Breast cancer is the most common cancer among Black women in the US, and empirical evidence consistently shows that they have poor breast cancer-related health outcomes. Although the five-year survival rate for breast cancer for women is 90%, racial differences are evident such that the five-year survival rate for Black women is 78%. There is a paucity of research that focuses on predictors of emotional and behavioral health outcomes, particularly in Black women, despite evidence that women in this clinical population report depressive and anxiety symptoms and sleep disturbance throughout the breast cancer continuum. The current study utilized a mixed-methods approach to examine predictors of emotional and behavioral health symptoms and identify behaviors and illness perceptions that are relevant for breast cancer. Participants (N=151) completed an online assessment to report risk factors (i.e., racial discrimination), resilience factors (i.e., hope, optimism), culturally-relevant factors (e.g., Strong Black Woman schema, John Henryism), coping strategies (i.e., COPE, Africultural Coping Systems Inventory), distress (i.e., depressive, anxiety symptoms), and sleep disturbance. Participants also completed open-ended responses to report Strong Black Woman qualities and breast cancer-related illness perceptions. Consistent with hypotheses, psychological resilience was associated with lower levels of distress and sleep disturbance. In addition, racial discrimination and Strong Black Woman qualities were associated with higher levels of distress and sleep disturbance. Mediation analyses showed that approach-oriented coping strategies significantly mediated effects of psychological resilience and race-related factors on sleep disturbance as hypothesized, and avoidant-oriented coping strategies significantly mediated effects of psychological resilience and race-related factors on distress. Analyses of qualitative data indicate that Black women acknowledge that they neglect their health by engaging in behaviors that increase risk for poor health, underutilizing the healthcare system, and encountering barriers to seeking care. Relatedly, participants most frequently attributed their breast cancer to well-known social determinants of health, including food, neighborhood and physical environment, community and social context, and health and healthcare. Study findings underscore the importance of examining culturally-relevant factors that shape psychological responses and demonstrate how unique experiences of Black women may enhance understanding of poor physical health outcomes among Black women diagnosed with breast cancer.