A mixed-methods longitudinal study of demoralization and depression in breast cancer survivors.

[BACKGROUND] Demoralization and depression are common among breast cancer survivors (BCS) following treatment. Although these conditions may be comorbid, their clinical distinctiveness highlights the need for deeper longitudinal and integrative examination.

[AIMS] This study examined longitudinal associations of demoralization and depression with selected psychological factors and their expression over time among BCS following treatment.

[METHODS] A mixed-methods longitudinal design was employed. Quantitatively, 190 BCS completed self-report measures at baseline (1-2 years postdiagnosis) and 6 months later. Linear mixed-effects models examined time-invariant and time-dependent associations. Qualitatively, 20 participants were interviewed in depth at both time points, and deductive, theory-driven thematic analysis was conducted.

[RESULTS] Quantitative analyses indicated that negative and positive self-compassion were associated with both demoralization and depression across time. Fear of recurrence was associated with demoralization across time, whereas its association with depression was primarily time-dependent. Qualitative findings revealed substantial heterogeneity and temporal complexity. At baseline, demoralization was marked by loss of the familiar self, diminished agency, and existential distress. Over time, participants followed divergent trajectories: Some experienced restoration of agency, meaning, and self-trust despite ongoing fear of recurrence, whereas others showed persistent or worsening depressive states characterized by resignation, isolation, and self-blame. Fear of recurrence was not uniformly destabilizing and became clinically salient primarily when accompanied by depression.

[CONCLUSIONS] Integrated findings suggest that demoralization and depression reflect distinct yet intersecting processes that vary over time. Differential assessment and interventions are essential. Demoralization may be best addressed through meaning-centered and identity-focused approaches, whereas depression may require mood-focused and behavioral interventions.