Network Analysis of Social Anxiety, Avoidant Behavior, and Spiritual Well-Being in Breast Cancer Patients: A Pathway to Targeted Psychosocial Interventions.

Background: Social anxiety and avoidance behaviors are prevalent among breast cancer patients, yet their interrelationships with protective factors such as spiritual well-being remain poorly understood. Network analysis offers a novel approach to identify central and bridge nodes that may serve as key targets for psychosocial intervention. Methods: We conducted a cross-sectional study of 302 female breast cancer patients from a tertiary hospital in China. Participants completed the Social Anxiety Scale (SAS_1), Social Avoidance Scale (SAS_2), and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp). A network model was constructed to examine the interrelationships among these constructs, with centrality and bridge centrality indices used to identify influential nodes. Results: Spiritual well-being-particularly items such as "strength from faith" and "confidence in recovery"-showed the highest strength centrality, indicating its central role in the psychological adaptation network. Social avoidance emerged as the strongest bridge node, connecting spiritual well-being with social anxiety. Surgical approach did not significantly alter the global network structure, but subgroup analyses revealed distinct node-level bridge strengths, suggesting differential psychological adaptation pathways. Conclusion: Spiritual well-being occupies a central position in the psychological network of breast cancer patients, and social avoidance shows the strongest bridging function between spiritual resources and emotional symptoms. These findings support the integration of spiritual assessment and targeted avoidance-reduction strategies into supportive care. Future research should validate these networks in larger samples and develop node-specific interventions to improve psychological adjustment.