Background Because of the increasing 5-year survival rate of breast cancer, adjustment to breast cancer survivorship is pertinent to the patient's life after diagnosis. Despite the psychological changes occurring during the transitional period (first 5 years after diagnosis) and after primary therapy having a known, critical effect on survivorship status, the data related to this topic are very limited. Purpose This study was designed to examine the relationships among demoralization, stress, sleep disturbance, and psychological well-being in women with breast cancer after primary therapy. Methods Two hundred eight women with breast cancer (mean age = 51.96 ± 8.27) participated in a cross-sectional study in central Taiwan. Recruitment was conducted using convenience snowball sampling at a local teaching hospital. All of the participants had completed primary therapy and were in the 5-year postdiagnosis period. The average duration of cancer was 28 months. The participants completed the Stress of Breast Cancer after Primary Therapy Scale, Demoralization Scale, Pittsburgh Sleep Quality Inventory, and Ryff's Psychological Well-Being Scale–Short Form. Data were analyzed using a structural equation model to find plausible path relationships among stress, demoralization, sleep disturbances, and psychological well-being. Results Demoralization was shown to completely mediate the effect of stress on sleep disturbances. In addition, the predictive effect of sleep disturbances on psychological well-being was overwhelmingly explained by demoralization when competing with sleep disturbances. Furthermore, a positive path was found between stress and psychological well-being because of the suppression effect of demoralization. Conclusions/Implications for Practice Demoralization was found to be a mediator that suppressed the relationships among stress, sleep disturbances, and psychological well-being in the adaptation process of patients with breast cancer after primary therapy. This article adds to the limited research on women with breast cancer after primary therapy who are in their initial 5 years of diagnosis. In addition, this study used structural equation model to find the plausible path relationships among the psychological factors involved in the well-being of women with breast cancer. Supporting patients with cancer and effectively reducing their perceived demoralization will be key to transforming stress into personal growth and a facilitator of long-term recovery.

The aim of this study was to confirm post-traumatic growth with respect to the psychological well-being of women with breast cancer compared to women without disease. Propensity score was used to match the two groups according to age, religious beliefs, education level, monthly income, and marital status. A psychological well-being scale with six factors was used, including positive relations with others (PR), autonomy (AU), environmental mastery (EM), personal growth (PG), purpose in life (PL), and self-acceptance (SA). A total 178 women with vs. 178 women without breast cancer were compared by matching with propensity scores, using factorial invariance tests to reduce measurement errors. The results showed that women with breast cancer had significantly higher psychological well-being for all the six factors (Δχ2 = 37.37, p < 0.001) and higher variability in terms of PR, AU, and PL than women without breast cancer (Δχ2 = 45.94, p < 0.001). Furthermore, women with breast cancer exhibited a significantly higher association between PG and PL and a significantly lower association between PG and EM than women without breast cancer (Δχ2 = 44.49, p < 0.001). This implies that psychological well-being could assess broader and more subtle post-traumatic growth in women with breast cancer and that growth was more associated with internal life value than with external environmental control.

Objective: This is a cross-sectional study aimed to explore the risk factors associated with diabetes distress in type 2 diabetes. Research Design and Methods: Patients with type 2 diabetes were recruited from tertiary hospital in central Taiwan for a diabetes distress evaluation. Diabetes distress was assessed both at baseline using a 17-item Diabetes Distress Scale (DDS-17) in Chinese version. Baseline demographic characteristics and biochemistry data were collected. Linear regression models were used to examine the relationship between baseline variables and the scores in DDS-17. Results: Three hundred and sixty participants completed DDS-17 scale, their mean (SD) age and diabetes duration were 59.9 (11.6) years and 9.8 (7.4) years, respectively, and 49.1% were women.The correlation between glycaemia and distress was significantly positive (r=.472, p&lt;.01) and distress can predict glycaemia significantly (R2=.223, p&lt;.01). The correlation between HbA1C and diabetes duration, diabetes distress were significantly positive (r = .142, .294, p&lt;.01). Furthermore, when diabetes distress predicted HbA1C, diabetes duration and age were mediators (βd = -.121, δR2 = .102, p&lt;.05; βa = -.128, δR2 = .091, p&lt;.05). Linear regression models, diabetes duration less than 4 years group were 3.26 times than the others (OR = 3.26, 95% CI 1.22-8.71). Younger age less than 50 years old were 5.53 times than the older aged (OR = 5.53, 95% CI 5.23-5.83). If considering age and duration simultaneously, the odds ratio of younger age and shorter disease duration were 10.71 times (OR = 10.71, 95% CI 2.28-50.36). Conclusions: The high-risk group for diabetes distress was younger than 50 years old and shorter duration less than 4 years. HbA1C was easily raised in shorter duration of disease and in younger age patients when their diabetes distress increased. The findings can help clinicians to select in education or psychotherapy, and improve their distress and stabilize their glycemic control. Disclosure Y. Liao: None. Y. Yang: None. C. Huang: None. H. Peng: None.

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