Perceived social support, coping strategies, anxiety and depression among women with breast cancer: Evaluation of a mediation model

Impact of social support on body image during chemotherapy in patients with breast cancer: The chain mediating role of depression and self-efficacy

Objective

To explore the mediating roles of depression and self-efficacy in the relationship between social support and body image in patients with breast cancer during chemotherapy.

Methods

A convenience sampling method was employed to survey 647 breast cancer chemotherapy patients. The survey included validated scales assessing social support, depression, self-efficacy, and body image. The chain mediation model was established using Mplus 8.3 software.

Results

Social support was negatively correlated with depression (P < 0.001) and poor body image (P < 0.001) and positively correlated with self-efficacy (P < 0.001). Social support indirectly affected body image through three mediating pathways: depression (β = -0.084, P < 0.001), self-efficacy (β = -0.060, P < 0.01), and the depression-self-efficacy pathway (β = -0.058, P < 0.001). The indirect effect accounted for 55.96% of the total effect.

Conclusions

The results support our hypothesis. Enhancing social support, alleviating depression, and improving self-efficacy through psychological interventions are recommended to improve body image in breast cancer patients during chemotherapy.

Coping skills and associated sociodemographic, clinical, and psychological factors among women with breast cancer in Iraq: a cross-sectional study"

BACKGROUND

Coping skills play a vital role in managing the physical and psychological effects of breast cancer (BC). Despite improvements in early detection and treatment, Breast cancer survivors continue to face long-term challenges after diagnosis. Therefore, this study aims to evaluate the coping skills employed by breast cancer women in Iraq and to identify the sociodemographic, clinical, and psychological factors associated with these coping skills.

METHODS

A cross-sectional study was conducted among 244 breast cancer women in The Medical City Teaching Oncology Hospital, Baghdad, Iraq, from August 2023 to October 2023, coping skills and psychological factors were assessed using the BRIEF COPE-28, and Hospital Anxiety Depression scale (HADS), respectively. Sociodemographic and clinical characteristics were also assessed. The associations between the associated factors and coping skills were assessed using multiple linear regression.

RESULTS

Mean (SD) coping skills for active coping, passive coping, and seeking support were 5.96 (1.31), 4.00 (1.10), and 7.58 (0.84), respectively. Multiple linear regression analysis indicated that active coping was significantly influenced by hormonal therapy, anxiety, and depression (p < 0.05), while type of surgery and anxiety were associated with passive coping (p < 0.05), whereas seeking support was affected by disease stage, duration surgery, and anxiety (p < 0.05).

CONCLUSION

This study highlights the associated factors influencing the coping skills among breast cancer women in Iraq, and the need for targeted psychological and clinical interventions to improve coping skills.

The preferences of breast cancer patients regarding a digital social care platform

BACKGROUND

Breast cancer is a multifaceted condition affecting women globally, with patients often facing emotional, psychological, and social challenges. This study explored breast cancer patients' preferences for features of a digital social care platform.

METHODS

A cross-sectional study using Conjoint Analysis (CA), grounded in economic utility theory, was conducted. A Discrete Choice Experiment (DCE) questionnaire was administered to 158 breast cancer patients at a university hospital in Iran between November 2023 and January 2024. Data were analysed using ordered logistic regression in Stata 13.

RESULTS

All platform attributes significantly influenced preferences (P ≤ 0.05). Emotional support had the highest impact (β = 1.132), followed by informational (β = 0.973) and esteem support (β = 0.864). Instructional videos increased the likelihood of choosing a digital platform 2.45 times compared to text-based messages (P < 0.001). Personalized online support was 1.42 times more preferred than generic supportive messages (P < 0.001). Mindfulness affirmations were 1.14 times more preferred than inspirational messages (P < 0.001).

CONCLUSION

Digital tools that prioritize emotional, informational, and esteem support-especially through personalized online support and instructional videos can improve patient engagement and acceptability. These findings support the patient-centred design of digital social care platforms to enhance quality of life for breast cancer patients.

Anxiety and depression among patients newly diagnosed with lymphoma and myeloma

ABSTRACT

Although lymphoma and myeloma confer physical and psychological burden, data are limited regarding anxiety and depression symptoms in affected patients. We conducted a survey between July 2021 and September 2022 to characterize anxiety and depression in a cohort of adult patients, within 6 months of a lymphoma or myeloma diagnosis. Clinically significant anxiety and depression symptoms were defined as scores of ≥8 on the corresponding subscales of the Hospital Anxiety and Depression Scale. We assessed sociodemographic factors associated with anxiety/depression symptoms and examined the relationship between anxiety/depression symptoms and quality of life (QOL) in multivariable analyses. Our cohort included 200 patients (response rate, 74.9%), of whom 45.5% were female, and 55.5% were aged ≥60 years. Over half of the cohort (56.2%) had clinically significant anxiety and/or depression symptoms, with 52.0% (95% confidence interval [CI], 44.9-59.1) meeting the cutoff for anxiety and 27.5% (95% CI, 21.6-34.3) for depression. Lower financial satisfaction (adjusted odds ratio [AOR], 2.43; 95% CI, 1.25-4.78) and greater levels of medical mistrust (AOR, 2.09; 95% CI, 1.10-4.02) were associated with higher odds of anxiety. Lower financial satisfaction (AOR, 2.12; 95% CI, 1.07-4.30) and lower levels of social support (AOR, 2.88; 95% CI, 1.42-6.00) were associated with higher odds of depression. Depression was associated with lower QOL (adjusted mean difference, -22.0; 95% CI, -28.1 to -15.9). More than half of patients newly diagnosed with lymphoma or myeloma experience clinically significant anxiety or depression symptoms, with associated detriment to their QOL. These findings underscore the need for systematic mental health screening and psychological interventions for this population.

How family support alleviates death anxiety in breast cancer patients: the mediating role of meaning in life

Previous studies have predominantly focused on the relationship between death anxiety and quality of life in breast cancer patients, with limited exploration on how to alleviate their death anxiety. To address this gap, we recruited 533 breast cancer patients and utilized structural equation modeling and Process Model 4 to analyze the internal mechanisms and boundary conditions between family support and death anxiety. The study results indicated that family support significantly negatively impacts death anxiety in breast cancer patients; similarly, meaning in life also significantly negatively impacts death anxiety. More importantly, we found that meaning in life plays a full mediating role between family support and death anxiety. This study suggests that by enhancing family support levels and strengthening patients' perception of meaning in life, we can significantly improve the psychological health status of breast cancer patients, thereby potentially improving their quality of life.

The effect of an interactive nurse support program developed with a mobile application on patient outcomes in breast cancer patients who received outpatient chemotherapy: A randomized controlled trial

PURPOSE

To determine the effect of the interactive nurse support program developed with a mobile application on patient outcomes (symptom management, quality of life, perception of social support, anxiety) in breast cancer patients who received outpatient chemotherapy.

METHODS

The randomized controlled study was conducted in the outpatient chemotherapy unit of a public hospital between 2021 and 2023. The study sample consisted of 100 breast cancer patients receiving anthracycline-cyclophoshamide chemotherapy. Patients in the control group received standard care, and patients in the intervention group were applied an interactive nurse support program developed with a mobile application throughout four chemotherapy cycles. Memorial Symptom Assessment Scale (MSAS), EORTC QLQ-C30, EORTC QLQ-BR23 Scales, Multidimensional Perceived Social Support Scale (MPSSS), Beck Anxiety Scale (BAS) were used in data collection. Data were collected five times, including before chemotherapy (t0) and at the end of the first week after each chemotherapy (t1, t2, t3, t4).

RESULTS

MSAS, BAS total scores, EORTC QLQ-C30 and EORTC QLQ-BR23 Scales "Symptom Dimension" scores of the patients in the intervention group were found to be significantly lower than the control group at t1, t2, t3, t4 (p˂0.05). EORTC QLQ-C30 Scale "General Well-Being", "Functional Status", EORTC QLQ-BR23 "Functional Status" scores, MPSSS total scores of the patients in the intervention group were found to be significantly higher than the control group at t1, t2, t3, t4 measurements (p˂0.05).

CONCLUSIONS

The interactive nurse support program developed with the mobile application is effective on patient outcomes in breast cancer patients who received outpatient chemotherapy.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov, NCT05739175.

Prevalence and Associated Factors for Depression Among Patients With Sarcoma

PURPOSE

Prevalence and risk factors for depression among patients with sarcoma and survivors of sarcoma are not well characterized.

METHODS

A sarcoma survivorship cohort was constructed from patients diagnosed between April 2022 and September 2023. Depression symptoms were assessed via the eight-item Patient-Reported Outcomes Measurement Information System-57 depression scale at enrollment. Standardized T-score levels (<50, 50-59, and ≥60) were calculated and evaluated in association with demographics, lifestyle characteristics, clinical data, and modifiable factors using multinomial logistic regression models.

