Advertisement

Supportive Care in Cancer

, Volume 21, Issue 9, pp 2469–2476 | Cite as

Psychological resilience contributes to low emotional distress in cancer patients

  • Jung-Ah Min
  • Sujung Yoon
  • Chang-Uk Lee
  • Jeong-Ho Chae
  • Chul Lee
  • Kyo-Young Song
  • Tae-Suk KimEmail author
Original Article

Abstract

Purpose

Although a considerable number of cancer patients suffer from emotional distress which may have an impact on their quality of life, it still remains poorly understood which psychosocial factors contribute to individual vulnerabilities to emotional distress of cancer patients. Recently, resilience has been suggested as the capacity to cope with adversities like cancer. In this study, we investigated the relationships between resilience and emotional distress in cancer patients.

Methods

One hundred fifty-two cancer patients who were consecutively hospitalized for their scheduled treatments at the Seoul St. Mary’s Hospital were enrolled and completed the Connor–Davidson Resilience Scale and Hospital Anxiety Depression Scale to measure resilience and emotional distress. The relationships between the levels of psychological resilience and emotional distress were evaluated using univariate and multivariate logistic regression analyses.

Results

Psychological resilience levels were negatively associated with emotional distress after controlling for relevant covariates. The highest quartile of resilience level was associated with a 90 % (adjusted odds ratio [OR] = 0.10, 95 % confidence interval [CI] = 0.03–0.34, P < 0.001) reduction in the risk for emotional distress compared to the lowest quartile. Among metastatic cancer patients, resilience was also found to be a significant protective factor for emotional distress (adjusted OR = 0.14, 95 % CI = 0.02–0.79, P = 0.02).

Conclusion

The present study suggests that psychological resilience may independently contribute to low emotional distress in cancer patients. The relationship between resilience and emotional distress was also significant in the subgroup of metastatic cancer patients. Psychosocial interventions to enhance resilience might provide useful approaches to overcome cancer-related emotional distress.

Keywords

Cancer Emotional distress Metastasis Oncology Resilience 

Notes

Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2010-0003505), by the Cancer Research Fund of the Catholic Comprehensive Cancer Institute in 2008, and by the Dr. Dae-Kyoon Bae Memorial fund from the Korean Neuropsychiatric Association Research Foundation in 2009.

Conflict of interest

The authors do not have a financial relationship with the organization that sponsored the research. The principal author (T.-S. Kim) has full control of all primary data, and the authors agree that Supportive Care in Cancer can review these data if requested.

