The mediating role of perceived spousal support in the association between psychological crisis and psychological distress among breast cancer patients and their spouses: a longitudinal study based on an actor–partner interdependence mediation model with cross-lagged analysis

Abstract

Aim Grounded in the Actor-Partner Interdependence Mediation Model (APIMeM), this study aimed to investigate the longitudinal dyadic interactions between psychological crisis and psychological distress among breast cancer patients and their spouses, and to examine the mediating mechanism of perceived spousal support. Methods A convenience sample of 265 breast cancer patients and their spouses was recruited. Participants completed the Triage Assessment Form (TAF), the Distress Thermometer (DT), and the Perceived Spousal Support Scale for Breast Cancer Patients at three time points: pre-chemotherapy (T1), mid-chemotherapy (T2), and post-chemotherapy (T3). Measurement invariance testing and the Actor-Partner Interdependence Cross-Lagged Model (APIM-CLPM) were employed to identify pathways. Subsequently, an APIMeM incorporating actor-mediator-outcome and partner-mediator-outcome paths was constructed. A bias-corrected non-parametric percentile Bootstrap method (5,000 samples) was used to test the significance of the mediating effects. Missing data were handled using full information maximum likelihood (FIML) estimation. Results After excluding 7 dropouts, data from 258 couples were analyzed. The reasons for dropout included relocation (n = 2), voluntary withdrawal without providing a reason (n = 3), and severe treatment-related complications requiring a change in treatment protocol (n = 2). (1) Significant actor effects were observed for both psychological crisis and distress: T1 psychological crisis positively predicted T2 psychological distress in both patients (β = 0.15) and spouses (β = 0.13, p < 0.01), while T1 psychological distress positively predicted T2 psychological crisis in patients (β = 0.18) and spouses (β = 0.16, p < 0.001). (2) Perceived spousal support significantly mediated the path from psychological crisis to psychological distress: the indirect effect was 0.06 (95% CI: 0.02–0.11) for patients and 0.05 (95% CI: 0.01–0.09) for spouses. (3) Significant partner mediating effects were found: patient T1 psychological crisis was associated with exacerbated spouse T3 psychological through the pathway of reduced spouse T2 perceived support (indirect effect = 0.04, 95% CI: 0.01–0.08). Conclusion Perceived spousal support acts as a critical mediator linking psychological crisis to psychological distress. Clinical interventions should adopt a dyadic perspective, focusing on enhancing the quality of perceived support to interrupt the negative cycle of crisis and distress and alleviate psychological suffering in both patients and spouses.