RESULTS

Among 612 participants, the mean T-score was 48.3 (standard deviation, 10.0); 58.8% had a T-score <50, 27.9% scored between 50 and 59, and 13.2% scored ≥60. Participants age 18-39 years and age 40-59 years were more likely to have a T-score ≥60, with respective odds ratios (ORs) of 3.65 (95% CIs, 1.70 to 7.83) and 2.80 (1.52 to 5.17) compared with participants older than 60 years. Household incomes of $70,000-$120,000 in US dollars (USD) (OR, 0.46 [95% CI, 0.23 to 0.92]) and >$120,000 USD (OR, 0.15 [95% CI, 0.06 to 0.37]) were inversely associated with T-score ≥60 compared with household incomes <$45,000 USD. Marijuana use within the past 30 days was positively (OR, 3.48 [95% CI, 1.46 to 8.27]) associated, while regular exercise (OR, 0.43 [95% CI, 0.24 to 0.75]) and emotional support (OR, 0.37 [95% CI, 0.28 to 0.48]) were inversely associated with having T-score ≥60.

CONCLUSION

A higher prevalence of depression symptoms was notable in younger participants, marijuana users, and households with lower incomes. Regular exercise and increased emotional support were inversely associated with depression symptoms. Our study provides information for developing personalized supportive care strategies to ameliorate depression symptoms among patients with sarcoma.

The relationship between social support and depression among older adults with hypertension in urban communities: mediating effects of coping styles

Background

Older adults with hypertension are at an increased risk of depression. Social support and coping style significantly influence this risk, with social cognitive theory suggesting that social support can affect an individual's coping style, and coping style can affect the effective use of social support. However, the mediating role of coping style in the relationship between social support and depression in older hypertensive patients remains unclear. This study aimed to explore the inter-relationships between social support, coping style and depression in older hypertensive patients within a community setting, and to investigate the mediating effects of coping style.

Methods

A cross-sectional questionnaire survey was conducted with 4211 older hypertensive patients from Fuzhou, Fujian Province, China. Participants were assessed for depression, social support, coping styles, and general demographic information. Pearson correlation analysis was employed to test the correlation between variables. Mediation effect test was conducted using SPSS macro program PROCESS with Bootstrap based Model 4, after controlling for confounding factors.

Results

A total of 4211 valid questionnaires were collected, yielding an effective response rate of 98.6%. The average depression score among participants was 7.99 ± 4.92 points, with 29.5% of respondents experiencing varying degrees of depression. Both social support and coping style were associated with depression in older hypertensive patients. Specifically, objective support, subjective support, support utilization, and positive coping style were negatively correlated with depression, with correlation coefficients of -0.159, -0.160, -0.145, and -0.163, respectively. Conversely, negative coping style was positively correlated with depression, with a correlation coefficient of 0.170. Mediating effect analysis showed that coping style played a mediating role between social support and depression. Social support negatively moderated depression through positive coping style (moderating effect =-0.020, Bootstrap 95%CI [-0.027, -0.138], mediating effect value was 15.87%), while it positively influenced depression through negative coping style (moderating effect =0.012, Bootstrap 95%CI [0.008,0.017], intermediate effect value =9.52%).

Conclusion

Social support exerts a direct negative effect on depression, while coping styles mediate the relationship between social support and depression. Interventions to reduce depression in this population should focus on enhancing social support (across objective, subjective, and utilization aspects) and promoting positive coping strategies, thus strengthening psychological resilience and improving overall health and quality of life for older adults with hypertension.

Coping strategies utilized by patients with cervical cancer: an explorative qualitative study at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania

BACKGROUND

Cervical cancer ranks as the fourth most prevalent cancer among women globally, particularly affecting socioeconomically disadvantaged populations such as those in Tanzania. Receiving a cervical cancer diagnosis induces considerable stress and elicits negative reactions. Coping mechanisms, ranging from adaptive to maladaptive, are employed to navigate this challenging condition and are influenced by factors such as race, socioeconomic status, and sociocultural background. Despite its significance, little is known about the coping strategies utilized by cervical cancer patients in Tanzania.

METHODS

By employing purposeful sampling, a qualitative descriptive study was conducted at the Ocean Road Cancer Institute in Dar es Salaam from December 2022 to January 2023, aiming to explore coping strategies adopted by cervical cancer patients. Thematic analysis was employed to analyse the gathered data.

FINDINGS

The key themes that emerged included problem-focused coping, emotion-focused coping, social support, religious coping, and escapism.

CONCLUSIONS

Cervical cancer patients employ a diverse array of coping strategies to manage their condition. While many strategies observed were adaptive, some proved to be maladaptive, underscoring the importance of ongoing assessments to bolster adaptive coping mechanisms among this population.

Satisfaction with Social Support and Quality of Life Among Portuguese Patients with Breast Cancer: Mediating Effects of Coping Styles-Cross-Sectional Study

Background/Objectives: The purpose of this study was to analyze the mediating effects of coping styles on the relationship between satisfaction with social support (SSS) and quality of life (QoL) in breast cancer patients. Methods: A cross-sectional structural equation modeling (SEM) approach was used to examine the mediating effects. The participants were 311 women who were breast cancer patients, aged between 27 and 86 years (M = 46.61, SD = 9.53). Results: SEM analyses showed that SSS was positively associated with fighting spirit (β = 0.31, p < 0.05), cognitive avoidance (β = 0.19, p > 0.05), and QoL (β = 0.21, p < 0.05), and negatively associated with helplessness-hopelessness (β = -0.28, p < 0.05). Furthermore, fighting spirit and helplessness-hopelessness showed significant relationships with QoL. Anxious preoccupation was negatively related to QoL. Furthermore, fighting spirit and helplessness-hopelessness showed significant relationships with quality of life (β = 0.18, p < 0.05; β = -0.15, p < 0.05, respectively). In addition, the mediation analysis revealed that coping styles (i.e., fighting spirit and helplessness-hopelessness) mediated the relationship between SSS and QoL. Conclusions: The findings suggest that perceptions of SSS from family and friends may promote perceived QoL via adaptive coping, such as fighting spirit and helplessness-hopelessness strategies to deal with the cancer experience.

Perceived stress and family adaptability in head and neck cancer patients receiving radiotherapy: the chain-mediated effect of social support and family resilience

Objective

Patients with head and neck tumors undergoing radiotherapy are burdened with a variety of disease-related stressors that may affect their family adaptability. The aim of the present study was to investigate the relationship between perceived stress and family adaptability in patients with head and neck tumors and to analyze whether social support and family resilience play a mediating role in this relationship.

Methods

The convenience sample approach was utilized to recruit 316 patients with head and neck tumors who received radiation. Self-developed general information questionnaires, the Chinese Perceived Stress Scales, Social Support Rating Scale, the Shortened Chinese Version of the Family Resilience Assessment Scale, and Family Adaptability Scale were used to collect data. Bootstrap methods to analyze independent and chained mediation effects between variables.

Results

The research participants had a mean age of 43.63 ± 12.78 years, were mostly male (61.7%), married (85.8%), had a university education (51.6%), were uninsured (50.9%), had ear, nose, and throat tumors (56.3%), and had an illness duration of 1-6 months (43.4%). The findings of the chain mediation effect research indicate that the direct negative effect of perceived stress on family adaptability (-0.163) accounted for 45.63% of the overall effect (-0.355), while the indirect effect (-0.194) accounted for 54.37%. Perceived stress independently mediated family adaptability through social support (effect: -0.062) and family resilience (effect: -0.080), with the independent mediator effect accounting for 32.12% and 41.45% of the indirect effect, respectively, and chain-mediated mediation of social support and family resilience, with the chain effect (-0.051) accounting for 31.30%.

Conclusion

Perceived stress in patients with head and neck cancer receiving radiotherapy directly or indirectly negatively affects family adaptability. Clinical staff should meet the patient's health care service needs while also utilizing the family's internal and external resources to reduce disease-related stress and improve family adaptability.

Cross-cultural adaptation and psychometric evaluation of the Thai version of the Enhancing Recovery in Coronary Heart Disease Social Support Inventory in individuals with chronic illnesses

Objectives

This study aimed to translate and psychometrically test the 7-item Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory (ESSI) scale within the Thai population.

Methods

A scale translation and cross-sectional validation study was conducted. The English version was translated for Thai involved nine steps: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing and finalization, and proofreading. Psychometrics testing used data from a cross-sectional study from July to November 2022 at 16 primary care centers in southern Thailand, involving 405 participants. Structural validity was tested with exploratory and confirmatory factor analysis (EFA and CFA). Hypothesis testing validity was assessed through correlations with the Self-Care Self-Efficacy Scale version 3.0 (SCSES-v3.0) and the Self-Care of Chronic Illness Inventory version 4.c (SC-CII-v4.c). Reliability was evaluated using Cronbach's α coefficient and the intraclass correlation coefficient.