References

  1. 1.
    Ross L, Boesen EH, Dalton SO, Johansen C (2002) Mind and cancer: does psychosocial intervention improve survival and psychological well-being? Eur J Cancer 38:1447–1457CrossRefGoogle Scholar
  2. 2.
    Singer S, Das-Munshi J, Brähler E (2010) Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis. Ann Oncol 21:925–930CrossRefGoogle Scholar
  3. 3.
    Kroenke K, Theobald D, Wu J, Loza JK, Carpenter JS, Tu W (2010) The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. J Pain Symptom Manag 40:327–341CrossRefGoogle Scholar
  4. 4.
    Weisman AD (1979) A model for psychosocial phasing in cancer. Gen Hosp Psychiatry 1:187–195CrossRefGoogle Scholar
  5. 5.
    Bultz BD, Groff SL, Fitch M, Blais MC, Howes J, Levy K, Mayer C (2011) Implementing screening for distress, the 6th vital sign: a Canadian strategy for changing practice. Psychooncology 20:463–469CrossRefGoogle Scholar
  6. 6.
    Harrison J, Maguire P (1994) Predictors of psychiatric morbidity in cancer patients. Br J Psychiatry 165:593–598CrossRefGoogle Scholar
  7. 7.
    Breen SJ, Baravelli CM, Schofield PE, Jefford M, Yates PM, Aranda SK (2009) Is symptom burden a predictor of anxiety and depression in patients with cancer about to commence chemotherapy? Med J Aust 190:S99–S104PubMedGoogle Scholar
  8. 8.
    Aspinwall LG, MacNamara A (2005) Taking positive changes seriously. Cancer 104:2549–2556CrossRefGoogle Scholar
  9. 9.
    Hulbert-Williams N, Neal R, Morrison V, Hood K, Wilkinson C (2011) Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust? Psychooncology. doi: 10.1002/pon.1980 CrossRefGoogle Scholar
  10. 10.
    Broadhead WE, Kaplan BH (1991) Social support and the cancer patient. Implications for future research and clinical care. Cancer 67:794–799CrossRefGoogle Scholar
  11. 11.
    Pinar G, Okdem S, Buyukgonenc L, Ayhan A (2012) The relationship between social support and the level of anxiety, depression, and quality of life of Turkish women with gynecologic cancer. Cancer Nurs 35:229–235CrossRefGoogle Scholar
  12. 12.
    Mehnert A, Lehmann C, Graefen M, Huland H, Koch U (2010) Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. Eur J Cancer Care Engl 19:736–745CrossRefGoogle Scholar
  13. 13.
    Kornblith AB, Herndon JE 2nd, Zuckerman E, Viscoli CM, Horwitz RI, Cooper MR, Harris L, Tkaczuk KH, Perry MC, Budman D, Norton LC, Holland J (2001) Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer 91:443–454CrossRefGoogle Scholar
  14. 14.
    Lutgendorf SK, Anderson B, Ullrich P, Johnsen EL, Buller RE, Sood AK, Sorosky JI, Ritchie J (2002) Quality of life and mood in women with gynecologic cancer: a one year prospective study. Cancer 94:131–140CrossRefGoogle Scholar
  15. 15.
    de Moor JS, de Moor CA, Basen-Engquist K, Kudelka A, Bevers MW, Cohen L (2006) Optimism, distress, health-related quality of life, and change in cancer antigen 125 among patients with ovarian cancer undergoing chemotherapy. Psychosom Med 68:555–562CrossRefGoogle Scholar
  16. 16.
    Boscaglia N, Clarke DM (2007) Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer. Psychooncology 16:189–195CrossRefGoogle Scholar
  17. 17.
    Lo C, Zimmermann C, Rydall A, Walsh A, Jones JM, Moore MJ, Shepherd FA, Gagliese L, Rodin G (2010) Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. J Clin Oncol 28:3084–3089CrossRefGoogle Scholar
  18. 18.
    Gall TL, Kristjansson E, Charbonneau C, Florack P (2009) A longitudinal study on the role of spirituality in response to the diagnosis and treatment of breast cancer. J Behav Med 32:174–186CrossRefGoogle Scholar
  19. 19.
    Rowland JH, Baker F (2005) Introduction: resilience of cancer survivors across the lifespan. Cancer 104:2543–2548CrossRefGoogle Scholar
  20. 20.
    Rutter M (1987) Psychosocial resilience and protective mechanisms. Am J Orthopsychiatry 57:316–331CrossRefGoogle Scholar
