Objective To explore the mediating effects of experience avoidance and rumination on self-concealment and post-traumatic stress response in breast cancer survivors.

Methods A total of 257 breast cancer survivors were selected by convenience sampling method, and investigated using the general data questionnaire, Chinese version of event Impact Scale, self-concealment questionnaire, acceptance and action questionnaire and rumination thinking scale. The chain mediation effect model was constructed.

Results The scores of self-concealment, experience avoidance, rumination and post-traumatic stress symptoms were (24.75 ± 7.34), (18.48 ± 5.44), (38.27 ± 8.32) and (32.29 ± 14.14), respectively. The results of Pearson correlation analysis showed that the self-concealing was positively correlated with experience avoidance, rumination and traumatic stress response (r = 0.343, 0.421, 0.467, P ＜ 0.01), the experience avoidance was positively correlated with rumination and traumatic stress response (r = 0.556, 0.534, P ＜ 0.01), and the rumination was positively correlated with post-traumatic stress response (r = 0.602, P ＜ 0.01). The total effect of self-concealment on post-traumatic stress response was 0.491, and the direct effect path coefficient was 0.236. The intermediate effect path coefficient of experience avoidance between self-concealment and post-traumatic stress response was 0.058 (95%CI: 0.013–0.139), accounting for 11.81% of the total effect. The mediated pathway coefficient of rumination between self-concealment and post-traumatic stress response was 0.122 (95%CI: 0.062–0.199), accounting for 24.85% of the total effect. The path coefficient of the chain mediated effect of experience avoidance and rumination was 0.075 (95%CI: 0.045–0.121), accounting for 15.27% of the total effect.

Conclusions The self-concealment in breast cancer survivors can directly affect their post-traumatic stress symptoms, and the experiential avoidance and rumination play a chain-mediated mediating effect between self-concealment and post-traumatic stress symptoms.