Results

The Thai ESSI demonstrated excellent content validity. EFA revealed a one-factor structure, with high factor loadings for the first six items assessing informational, emotional, and instrumental support. The last item on structural support demonstrated inadequate factor loadings, suggesting its removal. CFA confirmed a well-fit one-factor structure for the 6-item ESSI. Hypothesis testing showed positive correlations with the SCSES-v3.0 and SC-CII-v4.c scales. Cronbach's α coefficient improved from 0.88 for the 7-item to 0.91 for the 6-item ESSI. Both the 7-item and the 6-item scales exhibited excellent test-retest reliability.

Conclusions

Our study affirms the strong validity and reliability of the ESSI in the Thai population with chronic illnesses. The ESSI is deemed appropriate for evaluating social support in the context of chronic illness self-care.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression

AIMS

To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions.

DESIGN

A cross-sectional study reported according to the STROBE checklist.

METHODS

A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro.

RESULTS

Self-care ability was positively associated with social support (β = .229) and resilience (β = .290), and negatively associated with depression (β = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability.

CONCLUSION

Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

Relationship between perceived social support, mental adjustment to cancer, and depression among patients with breast cancer

OBJECTIVE

Psychological morbidity is common among patients with breast cancer. The present study aimed to find the relationship between modifiable determinants, that is, perceived social support (PSS) and mental adjustment to cancer (reflecting coping) with depression in patients with breast cancer.

METHODS

A total of 76 adult patients with breast cancer undergoing treatment at a tertiary care hospital were recruited in this cross-sectional study. Patients were diagnosed for depression as per ICD-10 criteria. Hamilton Depression Rating Scale was used for assessing the severity of depression. PSS and coping style were assessed using the Multidimensional Scale for Perceived Social Support and Mini-Mental Adjustment to Cancer scale. We analyzed the data using Fisher exact test, Mann-Whitney U test, Spearman's correlation, logistic regression, and mediation analysis.

RESULTS

26.3% patients had depression. The logistic regression showed that PSS is a significant predictor of the occurrence of depression in patients with breast cancer (OR = 0.793, 95% CI: 0.634-0.992). The mediation analysis showed that hopelessness-helplessness (a maladaptive subscale) mediates the effects of PSS on depression.

CONCLUSION

The effect of PSS on the occurrence of depression is mediated through maladaptive coping (hopelessness-helplessness). Accessing these factors can provide an important avenue for psychological intervention in breast cancer patients.

Social isolation, perceived social support, and type D personality among gastrointestinal cancer survivors in China: A mediating model analysis

Objective

To explore the mediating effect of social isolation between perceived social support and type D personality in gastrointestinal cancer survivors based on the WHITE heuristic cognitive-behavioral model of emotion cognition theory.

Methods

The study utilized a convenience sampling method to recruit 183 survivors of gastrointestinal cancer who were undergoing chemoradiotherapy. SPSS 26.0 was used to analyze the correlation among social isolation, perceived social support, and type D personality. Additionally, SmartPLS 3.0 was utilized to analyze the mediating role of social isolation in the relationships between perceived social support and type D personality.

Results

The study found that gastrointestinal cancer survivors scored 60.58 ​± ​10.94 for perceived social support, 36.25 ​± ​4.71 for social isolation, and 26.26 ​± ​5.84 for type D personality. We discovered that perceived social support has a negative correlation with social isolation and type D personality (r ​= ​-0.593, -0.396, both P ​< ​0.001), while social isolation was positively correlated with type D personality (r ​= ​0.564, P ​< ​0.001). The association between type D personality and perceived social support was partially mediated by social isolation (VAF ​= ​59.67%).

Conclusions

The association between type D personality and perceived social support is mediated by social isolation in gastrointestinal cancer survivors undergoing chemoradiotherapy. Clinical staff should prioritize evaluating social isolation among these survivors to enhance social support and potentially reduce the prevalence of type D personality traits.

The relationship between psychological resilience, coping strategies and fear of cancer recurrence in patients with breast cancer undergoing surgery: A descriptive, cross-sectional study

PURPOSE

This study aims to determine the relationship between psychological resilience, coping strategies and the fear of cancer recurrence in women who have undergone surgical procedures due to breast cancer.

METHODS

The study was conducted using a descriptive, cross-sectional, and correlational research design. The sample of the study consisted of 252 women. Data were collected with The Patient Information Form, The Psychological Resilience Scale for Adults, The Ways of Coping Questionnaire and The Fear of Cancer Recurrence Inventory.

RESULTS

The mean scores of Psychological Resilience Scale for Adults, Fear of Cancer Recurrence Inventory, and the optimistic and self-confident subscales of the Ways of Coping Questionnaire among participants were found to be above average. The mean scores of the seeking social support and submissive subscales were at a moderate level, while the mean scores of the hopelessness approach subscale were below the moderate level. A moderate positive significant relationship was found between the total mean score of the Psychological Resilience Scale for Adults and the mean scores of the optimistic approach, self-confident approach, submissive approach, and seeking social support subscales of the Ways of Coping Questionnaire.

CONCLUSION

A direct relationship was found between psychological resilience and coping strategies. However, this relationship could not be found with fear of cancer recurrence. It was concluded that the level of psychological resilience and coping strategies among breast cancer survivors can be positively influenced through the implementation of professional interventions aimed at fostering growth, addressing the initial cancer diagnosis, and promoting healthy adaptation.

Social Support Protects Against the Negative Psychological Impacts of Death Anxiety, and Depression on Posttraumatic Growth in Cancer Patients

People living with cancer may experience death anxiety and depression which may impact their experience of posttraumatic growth (PTG). Social support is a psychosocial resource that protects against negative psychological outcome. Although a direct association among these variables exist, little is known about their interactive effect. Dwelling on the buffering hypothesis, this study examined the role of social support in the association of death anxiety and PTG. We further investigated whether depression-PTG relationship would be moderated by social support. Cancer patients (N = 412) were randomly selected from two healthcare institutions. Participants completed relevant self report measures, and data were analyzed using Hayes PROCESS macro for SPSS. Results showed that social support buffered the effect of death anxiety on PTG. The relationship between depression and PTG was also moderated by social support. Interventions to facilitate PTG should target social support network of patients due to its potentials in buffering the effect of death-related anxiety and depression on patients' PTG.

The influential factors of anxiety among caregivers of children with CL/P: a path analysis based on diathesis-stress theoretical model

BACKGROUND

This study aims to validate a hypothesized model of the relationships between optimism, resilience, coping, parenting stress, perceived social support, and anxiety, as well as their influencing factors and consequences among caregivers of children diagnosed with cleft lip and/or palate (CL/P).

METHODS

A hypothesized model was proposed based on diathesis-stress theoretical model and existing literature. A convenience sample of two CL/P treatment centers in China was collected between April 2019 and July 2020. Various well-validated instruments were used to collect 248 valid data points. Descriptive statistics and correlations were computed to assess model fitness and path analysis was performed to investigate direct and indirect effects.

RESULTS

The results revealed that the average level of anxiety among caregivers of children suffering from CL/P was 3.00 (0.00,6.00). The fitness of the modified path model was evaluated using various measures, including χ2/df = 1.806, GFI = 0.989, RFI = 0.916, IFI = 0.990, CFI = 0.989, TLI = 0.960, RMSEA = 0.0570. Parenting stress had the greatest direct associated with anxiety, followed by perceived social support. Moreover, indirect relations to anxiety were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.

CONCLUSION

In summary, this work suggests that both parenting stress and perceived social support in caregivers of children suffering from CL/P are associated with anxiety. Therefore, developing effective intervention approaches targeting key factors might potentially instrumental to alleviate anxiety.

Canonical correlation-based relationships between social support and sleep quality in a hospital psychiatric outpatient population with examining the mediating roles of anxiety and depressive symptoms

OBJECTIVE

This study aims to examine the associations between various dimensions of social support and sleep quality in a hospital psychiatric outpatient population using canonical correlation analysis, while also investigating the potential mediating roles of anxiety and depressive symptoms.

METHODS

Employing a cross-sectional design, survey data were collected from 10,071 individuals visiting Hangzhou Seventh People's Hospital between October 2020 and October 2023. After excluding invalid cases, a total of 10,063 participants were included for analysis. The survey encompassed gathering basic demographic information as well as administering the Social Support Rating Scale, Self-rating Depression Scale, Self-rating Anxiety Scale, and Pittsburgh Sleep Quality Index Scale. Data analysis was conducted using SPSS 27.0 statistical software with canonical correlation analysis employed to examine the relationships. Additionally, the mediating effects of anxiety and depression symptoms were examined using the SPSS PROCESS macro.