  21. 21.
    Southwick SM, Vythilingam M, Charney DS (2005) The psychobiology of depression and resilience to stress: implications for prevention and treatment. Annu Rev Clin Psychol 1:255–291CrossRefGoogle Scholar
  22. 22.
    Mancini AD, Bonanno GA (2006) Resilience in the face of potential trauma: clinical practices and illustrations. J Clin Psychol 62:971–985CrossRefGoogle Scholar
  23. 23.
    Hjemdal O (2006) Resilience predicting psychiatric symptoms: a prospective study of protective factors and their role in adjustment to stressful life events. Clin Psychol 13:194Google Scholar
  24. 24.
    Hoge EA, Austin ED, Pollack MH (2007) Resilience: research evidence and conceptual considerations for posttraumatic stress disorder. Depress Anxiety 24:139–152CrossRefGoogle Scholar
  25. 25.
    Golden-Kreutz DM, Thornton LM, Wells-Di Gregorio S, Frierson GM, Jim HS, Carpenter KM, Shelby RA, Andersen BL (2005) Traumatic stress, perceived global stress, and life events: prospectively predicting quality of life in breast cancer patients. Health Psychol 24:288–296CrossRefGoogle Scholar
  26. 26.
    Brix C, Schleussner C, Füller J, Roehrig B, Wendt TG, Strauss B (2008) The need for psychosocial support and its determinants in a sample of patients undergoing radiooncological treatment of cancer. J Psychosom Res 65:541–548CrossRefGoogle Scholar
  27. 27.
    Strauss B, Brix C, Fischer S, Leppert K, Füller J, Roehrig B, Schleussner C, Wendt TG (2007) The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT). J Cancer Res Clin Oncol 133:511–518CrossRefGoogle Scholar
  28. 28.
    Vahdaninia M, Omidvari S, Montazeri A (2010) What do predict anxiety and depression in breast cancer patients? A follow-up study. Soc Psychiatry Psychiatr Epidemiol 45:355–361CrossRefGoogle Scholar
  29. 29.
    Parker PA, Baile WF, de Moor C, Cohen L (2003) Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology 12:183–193CrossRefGoogle Scholar
  30. 30.
    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemo-therapeutic agents in cancer. In: Maclead CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 191–205Google Scholar
  31. 31.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefGoogle Scholar
  32. 32.
    Vodermaier A, Millman RD (2011) Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis. Support Care Cancer 19:1899–1908CrossRefGoogle Scholar
  33. 33.
    Singer S, Kuhnt S, Götze H, Hauss J, Hinz A, Liebmann A, Krauss O, Lehmann A, Schwarz R (2009) Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. Br J Cancer 100:908–912CrossRefGoogle Scholar
  34. 34.
    Connor KM, Davidson JR (2003) Development of a new resilience scale: the Connor–Davidson Resilience Scale (CD-RISC). Depress Anxiety 18:76–82CrossRefGoogle Scholar
  35. 35.
    Windle G, Bennett KM, Noyes J (2011) A methodological review of resilience measurement scales. Health Qual Life Outcomes 9:8CrossRefGoogle Scholar
  36. 36.
    Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH (1988) The Duke–UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients. Med Care 26:709–723CrossRefGoogle Scholar
  37. 37.
    Baek HS, Lee KU, Joo EJ, Lee MY, Choi KS (2010) Reliability and validity of the Korean version of the Connor–Davidson resilience scale. Psychiatry Investig 7:109–115CrossRefGoogle Scholar
  38. 38.
    Kirk RE (1995) Completely randomized design. In: Kirk RE (ed) Experimental design: procedures for the behavioral sciences. Brooks/Cole, Pacific Grove, CAGoogle Scholar
  39. 39.
    Bultz BD, Carlson LE (2006) Emotional distress: the sixth vital sign—future directions in cancer care. Psychooncology 15:93–95CrossRefGoogle Scholar
  40. 40.
    Ozalp E, Cankurtaran ES, Soygür H, Geyik PO, Jacobsen PB (2007) Screening for psychological distress in Turkish cancer patients. Psychooncology 16:304–311CrossRefGoogle Scholar
  41. 41.
