One-year recovery from breast cancer: Importance of tumor and treatment-related factors, resilience, and sociodemographic factors for health-related quality of life.

Aim: This study investigated the changes in health-related quality of life from diagnosis to 1 year after diagnosis in breast cancer (BC) patients and the influence of clinical, psychological, and sociodemographic variables. An additional aim was to explore the mediating and moderating effects of resilience on changes in health-related quality of life. Methods: A longitudinal population-based study was conducted in southern Sweden. Newly diagnosed BC patients filled in measures of health-related quality of life, resilience, and sociodemographic variables at diagnosis (N = 980) and 1 year post-diagnosis (N = 780). Clinical variables were extracted from the Swedish national breast cancer quality registry. Mixed-model analyses were performed. Results: Most health-related quality of life outcomes declined from diagnosis to 1 year post-diagnosis. Role limitations due to emotional problems remained the same, whereas mental health improved. Lower health-related quality of life outcomes were associated with symptomatic detection and axillary dissection. Patients with a higher TNM stage and histologic grade and estrogen receptor (ER)-negative and human epidermal growth factor 2 (HER2)-positive status, who received chemotherapy, antibody therapy, or bisphosphonate therapy, had a steeper decline in outcomes. Changes in resilience were positively associated with all outcomes but did not mediate or moderate changes in any. Resilience at baseline moderated changes in bodily pain, vitality, and mental health, with higher baseline resilience being associated with a steeper decline, possibly due to floor or ceiling effects. Patients with lower socioeconomic status, educational level, and older age had a lower health-related quality of life. Conclusion: Physical health-related quality of life among breast cancer patients declined 1 year post-diagnosis, whereas mental health-related quality of life improved. Low resilient patients may be especially vulnerable at diagnosis. Biopsychosocial assessment at diagnosis can help identify patients who may require additional support. A multidimensional treatment plan should be started early to help overcome the problems in everyday activities.

Psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a non-clinical population in Sweden.

BACKGROUND: The Connor-Davidson Resilience Scale (CD-RISC) is the most widely used scale which assesses psychological resilience. Although it is recommended to be applied as a unidimensional scale, its factor structure, reliability, as well as discriminant and predictive validity need to be assessed when used in a new context. Moreover, the original five-factor structure has not been replicated in previous investigations. This study aimed to explore psychometric properties of the scale in a Swedish context. METHODS: Construct validity of the five-factor model of CD-RISC was assessed using Exploratory and Confirmatory Factor Analyses. Its discriminant validity was assessed in relation to a measure of emotion regulation (Brief Version of the Difficulties in Emotion Regulation Scale) using a Confirmatory Factor Analysis. Predictive validity of CD-RISC was assessed in relation to measures of physical and mental health-related quality of life (The 12-Item Short Form Survey) using hierarchical multiple regression analyses. A population based sample cohort was employed (N = 2599). RESULTS: Exploratory and Confirmatory Factor Analyses suggested a 22-item unidimensional model of CD-RISC. Psychological resilience was found to be independent from the measure of emotion regulation. It was shown to predict both physical and mental health-related quality of life, being especially strongly associated with mental health aspects. CONCLUSIONS: The study showed that the Swedish version of CD-RISC is an instrument with high discriminant and predictive validity, although the original factor structure does not apply in this context. CD-RISC can thus be used to identify individuals with a higher need of psychosocial support, especially relating to mental health needs.

They (Don't) Need Us: Functional Indispensability Impacts Perceptions of Representativeness and Commitment When Lower-Status Groups Go Through an Intergroup Merger.

Intergroup changes occur often between subgroups who are asymmetric in status (e.g., size, power, prestige), with important consequences for social identification, especially among the members of lower-status groups. Mergers offer an example of such changes, when subgroups (merger partners) merge into a common, superordinate group (post-merger group). Lower-status subgroups frequently perceive they are less represented in the post-merger group, therefore committing less to the changes a merger implies. Five studies offered an intergroup relations' perspective on mergers (N's = 479, 150, 266, 113, and 229, respectively), examining how functional indispensability (instrumental contribution of the ingroup) positively influences perceptions of representativeness in the post-merger group (relative ingroup prototypicality), which, in turn, affect post-merger identification and, finally, change commitment. Additionally, the role of cognitive information processing (heuristic vs. systematic) on prototypicality was explored. Results suggest that functional indispensability impacts relative ingroup prototypicality (Studies 1-5), and this may be moderated by information processing (Study 2). Moreover, prototypicality and identification with the superordinate post-merged group mediated the effect of functional indispensability on change commitment (Studies 1-3). These findings provide important theoretical insights into prototypicality perceptions held by lower-status merger partners and minority groups in general, by identifying functional indispensability as a source of prototypicality other than relative status. In addition, by proposing a functional approach to the relations between social groups, these findings suggest better practices for managing structural changes, such as combining sources of strategic/functional and identity fit when announcing an intergroup change.