RESULTS

Canonical correlation analysis reveals a significant positive correlation between social support dimensions and various aspects of sleep quality. The first pair of canonical variables (r = 0.586, p < 0.001) accounts for an impressive 97% of the cumulative contribution. It is found that this pair of canonical variables explains 68.9% of the variance in social support and 49.0% in sleep quality. Mediation analysis revealed that anxiety and depressive symptoms significantly mediated the relationship between social support and sleep quality, accounting for 88% of the total effect. Specifically, anxiety accounted for 47% mediation while depression accounted for 41%.

CONCLUSION

The study findings revealed a significant positive correlation between social support and sleep quality dimensions, indicating a robust association between increased social support and enhanced individual sleep quality. Furthermore, the results indicated that anxiety and depression partially mediated the relationship between social support and sleep quality, offering novel insights into the intricate connection between mental health and sleep quality.

"I thought I was Probably Going to Die due to People Looking at me with Pity": A Phenomenological Qualitative Study on the Lived Cancer Stigma Experiences of Breast Cancer Patients

OBJECTIVES

It has been stated that there is a need for more recognition of the "stigma concept," which negatively affects the lives of patients with breast cancer during the diagnosis and treatment process. There are no recent studies on the experiences of Turkish women with breast cancer about stigmatization that employ qualitative methods. This study aims to examine in depth the lived stigma experiences of women with breast cancer during the diagnosis and treatment process.

METHODS

In total, 18 phenomenological semistructured in-depth individual interviews were conducted with patients with breast cancer between December 2023 and March 2024. Data were analyzed using Collaizzi's 7-step descriptive analysis approach.

RESULTS

Four main themes and 8 subthemes developed from the phenomenological analysis of the interviews: (1) Cancer Metaphors: "A dark journey," "A bomb falling on the house!" and "Cancer = death!"; (2) Social Stigma: "Cancer = an infectious disease," "Negative and Disturbing Attitudes/Approaches of People"; (3) Internalized Stigma, and (4) Coping: "Acceptance" and "Social support."

CONCLUSION

It was determined that the patients experienced social stigmatization due to negative attitudes of people toward cancer, perceiving it as infectious and approaching them with pity or demonstrating disturbing expressions. In addition, their social interactions were negatively affected due to the internalized stigma, and they were in an effort to cope with all the problems they experienced.

IMPLICATIONS FOR NURSING PRACTICE

The study highlighted the psychological needs of patients with breast cancer related to "stigmatization." Cancer nurses should monitor the stigmatization experiences of women with breast cancer, reveal their perceptions of internalized stigma, and implement programs to cope with stigma. It is also recommended that interventional studies, including coping programs with "stigma" for patients with breast cancer, should be conducted in future research.

The association between religiosity, suicidality, psychological distress, and quality of life among breast cancer patients, an example of a Middle Eastern population

The study aimed to explore the relationship between religiosity, psychological distress, and quality of life (QOL) in Saudi breast cancer patients. Utilizing a multi-center cross-sectional design, 277 patients were recruited. Patients completed questionnaires assessing religiosity, depression, anxiety, suicidality, and QOL. Results revealed a high prevalence of depression (35.7%) and anxiety (18.1%), with no significant variations in internal religiosity across different health stages, despite high levels of perceived social support. Suicidal ideation was reported by a small proportion of patients (2.5%). Multivariate analysis identified anxiety, therapy side effects, and breast symptoms as significant predictors of depression, while depression and previous psychiatric treatment predicted anxiety levels. QOL assessments indicated that body image received the highest satisfaction ratings, while sexual function received the lowest. These findings highlight the critical need for integrated mental health support in the treatment regimen of breast cancer patients.

Narratives of resilience: Understanding Iranian breast cancer survivors through health belief model and stress-coping theory for enhanced interventions

Breast cancer poses a significant global health challenge, with Iran experiencing particularly high incidence and mortality rates. Understanding the adaptation process of Iranian breast cancer survivors' post-treatment is crucial. This study explores the health perceptions, barriers, and coping mechanisms of Iranian survivors by integrating Stress-Coping Theory (SCT) and the Health Belief Model (HBM). Semi-structured interviews were conducted with 17 survivors, and a grounded theory approach guided the deductive content analysis of the data. The findings reveal key themes, including perceived susceptibility, benefits, barriers to care, cues to action, self-efficacy, and appraisal of action. Perceived susceptibility highlights diagnostic challenges stemming from practitioner errors and symptom misconceptions. Perceived benefits underscore the importance of early detection and support from healthcare providers and families. Barriers include cultural and financial obstacles, while cues to action reflect the influence of media, family, and personal experiences on healthcare-seeking behavior. The study also examines coping strategies, such as problem-focused and emotion-focused approaches, along with family support and external stressors. To address these barriers and enhance support systems, the study suggests specific strategies for healthcare providers, including targeted training to improve diagnostic accuracy and patient communication. Culturally sensitive awareness campaigns can correct symptom misconceptions, while financial counseling can mitigate economic barriers. Establishing community-based support groups and involving family members in care plans can enhance emotional and psychological support. These strategies aim to overcome the identified barriers and improve support systems for Iranian breast cancer survivors, ultimately fostering better recovery outcomes.

Psychological Distress Among Women With Breast Cancer in Saudi Arabia: A Phenomenological Study

BACKGROUND

Breast cancer has a negative impact on the psychological status of women.. In Saudi Arabia, there is limited research exploring the experience of women with breast cancer regarding the psychological influence of breast cancer.

OBJECTIVE

 To explore the experience of women with breast cancer regarding the psychological distress of breast cancer in Saudi Arabia.

METHODS

A descriptive phenomenological study was used. Semi-structured interviews were utilized to gather information from a purposive sample of 11 patients with breast cancer who were receiving treatment at the Princess Noorah Oncology Center (PNOC) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The study employed thematic analysis to discern significant themes concerning psychological stress.  Results: The study revealed that patients' psychological distress was a significant factor influencing their daily lives. This study also revealed four themes: psychological distress from the diagnosis and treatment side effects of breast cancer, daily and work-related activities reduction, the importance of social support, and the coping strategies employed by women with cancer.

CONCLUSION

Breast cancer leads to significant psychological distress. Interventional programs are needed to address the psychological distress that women with cancer experience and provide the necessary support for them to employ positive coping strategies.

Changes in the Frequency of Actions Associated With Mental Health During Online Treatment: Analysis of Demographic and Clinical Factors

BACKGROUND

Specific daily actions (eg, goal setting, meaningful activities) are associated with mental health. Performing specific daily actions at a higher frequency is associated with significantly lower baseline symptoms of depression and anxiety, as well as better psychological treatment outcomes for depression and anxiety.

OBJECTIVE

This study explored how the frequency of specific daily actions associated with mental health may differ prior to, during, and following treatment according to demographic and clinical characteristics.

METHODS

Using a sample of 448 patients from an Australian national digital psychology service, we examined baseline differences in daily action frequency and changes in daily action frequency during a digital psychological treatment according to demographic and clinical subgroups. A total of 5 specific types of daily actions were measured using the Things You Do Questionnaire: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections.

RESULTS

The frequency of daily actions differed according to employment status (largest P=.005) and educational level (largest P=.004). Daily action frequency was lower in those participants with more severe or chronic depression or anxiety symptoms (largest P=.004). Participants reported larger increases in how often they did these daily actions from baseline to midtreatment compared to mid- to posttreatment. Depression duration (P=.01) and severity (P<.001) were associated with differences in how daily action frequency changed during treatment.

CONCLUSIONS

The findings of this study support continued research exploring the relationship between daily actions and mental health, how this relationship might differ between individuals, and the clinical potential of supporting individuals to increase the frequency of daily actions to improve mental health.

Effects of social support on vision-related quality of life in older adults with dry eye disease: the chain mediating role of illness perception and coping style

Objective

This study explored the effects of social support, illness perception, coping style, and vision-related quality of life (VRQOL) in older patients with dry eye disease (DED) using a chain mediation model.

Methods

A total of 407 patients with DED from a tertiary hospital in Wuxi, Jiangsu Province, China, between June and December 2023 were selected as participants. A demographic questionnaire, the Social Support Rating Scale, the Brief Illness Perception Questionnaire, the Medical Coping Modes Questionnaire, and the National Eye Institute Visual Functioning questionnaire-25 were all given to them to complete. IBM SPSS (version 27.0) was used for data analysis, and Model 6 of the PROCESS Macro was used to test the predicted chain mediation model.

