DR

This study explores how personality traits and stress affect psychological well-being in breast cancer survivors using a structural equation model.

## Contribution

The paper introduces a novel structural equation model linking personality traits, stress, and psychological outcomes in breast cancer survivors.

## Key findings

- Extraversion and neuroticism have distinct direct effects on stress, demoralization, sleep disturbances, and psychological well-being.
- Post-breast-cancer stress and demoralization mediate the relationship between personality traits and psychological outcomes.
- A suppression effect was observed, where stress positively influences psychological well-being despite negative effects from demoralization.

## Abstract

There were few studies to build a path model on extraversion and neuroticism personality, post-breast-cancer stress, demoralization, sleep disturbances, and psychological well-being for survivors of women with breast cancer. Based on the personality five-factor theory (FFT), a structural equation model was built to help understand these psychosocial variables’ interplay processes. It showed that the extraversion and neuroticism personality traits had different influential paths on post-breast-cancer stress, demoralization, sleep disturbances, and psychological well-being. By describing different direct effects, indirect effects, and a suppression effect among these psychosocial variables with path coefficients, the complicated path relationships were understood and discussed. The paths make counseling with survivors of women with breast cancer more insightful. The path model implied that post-breast-cancer stress and demoralization played important roles in helping women survivors of breast cancer.

Objectives: According to the personality five-factor theory (FFT), this study explored a structural equation model for women with breast cancer involving variables, including extraversion and neuroticism, post-breast-cancer stress, demoralization, sleep disturbances, and psychological well-being (PWB). Methods: A total of 351 women with breast cancer were recruited from mid-Taiwan for the cross-sectional questionnaire survey. Results: In this model, extraversion had direct effects on demoralization (−0.21), sleep disturbances (−0.16), and PWB (0.36); neuroticism had direct effects on post-breast-cancer stress (0.28), demoralization (0.12), and sleep disturbances (0.19); post-breast-cancer stress had direct effects on demoralization (0.71) and PWB (0.38); demoralization had direct effects on sleep disturbances (0.33) and PWB (−0.75). Accordingly, extraversion had a higher direct influence on demoralization than neuroticism (−0.21 vs. 0.12); however, neuroticism correlated with demoralization more than extraversion with demoralization (0.36 vs. −0.28). Neuroticism had a higher direct influence on sleep disturbances than extraversion on sleep disturbances. With regards to indirect influences, post-breast-cancer stress partially mediated the path from neuroticism to demoralization. Demoralization completely mediated the path from post-breast-cancer stress to sleep disturbances and partially mediated the path from extraversion to sleep disturbances. Moreover, demoralization and post-breast-cancer stress together completely mediated the path from neuroticism to PWB. Furthermore, a suppression effect occurred, making the influence from post-breast-cancer stress to PWB positive, which seemed to characterize post-traumatic growth; meanwhile, the suppression enforced the negative effect of demoralization on PWB. Conclusions: Post-breast-cancer stress and demoralization play important roles in clinical counseling for survivors of women with breast cancer.