AccScience Publishing / HPR / Online First / DOI: 10.36922/HPR026170086
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RESEARCH ARTICLE

Stress and psychological adjustment in breast cancer patients: The mediator role of zest

M. Victoria Cerezo1 ,  Lorena M. Soria-Reyes* ,  María J. Blanca1
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1 Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain
HPR, 026170086 https://doi.org/10.36922/HPR026170086
Received: 23 April 2026 | Revised: 22 May 2026 | Accepted: 4 June 2026 | Published online: 6 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: A breast cancer diagnosis can be an emotionally overwhelming experience that poses significant challenges for coping and adjustment. Recent studies on the role of character strengths have shown that hope and zest can buffer the impact of disease stressors, improving patients’ well-being. However, it remains unclear whether they can also help reduce psychological distress during this stressful period.

Objectives: This study aims to expand knowledge regarding psychological adjustment in the context of breast cancer by exploring its association with character strengths and identifying those strengths which may mediate the relationship between breast cancer stressors (stress as stimulus) and psychological distress (depression, anxiety, and stress as response, and psychological distress).

Methods: Participants were 211 breast cancer patients from different Spanish healthcare centers. Correlational and statistical mediation analyses were performed.

Results: Correlation analysis revealed that depression, anxiety, stress, and distress were most strongly associated with four strengths: zest, hope, curiosity, and gratitude. Mediation analysis showed that zest was the sole mediator of the relationship between stressors and these indicators of psychological adjustment. These results indicate that higher levels of stressors are related to decreased zest, which in turn are associated with greater symptoms of depression, anxiety, stress, and distress. This pattern suggests that zest may be relevant for understanding the association between stressors and psychological outcomes.

Conclusion: Interventions promoting zest may therefore improve psychological adjustment in breast cancer patients, given that zest may function as a mediating resource in the association between cancer-related stressors and psychological distress.

Keywords
Breast neoplasms
Psychological distress
Depression
Anxiety
Hope
Psycho-oncology
Funding
This work was supported by the University of Malaga with the Andalusia FEDER Program 2021-2027 (PPRO-CTS110-G-2023). The funder had no role in the design of this study, data collection, management, analysis, and interpretation of data, writing of the manuscript, and the decision to submit the manuscript for publication.
Conflict of interest
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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