Results

The positive association between social support and VRQOL demonstrated the mediation role of illness perception and coping style. Social support affected VRQOL via three pathways: illness perception (effect = 0.190), confrontational coping style (effect = 0.103), and a combination of illness perception and confrontational coping style (effect = 0.067), accounted for 23.60%, 12.80%, and 8.32% of the total effect, respectively.

Conclusion

Social support in older patients with DED can significantly and positively predict the VRQOL. In addition to the independent mediating effect of illness perception and confrontational coping style, a chain-mediating effect exists between social support and VRQOL. The study serves as a valuable strategy for healthcare professionals to prevent and intervene in VRQOL for older patients with DED in the future.

A brief but comprehensive three-item social connectedness screener for use in social risk assessment tools

BACKGROUND

The 2014 IOM report "Capturing Social and Behavioral Domains and Measures in Electronic Health Records" described three subdomains of social relationships that affect patient health and well-being. However, most social risk screeners currently assess only one subdomain, frequency of social connections. We are proposing a three-item Brief Social Connectedness (SC) screener that additionally assesses risks in social/emotional support and loneliness/social isolation subdomains.

METHODS

For this cross-sectional study, we used data from a 2021 Kaiser Permanente Northern California (KPNC) social risk survey for 2244 members ages 35-85 years. The survey included three validated questions that covered the SC subdomains (frequencies of social contacts with people they care about, feeling lonely/socially isolated, and getting enough social/emotional support). Variables representing moderate/high versus low risk were created for each subdomain. We used weighted data for bivariate analyses and modified log-Poisson regression models that adjusted for age, sex, race, and ethnicity to examine cross-sectional associations among the three subdomain risks, as well as with two structural SC risks, living alone and not being in a committed relationship. We then used modified log-Poisson regression models to study cross-sectional associations of these five SC variables with three single-item self-report measures of emotional health.

RESULTS

In regression models that included all five SC variables, loneliness/social isolation and social/emotional support risks were significantly associated with all three emotional health measures, while frequency of social contacts, living alone, and no committed relationship were not. However, low frequency of social contacts and no committed relationship significantly increased risk of often feeling lonely/socially isolated and lacking in social/emotional support.

CONCLUSIONS

A three-item social connectedness screener that assessed risks of loneliness/social isolation, inadequate social/emotional support, and low frequency of social contacts provided more comprehensive information about emotional health risks than social connection frequency alone.

Inequality in Female Breast Cancer Relative Survival Rates between White and Black Women in the United States

BACKGROUND

This study assessed the difference in 3-, 5-, and 10-year relative survival rates (RSRs) for female breast cancer between White and Black patients across the levels of year, tumor stage, age, and marital status at diagnosis. Confounding factors and effect modifiers were considered.

METHODS

Analyses were based on 17 population-based tumor registries in the Surveillance, Epidemiology, and End Results (SEER) Program. Cases were diagnosed in 2000-2017 and followed through 2020.

RESULTS

Three-, 5-, and 10-year female breast cancer RSRs significantly improved for White and Black patients during the years 2000-2020, more so for Blacks than Whites. Three-, 5-, and 10-year estimated annual percent changes in trends were 0.09%, 0.16%, and 0.29% for Whites and 0.36%, 0.49%, and 0.86% for Blacks, respectively. However, a large difference in RSRs for White and Black patients persists, 4.2% for three-year RSRs, 5.7% for five-year RSRs, and 7.5% for 10-year RSRs, after adjusting for year, tumor stage, age, and marital status at diagnosis. The difference in RSRs between White and Black patients differs by tumor stage at diagnosis. For example, higher five-year RSRs in Whites than Blacks were 2.6% for local, 9.3% for regional, 10.4% for distant, and 6.2% for unknown/unstaged tumors at diagnosis.

CONCLUSION

Improvement in 3-, 5-, and 10-year female breast cancer RSRs occurred for both White and Black patients, albeit more so for Blacks. Yet the poorer RSRs for Blacks remain large and significant, increasingly so with later staged disease at diagnosis and as we move from 3- to 5- to 10-year RSRs.

Application Value of Music Therapy in Improving the Emotional State and Quality of Life of Hospitalized Patients with Breast Cancer: Retrospective Study

OBJECTIVE

This study aimed to apply music therapy as a clinical treatment for patients with breast cancer (BC) experiencing mild or moderate depression during hospitalization and observe any improvements in their depression and quality of life.

METHODS

A total of 102 patients who had mild-to-moderate depression, were diagnosed with BC, and were admitted to our hospital from October 2022 to October 2023 were selected as the subjects of a retrospective analysis. According to their participation in short-term music therapy, they were divided into a control group (routine nursing treatment n = 45) and an observation group (routine nursing treatment + music therapy n = 57). Self-rating depression (SDS) scale and functional assessment of cancer therapy-breast (FACT-B) scale Chinese version 4.0 scores and patient satisfaction after treatment were compared between the two groups.

RESULTS

After treatment, the SDS scale scores and FACT-B scores of the observation group were significantly better than those of the control group (P < 0.001). The patient satisfaction in the observation group was higher than in the control group (P < 0.05).

CONCLUSION

Music therapy is a highly safe method to improve the depression and quality of life of patients with BC. It also provides a simple and convenient nondrug clinical treatment with broad application prospects.

Interaction of social support and depressive symptoms on antiretroviral therapy adherence among people living with HIV in South Africa

Background

Depression consistently emerges as a significant predictor of poor antiretroviral therapy (ART) adherence among adult people living with human immunodeficiency virus (PLHIV). However, a gap exists regarding how social support and depressive symptoms can interact to influence ART adherence among adult PLHIV in South Africa (SA).

Aim

To investigate the interaction between social support and depressive symptoms on ART adherence among adult PLHIV.

Setting

A tertiary hospital in Durban, KwaZulu-Natal province of SA.

Methods

Utilising a quantitative cross-sectional research design along with time location sampling technique (TLS); the study recruited 201 adult patients enrolled in an ART programme.

Results

The results indicated that depressive symptoms were significantly associated with ART adherence with and without the interaction (B = -0.105; odds ratios [OR] 0.901; 95% confidence intervals [CI] = 0.827, 0.981; p = 0.016), while social support was not significantly associated with ART adherence (B = 0.007; OR 1.007; 95%CI = 0.989, 1.025; p = 0.475). However, a statistically significant interaction was found between social support and depressive symptoms (B = -0.006; OR 0.994; 95%CI = 0.989, 1.000; p = 0.037) on ART adherence.

Conclusion

Based on the results, depressive symptoms significantly influenced ART adherence. However, social support did not buffer the adverse effects of clinical depression associated with poor ART adherence.

Contribution

This study provides an evidence-based approach to address gaps in the mental health and social well-being of PLHIV in the context of ART adherence.

A moderated chain mediation model examining the relation between smartphone addiction and intolerance of uncertainty among master's and PhD students

The theories of relational regulation and compensatory Internet use suggest that intolerance of uncertainty influences smartphone addiction (SPA), which in turn is influenced by other aspects. This study used previous results to examine how intolerance of uncertainty affects SPA in PhD and master's degree programs. A convenience sample comprising 1727 master's and PhD students (99.9 %; 50.7 % female; Mage = 27.71; SD = 3.80; range = 21-43) was recruited. Using established questionnaires, we measured SPA, anxiety, positive coping style, perceived social support, and intolerance of uncertainty. The results demonstrated that intolerance of uncertainty positively affects SPA in terms of predictive power. Furthermore, anxiety and positive coping style mediate that link in a cascade fashion. A greater SPA indicates that the individual is less likely to use a positive coping style, has a higher anxiety level, and has a lower tolerance for uncertainty. While thinking about how intolerance of uncertainty affects anxiety and positive coping style, perceived social support mediates the relationship. Intolerance of uncertainty has less impact on anxiety and positive coping style when perceived social support is high. These results indicate the possibility of examining SPA prevention and intervention from several angles. Therefore, emotional regulation, which modifies anxiety and the tendency to use a positive coping style, may reduce the impact of intolerance of uncertainty on SPA. Another successful strategy for reducing smartphone addiction is to provide social support from loved ones and the community at large.

Increases in stress and adverse childhood experiences are associated with the co-occurrence of anxiety and depression in oncology patients

PURPOSE

Identify subgroups of patients with distinct joint anxiety AND depression profiles and evaluate for differences in demographic and clinical characteristics, as well as stress, resilience, and coping.

DESIGN

Longitudinal study.

PARTICIPANTS

Patients (n = 1328) receiving chemotherapy.

METHODS

Measures of state anxiety and depression were done six times over two cycles of chemotherapy. All of the other measures were completed prior to second or third cycle of chemotherapy. Latent profile analysis was used to identify the distinct joint anxiety and depression profiles.

