Intolerance of uncertainty and anxiety and depression symptomatology in breast cancer survivors: Mediating role of fear of cancer recurrence and moderating role of social support

Breast cancer is one of the most common cancer types and despite that, it has an increasing survival rate. Therefore, the number of cancer survivors is increasing throughout the world. The post-treatment process of breast cancer can be challenging, and it involves a lot of uncertainty. Intolerance of uncertainty (IU) is as a dispositional characteristic which is caused by negative cognitive, emotional, and behavioral reactions that people have against uncertain events. Although robust evidence exists regarding the association between IU and depression/anxiety symptoms, the underlying mechanism through which IU is related to depression/anxiety in breast cancer survivors have received little empirical attention. The uncertainty in the post-treatment process related to recurrence creates a fear of cancer recurrence (FCR). Several studies indicate that FCR is related with increased risk of depression while perceived social support has a positive impact on mental health. However, the mechanism of action by which perceived social support affects FCR is not clear in the literature. Overall, most of the studies done on these topics comes from Western countries, and the ones from Turkey are not sufficient to understand the specific pathways between these factors. Therefore, the aim of this study is to explore the mediating role of FCR and the moderating role of perceived social support on the association between IU and anxiety and depression. In this study, data were collected cross-sectionally through convenience sampling. A total of 269 participants were recruited for the study. Participants completed a sociodemographic questioner, Intolerance of Uncertainty Scale, Fear of Cancer Recurrence Scale, Multidimensional Scale of Perceived Social Support and Depression Anxiety Stress Scale. According to the results, there was a positive relationship between IU, FCR and depression and anxiety levels. Additionally, FCR fully mediated the association between IU and depression and anxiety. In other words, among breast cancer survivors, those with higher IU had higher FCR and consequently this led to higher anxiety and depression levels. There was no significant moderating effect of perceived social support in the association between FCR and depression and anxiety. Overall, these findings illustrate that individuals with high IU are more likely to have greater fear against cancer recurrence, which in turn is linked with increased symptoms of depression and anxiety. As a clinical implication, the findings of the current study are helpful for extending the current knowledge on the factors that are associated with anxiety/depression symptomology in breast cancer survivors. Furthermore, based on these findings, future studies can further investigate the effect of IU and FCR on cancer survivors' well-being and explore effective interventions for preventing psychopathology among breast cancer survivors.