title: Mental adjustment at different phases in breast cancer trajectory: re-examination of factor structure of the Mini-MAC and its correlation with distress.
abstract: OBJECTIVE
  The aim of this study is twofold. First, it aims to determine the factor structure of the Mini-Mental Adjustment to Cancer (Mini-MAC) Scale by using confirmatory factor analysis (CFA) to compare the three-factor, four-factor, and five-factor structures among 340 Taiwanese breast cancer patients. Second, it aims to test the difference in the correlations of coping strategies and the outcome measures between two populations: one-month newly diagnosed and five-year long-term survival patients.
  
  
  METHODS
  Two samples, composed of 142 newly diagnosed and 198 long-term survival breast cancer patients, were recruited. Cancer-specific coping and distress were assessed via the Mini-MAC Scale and the Hospital Anxiety and Depression Scale (HADS), respectively.
  
  
  RESULTS
  The CFA confirmed Watson's original five-factor structure fit the data best. The correlation difference between the two samples lies in the fighting spirit (FS), which correlated negatively with distress among the newly diagnosed sample but had no correlation among the long-term survivors. Moreover, fatalism (FA) was found to correlate positively with distress.
  
  
  CONCLUSIONS
  The five-factor structure represents a more psychometrically sound measure of psychological adjustment in the current data set. The findings also support the argument that the relationships between coping and distress vary, to some degree, at different phases in the cancer trajectory. FS is only a positive predictor of psychological adjustment among newly diagnosed patients. Because of the exclusion of two items, FA showed a positive correlation with distress, a result that contradicts previous findings. Further theoretical and practical implications for FS and FA are discussed.
authors.affiliation: Department of Psychology, National Chengchi University, Taipei, Taiwan.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Wang
authors.forename: Pei-Chiung
authors.initials: PC
authors.lastname: Tu
authors.forename: Tse-Jia
authors.initials: TJ
authors.lastname: Liu
authors.forename: Dah-Cherng
authors.initials: DC
authors.lastname: Yeh
authors.forename: Wen-Yau
authors.initials: WY
authors.lastname: Hsu
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D044466:Asian People / Q000523:psychology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008609:Mental Status Schedule; D008875:Middle Aged; D009367:Neoplasm Staging; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology; D013624:Taiwan; D016896:Treatment Outcome; D055815:Young Adult