FINDINGS

Three classes were identified (i.e. Low Anxiety and Low Depression (57.5%); Moderate Anxiety and Moderate Depression (33.7%), High Anxiety and High Depression (8.8%)). For all of the stress measures, a dose response effect was seen among the profiles. Two worst profiles reported higher occurrence rates for a number of adverse childhood experiences.

IMPLICATIONS FOR PROVIDERS

Patients need referrals for stress reduction techniques and mental health and social services.

Subjective well-being among Chinese breast cancer patients: The unique contributions of death anxiety, self-esteem, and social support

Previous studies have indicated that cancer patients may have a lower level of subjective well-being (SWB); nevertheless, the underlying factors for this phenomenon remain insufficiently investigated. Based on the characteristics of Chinese breast cancer patients and the unique culture, this study explored the independent contributions of death anxiety, self-esteem, and social support to SWB from the protective and risk perspectives. A cross-sectional survey recruited 514 females with breast cancer and collected participants' demographic and the above variables. The results found that death anxiety independently predicted SWB in a negative direction (β = -0.36, p < 0.001). In addition, self-esteem (β = 0.38, p < 0.001) and social support (β = 0.14, p < 0.001) also had the unique positive effects on SWB. These findings offer new insights into strengthening breast cancer patients' SWB, for instance, using relevant interventions to reduce death anxiety and improve self-esteem and social support.

Social enrichment alters the response of brain leukocytes to chemotherapy and tumor development in aged mice

Aging is a risk factor for the development of breast cancer. Foundational science studies have supported associations among neuroinflammation, breast cancer, and chemotherapy, but to date, these associations are based on studies using young adult rodents. The current study examined the neuroinflammatory effects of chemotherapy in aged, tumor-naïve and tumor-bearing mice with or without social enrichment. Mice received two intravenous injections of doxorubicin (A) and cyclophosphamide (C) at a two-week interval. Brain immune cells were enriched/assessed via flow cytometry, seven days following the second chemotherapy injection. Social enrichment enhanced peripheral immune cell trafficking in aged tumor-naive mice treated with AC. Group housed aged tumor bearing mice receiving AC had reduced percentage of IL-6+ monocytes and granulocytes relative to their singly housed counterparts. Notably, group housing aged experimental mice with young cage partners significantly reduced TNF + monocytes, tumor volume, and tumor mass. These data illustrate the importance of social enrichment in attenuating neuroinflammation and are the first to demonstrate that social support with young housing partners reduces tumor growth in aged mice.

Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study

PURPOSE

This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1).

METHODS

This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients.

RESULTS

A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004).

CONCLUSION

The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.

Frontal Alpha Asymmetry Argues for the Heterogeneity of Psychological Resilience

Depression is associated with frontal alpha asymmetry (FAA) and Psychological Resilience (PR), although in different ways. Only cursory attention has been given to how these three constructs interact despite the possible clinical and research implications of those associations. One limitation of recent research into these associations has been conceptualising PR as a unitary construct, whereas it has been shown to be multi-component. This study investigated the underlying components of PR, their correlations with FAA, and the effect that participants' depressive status had upon those correlations in a community sample of 54 males and 46 females aged between 18 yr and 75 years. Results confirmed the overall inverse association between total PR and depression for four of the original five PR components and for one of the two components found in this sample. Similarly, there were differences between the ways that FAA and PR components were associated, depending upon the depressive status of participants. Source localisation data indicated that the PR components were not uniformly correlated with alpha activity in the same brain regions. These findings of content, efficacy, and neurophysiological differences between the five components of PR and their associations with FAA argue against consideration of PR as a unitary construct.

The relationship between resilience and quality of life in advanced cancer survivors: multiple mediating effects of social support and spirituality

Background

While previous studies have revealed a positive association between resilience and quality of life in advanced cancer survivors, the mechanisms of the relationship is still unclear. This study aimed to explore the relationships between resilience, social support, spirituality, and quality of life and determine the multiple mediation effects of social support and spirituality on the relationship between resilience and quality of life.

Methods

With 286 advanced cancer survivors, a cross-sectional, correlational survey was adopted using convenience sampling. Resilience, social support, spirituality, and quality of life were evaluated by self-report questionnaires. The PROCESS macro for SPSS was used to test the multiple mediation model.

Results

The scores for resilience, social support, spirituality and quality of life were positively correlated with one another. Resilience was found to be directly impact quality of life. Meanwhile, the relationship between resilience and quality of life was mediated by social support (effect = 0.067, 95% CI [0.019, 0.120]) and by spirituality (effect = 0.221, 95% CI [0.134, 0.332]), respectively, and by these two serially (effect = 0.036, 95% CI [0.015, 0.067]).

Conclusion

Social support and spirituality played multiple mediating roles in the relationship between resilience and quality of life. Interventions aimed at increasing resilience, and then boosting social support and spirituality may be beneficial for promoting quality of life of advanced cancer survivors.

Effect of the Fit2Thrive Intervention on Patient-reported Outcomes in Breast Cancer Survivors: A Randomized Full Factorial Trial

BACKGROUND

Moderate to vigorous physical activity (MVPA) interventions improve patient-reported outcomes (PROs) of physical and psychological health among breast cancer survivors (BCS); however, the effects of specific intervention components on PROs are unknown.

PURPOSE

To use the Multiphase Optimization Strategy (MOST) to examine overall effects of the Fit2Thrive MVPA promotion intervention on PROs in BCS and explore whether there are intervention component-specific effects on PROs.

METHODS

Physically inactive BCS [n = 269; Mage = 52.5 (SD = 9.9)] received a core intervention (Fitbit + Fit2Thrive smartphone app) and were randomly assigned to one of 32 conditions in a full factorial experiment of five components ("on" vs. "off"): (i) support calls, (ii) deluxe app, (iii) text messages, (iv) online gym, and (v) buddy. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires assessed anxiety, depression, fatigue, physical functioning, sleep disturbance and sleep-related impairment at baseline, post-intervention (12-week), and 24-week follow-up. Main effects for all components at each time point were examined using an intention to treat mixed-effects model.

RESULTS

All PROMIS measures except sleep disturbance significantly improved (p's < .008 for all) from baseline to 12-weeks. Effects were maintained at 24-weeks. The "on" level of each component did not result in significantly greater improvements on any PROMIS measure compared to the "off" level.

CONCLUSIONS

Participation in Fit2Thrive was associated with improved PROs in BCS, but improvements did not differ for "on" vs. "off" levels for any component tested. The low-resource Fit2Thrive core intervention is a potential strategy to improve PROs among BCS. Future studies should test the core in an RCT and examine various intervention component effects in BCS with clinically elevated PROs.

Factors Associated with Depression, Anxiety, and Somatic Symptoms among International Salespeople in the Medical Device Industry: A Cross-Sectional Study in China

BACKGROUND

The physical and mental health of corporate employees is equally important, especially for international salespeople in the in vitro diagnostic (IVD) medical device industry. The rapid growth of the IVD market is driven by the increasing prevalence of chronic and infectious diseases. This study aims to determine the prevalence of depression, anxiety, and somatic symptoms among international salespeople in China's IVD industry and identify the association of socio-demographic, occupational, organizational, and psychosocial factors with mental health outcomes for depression, anxiety, and somatic symptoms in Chinese IVD international salespeople.

METHODS

The study was a cross-sectional survey of international salespeople (ISs) in IVD companies officially registered in China. An online survey was designed to collect data through email contact with IVD companies and social media between August 2022 and March 2023. Measured factors included effort-reward imbalance (ERI), health-promoting leadership (HPL), health climate (HC), inner strength (IS), and perceived social support (PSS). Mental health outcomes assessed using the Core Symptom Index (CSI) were depression, anxiety, and somatic symptoms.

RESULTS

A total of 244 salespeople responded to the survey. CSI scores indicated that 18.4% (n = 45) and 10.2% (n = 25) of the respondents had symptoms of major depression and anxiety, respectively. ERI was positively correlated, while the IS and PSS were negatively correlated with major depression, anxiety, and somatic symptoms (p < 0.01). The health climate was negatively correlated with major depression (p < 0.05). Education background was associated with somatic symptoms (p < 0.05). ERI, IS, and gender were significant predictors of major depression, anxiety, and somatic symptoms (p < 0.05).

CONCLUSION

The prevalence of depression and anxiety in China's IVD international salespeople was considered low compared with the prevalence in Chinese populations during COVID-19 but higher than those before the pandemic. Effort-reward imbalance, inner strength, and gender were significant factors in major depression, anxiety, and somatic symptoms among IVD international salespeople.

Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based study

BACKGROUND

Mental health disorders can potentially decrease quality of life and survival in patients with cancer. Little is known about the survival implications of mental health disorders in patients with diffuse large B-cell lymphoma (DLBCL). We aimed to evaluate the effect of pre-existing depression, anxiety, or both on survival in a US cohort of older patients with DLBCL.

METHODS

Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we identified patients aged 67 years or older, diagnosed with DLBCL in the USA between Jan 1, 2001, and Dec 31, 2013. We used billing claims to identify patients with pre-existing depression, anxiety, or both before their DLBCL diagnosis. We compared 5-year overall survival and lymphoma-specific survival between these patients and those without pre-existing depression, anxiety, or both using Cox proportional analyses, adjusting for sociodemographic and clinical characteristics, including DLBCL stage, extranodal disease, and B symptoms.

FINDINGS

Among 13 244 patients with DLBCL, 2094 (15·8%) had depression, anxiety, or both disorders; 6988 (52·8%) were female, and 12 468 (94·1%) were White. The median follow-up for the cohort was 2·0 years (IQR 0·4-6·9 years). 5-year overall survival was 27·0% (95% CI 25·1-28·9) for patients with these mental health disorders versus 37·4% (36·5-38·3) for those with no mental health disorder (hazard ratio [HR] 1·37, 95% CI 1·29-1·44). Although survival differences between mental health disorders were modest, those with depression alone had the worst survival compared with no mental health disorder (HR 1·37, 95% CI 1·28-1·47), followed by those with depression and anxiety (1·23, 1·08-1·41), and then anxiety alone (1·17, 1·06-1·29). Individuals with these pre-existing mental health disorders also had lower 5-year lymphoma-specific survival, with depression conferring the greatest effect (1·37, 1·26-1·49) followed by those with depression and anxiety (1·25, 1·07-1·47) and then anxiety alone (1·16, 1·03-1·31).

INTERPRETATION

Pre-existing depression, anxiety, or both disorders present within 24 months before DLBCL diagnosis, worsens prognosis for patients with DLBCL. Our data underscore the need for universal and systematic mental health screening for this population, as mental health disorders are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival.

FUNDING

American Society of Hematology, National Cancer Institute, Alan J Hirschfield Award.

A cross-sectional study of fear of surgery in female breast cancer patients: Prevalence, severity, and sources, as well as relevant differences among patients experiencing high, moderate, and low fear of surgery

BACKGROUND

Fear of surgery has been associated with more postoperative pain, disability, and a lower quality of life among patients undergoing various surgical procedures. While qualitative studies indicate breast cancer patients to be afraid of surgery, detailed quantitative analyses are lacking. The present research aimed at investigating the prevalence, severity, and sources of fear of surgery in this patient group and to compare patients reporting different degrees of such fear.

METHODS

This cross-sectional study included 204 breast cancer patients, 18-70 years old, and scheduled for surgery at Oslo University Hospital, Norway. Following their preoperative visit participants completed validated psychological questionnaires online. Among these, the primary outcome measure, the Surgical Fear Questionnaire (SFQ; scores: 0-10 per item, 0-80 overall). Patients were grouped based on SFQ-percentiles (<25th = little, 25th-75th = moderate and >75th percentile = high fear) and compared on psychological (anxiety, depression, experienced injustice, optimism and expected postsurgical pain), sociodemographic, and medical outcomes.

RESULTS

195 patients completed the SFQ. On average fear of surgery was low (M = 26.41, SD = 16.0, median = 26, min-max = 0-80), but omnipresent. Only 1.5% (n = 3) indicated no fear at all. Overall, patients feared surgery itself the most (M = 3.64, SD = 2.8). Groups differed significantly (p < .001) in their experience of anxiety, depression, and injustice, as well as their disposition to be optimistic, and expectance of postsurgical pain. Differences between groups concerning demographic and medical information were largely insignificant.

DISCUSSION

This study was the first to demonstrate fear of surgery to be prevalent and relevant among female breast cancer patients. The higher a patients' fear group, the poorer their preoperative psychological constitution. This, largely irrespective of their current diagnoses or treatments, medical history, and demographics. Fear of surgery might thus cater as a prognostic marker and treatment target in this patient group. However, given the cross-sectional character of the present data, prognostic studies are needed to evaluate such claims.

The influence of nutrition literacy, self-care self-efficacy and social support on the dietary practices of breast cancer patients undergoing chemotherapy: A multicentre study

PURPOSE

Breast cancer patients undergoing chemotherapy experience adverse reactions, which lead to poor nutritional status. The objective of this study was to explore the dietary practice of Chinese breast cancer patients undergoing chemotherapy and to analyse the influence of nutrition literacy, self-care self-efficacy and perceived social support on dietary practice.

METHOD

A total of 295 participants from three hospitals in China were enrolled. The Dietary Nutritional Knowledge, Attitude and Practice Questionnaire; Nutrition Literacy Measurement Scale for Chinese Adults; Strategies Used by People to Promote Health and Perceived Social Support Scale were administered. Multiple linear regressions were used to identify influencing factors.

RESULTS

The dietary practice of patients were generally satisfactory. Nutrition literacy (r = 0.460, p < 0.001), self-care self-efficacy (r = 0.513, p < 0.001) and perceived social support (r = 0.703, p < 0.001) were positively correlated with dietary practice. The main factors influencing participants' dietary practice were nutrition literacy, self-care self-efficacy, perceived social support, living environment, cancer stage, body mass index, chemotherapy cycle and average monthly household income (all p < 0.05). The model explained 59.0% of the variance in dietary practice.

CONCLUSIONS

Health professionals should emphasize breast cancer patients' dietary practice throughout the entire chemotherapy course, and dietary interventions should be designed by oncology nurses based on patients' nutrition literacy, self-care self-efficacy and perceived social support. Female patients who have a higher body mass index and income, live in rural areas, have a lower education level, have stage I cancer and have undergone numerous chemotherapy cycles are the focus population of intervention.

Sense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study

BACKGROUND

Depression and anxiety symptoms are two common psychological disturbances in cervical cancer patients. We tested whether sense of coherence (SOC) mediates the association of perceived social support (PSS) with depression and anxiety symptoms among cervical cancer patients in China.

METHODS

We conducted a survey involving 294 cervical cancer patients aged ≥ 18 years from July to December 2020 at three hospitals in Liaoning Province, China; 269 patients completed the survey. We included a demographic questionnaire, the Multidimensional Scale of Perceived Social Support (MSPSS), Antonovsky's Sense of Coherence Scale, the Hamilton Depression Rating Scale, and the Zung Self-Rating Anxiety Scale (SAS) in this study. We used hierarchical regression analysis to examine the relationship among PSS, SOC, and symptoms of depression and anxiety. We used asymptotic and resampling strategies to explore the mediating effect of SOC.

RESULTS

PSS was negatively associated with depressive symptoms (r = - 0.439, P < 0.01) and anxiety symptoms (r = - 0.325, P < 0.01). SOC was negatively related to depressive symptoms (r = - 0.627, P < 0.01) and anxiety symptoms (r = - 0.411, P < 0.01). SOC partially mediated the association between PSS and depressive symptoms (a*b = - 0.23, BCa95% CI: [- 0.31, - 0.14]) and anxiety symptoms (a*b = - 0.15, BCa95% CI: [- 0.23, - 0.08]). The proportions of the mediating effect accounting for SOC were 49.78% and 41.73% for depressive symptoms and anxiety symptoms, respectively.

CONCLUSION

The study showed that SOC could mediate the association between PSS and symptoms of depression and anxiety. This suggests that SOC might serve as a potential target for intervention in symptoms of depression and anxiety that accompany cervical cancer.

Stress-Buffering Effects of Social Support on Tourism Employees during the COVID-19 Pandemic: A Moderated Mediation Model

Since the beginning of 2020, China's tourism industry has been severely impacted by the COVID-19 pandemic, and domestic tourism revenues have plummeted. Tourism employees have faced reduced working hours, job instability, shut down, and unemployment. In the context of the normalization of epidemic prevention, the tourism industry is recovering slowly and uncertainly, and many tourism employees face increasing employment stress. To investigate the relationship between social support and employment stress among tourism employees, 308 tourism employees were surveyed, and the mediating role of positive coping styles and the moderating role of psychological resilience were examined using structural equation modeling. The results revealed three key findings: social support significantly and negatively influenced the employment stress of tourism employees; positive coping styles significantly mediated the relationship between social support and employment stress among tourism employees; and psychological resilience moderated the relationship between social support and employment stress among tourism employees, as well as moderating the relationship between social support and positive coping style. The current findings help to deepen the understanding of the relationship between social support and employment stress, and they have important implications for alleviating the employment stress of tourism employees in the context of the pandemic.

