Character strength patterns, social support and psychological distress in adolescents and young adults with cancer: a multicenter cross-sectional study

Objective: Adolescents and young adults with cancer (AYAC) experience severe psychological distress worldwide. Social support was associated with reduced distress among cancer patients, but the role of character strength patterns in this association is unexplored. This study explored whether character strength patterns influence the association between social support and psychological distress in AYAC. 

Methods: A multicenter cross-sectional study was conducted at four hospitals in Changsha, China. Participants completed questionnaires assessing sociodemographic, distress, social support, and character strengths. Latent profile analysis determined character strength patterns, and multiple linear regression models examined the association. Interaction terms tested moderation effects, and adjusted models examined confounding, all stratified by gender. 

Results: Among 728 participants, three character strength patterns emerged: low (LCS), moderate (MCS), and high (HCS). Across all patterns, higher social support was significantly associated with lower distress in AYAC (female: β = −0.124, 95% CI = −0.051 to −0.015; male: β = −0.180, 95% CI = −0.080 to −0.030; P < 0.001). AYAC with MCS and HCS experienced significantly less distress than those with LCS, across both genders. However, the association between character strength patterns and lower distress was stronger in males (MCS: β = −0.384, 95% CI = −1.898 to −1.033; HCS: β = −0.777, 95% CI = −3.420 to −2.495; P < 0.001) compared to females (MCS: β = −0.284, 95% CI = −1.215 to −0.700; HCS: β = −0.593, 95% CI = −2.776 to −2.102; P < 0.001). 

Conclusions: Character strength patterns didn't moderate or confound the association between social support and psychological distress, but had stronger protective effects against psychological distress than social support. Higher character strength patterns showed a stronger association with lower psychological distress, especially for males.