Different Effects of Perceived Social Support on the Relationship between Perceived Stress and Depression among University Students with Borderline Personality Disorder Symptoms: A Multigroup Mediation Analysis

Background: While perceived social support can mediate the relationship between perceived stress and depression, little is known about the differences between individuals with high and low borderline personality disorder symptoms (BPDS). This study aimed to investigate the associations among perceived stress, perceived social support, and depression, and compare low and high levels of BPDS. Methods. This cross-sectional analysis was a secondary analysis of data from the SI-Bord study. University students across Thailand completed a screening instrument for borderline personality disorder, the Perceived Stress Scale (PSS), the Revised Thai Multi-dimensional Scales of Perceived Social Support (MSPSS), and the Patient-Health Questionnaire (PHQ)-9. Mediation analysis using PROCESS was applied to test the direct and indirect effects of perceived stress on depression. Multigroup mediational analysis was adopted to compare low and high levels of BPDS. Results. The mean age of the 330 participants was 20.27 (SD, 1.4) and 80% were female. Significant correlations were observed between the PSS, MSPSS, and PHQ scores, with greater magnitude among the high-level BPDS group (p < 0.001). A significant direct effect on perceived stress and a significant indirect effect on depression through perceived social support were noted. Of all the sources of social support, only the significant others variable significantly differed between the two groups (p < 0.05). Conclusion. Perception of social support had a significant mediating role in perceived stress and depression. The magnitude of associations was remarkably high for individuals with high BPDS compared to those with low BPDS. Unlike those with low BPDS, all sources of social support were significant mediators between the two groups.

Coping strategies and anxiety in young breast cancer survivors

PURPOSE

We sought to describe coping strategies reported by young breast cancer survivors and evaluate the relationship between utilization of specific coping strategies and anxiety in survivorship.

METHODS

Participants enrolled in The Young Women's Breast Cancer Study, a multi-center, cohort of women diagnosed with breast cancer at age ≤ 40 years, completed surveys that assessed demographics, coping strategies (reported at 6-month post-enrollment and 18-month post-diagnosis), and anxiety (2 years post-diagnosis). We used univariable and multivariable logistic regression to examine the relationship between coping strategies and anxiety.

RESULTS

A total of 833 women with stage 0-3 breast cancer were included in the analysis; median age at diagnosis was 37 (range: 17-40) years. Social supports were the most commonly reported coping strategies, with the majority reporting moderate or greater use of emotional support from a partner (90%), parents (78%), other family (79%), and reliance on friends (88%) at both 6 and 18 months. In multivariable analyses, those with moderate or greater reliance on emotional support from other family (odds ratio (OR): 0.37, 95% confidence ratio (CI): 0.22-0.63) at 18 months were less likely to have anxiety at 2 years, while those with moderate or greater reliance on alcohol/drug use (OR: 1.83, 95%CI: 1.12-3.00) and taking care of others (OR: 1.90, 95%CI: 1.04-3.45) to cope were more likely to have anxiety.

CONCLUSION

Young breast cancer survivors rely heavily on support from family and friends. Our findings underscore the importance of considering patients' social networks when developing interventions targeting coping in survivorship.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01468246 (first posted November 9, 2011).

Associations of body image with depressive symptoms and PTG among breast cancer patients: The mediating role of social support

Background

Cancer diagnosis and treatment usually trigger positive and negative psychological health outcomes. Social support is a coping resource for psychological health outcomes. However, little research is available on the relationships between social support, body image, and overall psychological health outcomes in breast cancer (BC) patients. This study aimed to estimate the prevalence of depressive symptoms and post-traumatic growth (PTG) and examine the mediating roles of social support between body image and depressive symptoms and PTG among BC patients, respectively.

Methods

A cross-sectional study was conducted in the Northeast China from December 2015 to August 2017. All the participants were diagnosed with BC and underwent surgery. This study was conducted with 405 BC patients from the First Affiliated Hospital of China Medical University. Participants completed the Center for Epidemiologic Studies Depression scale, Post Traumatic Growth Inventory, Body Image Scale, and Perceived Social Support Scale. The associations of social support, body image with depressive symptoms, and PTG were examined by hierarchical linear regression analysis. Asymptotic and resampling strategies were used to explore the mediating role of social support.

Results

The prevalence of depressive symptoms was 88.1%, and 67.2% of the patients had moderate-high PTG, 52.84% of the patients had body concerns, and 264 (65.19%) patients had high-level social support. Body image was positively associated with depressive symptoms (β = 0.445, P < 0.001) and social support was negatively associated with depressive symptoms (β = −0.219, P < 0.001). Body image was negatively associated with PTG (β = −0.095, P = 0.023), whereas social support was positively associated with PTG (β = 0.533, P < 0.001). Social support significantly mediated the associations among body image, depressive symptoms (effect size = 0.057), and PTG (effect size = −0.304), respectively.

Conclusions

Social support played mediating role in the relationships between body image and depressive symptoms and PTG. The interventions based on social support and body image should be included in psychological health prevention.

Research on body image cognition, social support and illness perception in breast cancer patients with different surgical methods

In parallel with the rapid rise in breast cancer incidence, there is also a noticeable rise in the number of patients who experience persistent negative body image cognition after breast cancer surgery. This study aimed to explore the differences in illness perception, social support, and body image cognition among breast cancer patients with different surgical methods, and the correlation, regression, and mediation among the three variables. The Brief Illness Perception Questionnaire (BIPQ), the Social Support Rating Scale (SSRS) and the Body Image Cognition after Breast Cancer Questionnaire (BIBCQ) were used to evaluate breast cancer patients’ illness perception, social support and body image cognition. Data analyses were performed by descriptive statistics, independent samples t-test, analysis of variance (ANOVA), Pearson correlation, and linear regression. The mediation was explored by the PROCESS V3.3. The study found that breast cancer patients undergoing radical mastectomy (RM) and modified radical mastectomy (MRM) demonstrated more negative illness perception, body image cognition, and lower social support compared with the patients receiving nipple-sparing mastectomy (NSM; p < 0.05). The subscale cognitive representation (CR) of BIPQ was strongly positively correlated with BIBCQ (p < 0.05). Illness perception positively predicted body image cognition (p < 0.01), while social support negatively predicted body image cognition. Social support partially mediated illness perception and body image cognition, exhibiting a positive role in post-operative body image cognition.

Hope and life satisfaction among Chinese shadow education tutors: The mediating roles of positive coping and perceived social support

Previous studies of the relationship between hope and life satisfaction left the underlying mechanism of how hope predicts life satisfaction unexplored to scholars. This study thus investigates the two potential mediators in the relationship between hope and life satisfaction among a sample of Chinese shadow education institution (SEI) tutors who may be under immense professional development pressure from a cross-sectional approach. The main body of the study consists of an online survey in which 221 SEI tutors reported their hope, positive coping, perceived social support, and life satisfaction. The survey results were analyzed using mediation and moderation analysis via SPSS 23.0. The results indicated that positive coping improved the relationship between hope and life satisfaction, supporting the hypothesis regarding the serial mediating effect of positive coping and perceived social support. In other words, tutors with a high level of hope tend to adopt positive coping strategies, thus will receive more social support and improve life satisfaction. Our findings revealed the independent and accumulative mediating effects of positive coping and perceived social support on the relationship between hope and life satisfaction, and had implications for the psychological intervention of SEI tutors who are currently facing enormous industry pressure.

Social relationships and their associations with affective symptoms of women with breast cancer: A scoping review

BACKGROUND

Problems in affective and cognitive functioning are among the most common concurrent symptoms that breast cancer patients report. Social relationships may provide some explanations of the clinical variability in affective-cognitive symptoms. Evidence suggests that social relationships (functional and structural aspects) can be associated with patients' affective-cognitive symptoms; however, such an association has not been well studied in the context of breast cancer.

PURPOSE

The purpose of this scoping review was to address the following question: What social relationships are associated with affective-cognitive symptoms of women with breast cancer?

METHODS

This scoping review used the framework proposed by Arksey and O'Malley and PRISMA-Sc. Studies published by February 2022 were searched using four databases: MEDLINE (PubMed), Embase (Elsevier), PsycINFO (EBSCOhost), and Web of Science (Clarivate). All retrieved citations were independently screened and eligibility for inclusion was determined by study team members. Extracted data included research aims, design, sample, type and measures of social relationships (functional and structural), and the association between social relationships and affective-cognitive symptoms.

RESULTS

A total of 70 studies were included. Affective symptoms were positively associated with social support, family functioning, quality of relationships, social networks, and social integration, whereas the negative association was found with social constraints.

CONCLUSION

Our findings suggest positive social relationships may mitigate affective symptoms of women with breast cancer. Thus, health care providers need to educate patients about the importance of building solid social relationships and encourage them to participate in a supportive network of friends and family members.