    Graves KD, Arnold SM, Love CL, Kirsh KL, Moore PG, Passik SD (2007) Distress screening in a multidisciplinary lung cancer clinic: prevalence and predictors of clinically significant distress. Lung Cancer 55:215–224CrossRefGoogle Scholar
  42. 42.
    Wilson KG, Chochinov HM, McPherson CJ, LeMay K, Allard P, Chary S, Gagnon PR, Macmillan K, De Luca M, O'Shea F, Kuhl D, Fainsinger RL (2007) Suffering with advanced cancer. J Clin Oncol 25:1691–1697CrossRefGoogle Scholar
  43. 43.
    Talley A, Molix L, Schlegel RJ, Bettencourt A (2010) The influence of breast cancer survivors' perceived partner social support and need satisfaction on depressive symptoms: a longitudinal analysis. Psychol Health 25:433–449CrossRefGoogle Scholar
  44. 44.
    Singer S, Krauss O, Keszte J, Siegl G, Papsdorf K, Severi E, Hauss J, Briest S, Dietz A, Brahler E, Kortmann RD (2011) Predictors of emotional distress in patients with head and neck cancer. Head Neck 34:180–187CrossRefGoogle Scholar
  45. 45.
    Vanderpol M (2002) Resilience: a missing link in our understanding of survival. Harv Rev Psychiatry 10:302–306CrossRefGoogle Scholar
  46. 46.
    Skrove M, Romundstad P, Indredavik MS (2013) Resilience, lifestyle and symptoms of anxiety and depression in adolescence: the Young-HUNT study. Soc Psychiatry Psychiatr Epidemiol 48:407–416CrossRefGoogle Scholar
  47. 47.
    Wingo AP, Wrenn G, Pelletier T, Gutman AR, Bradley B, Ressler KJ (2010) Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. J Affect Disord 126:411–414CrossRefGoogle Scholar
  48. 48.
    Catalano D, Chan F, Wilson L, Chiu CY, Muller VR (2011) The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol 56:200–211CrossRefGoogle Scholar
  49. 49.
    Southwick SM, Charney DS (2012) The science of resilience: implications for the prevention and treatment of depression. Science 338:79–82CrossRefGoogle Scholar
  50. 50.
    Richardson GE, Waite PJ (2002) Mental health promotion through resilience and resiliency education. Int J Emerg Ment Health 4:65–75PubMedGoogle Scholar
  51. 51.
    Waite PJ, Richardson GE (2004) Determining the efficacy of resiliency training in the work site. J Allied Health 33:178–183PubMedGoogle Scholar
  52. 52.
    Bradshaw BG, Richardson GE, Kumpfer K, Carlson J, Stanchfield J, Overall J, Brooks AM, Kulkarni K (2007) Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. Diabetes Educ 33:650–659CrossRefGoogle Scholar
  53. 53.
    Burton NW, Pakenham KI, Brown WJ (2010) Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program. Psychol Health Med 15:266–277CrossRefGoogle Scholar
  54. 54.
    Carver CS (2005) Enhancing adaptation during treatment and the role of individual differences. Cancer 104:2602–2607CrossRefGoogle Scholar
  55. 55.
    Abrahm JL (2011) Advances in palliative medicine and end-of-life care. Annu Rev Med 62:187–199CrossRefGoogle Scholar
  56. 56.
    Lloyd-Williams M, Shiels C, Taylor F, Dennis M (2009) Depression—an independent predictor of early death in patients with advanced cancer. J Affect Disord 113:127–132CrossRefGoogle Scholar
  57. 57.
    Cartledge Hoff A, Haaga DA (2005) Effects of an education program on radiation oncology patients and families. J Psychosoc Oncol 23:61–79CrossRefGoogle Scholar
  58. 58.
    Politi MC, Enright TM, Weihs KL (2007) The effects of age and emotional acceptance on distress among breast cancer patients. Support Care Cancer 15:73–79CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jung-Ah Min
    • 1
  • Sujung Yoon
    • 2
    • 3
  • Chang-Uk Lee
    • 1
  • Jeong-Ho Chae
    • 1
  • Chul Lee
    • 1
  • Kyo-Young Song
    • 4
  • Tae-Suk Kim
    • 1
    • 2
    Email author
  1. 1.Department of PsychiatrySeoul St. Mary’s Hospital, The Catholic University of Korea, College of MedicineSeoulSouth Korea
  2. 2.The Brain Institute and Department of PsychiatryUniversity of UtahSalt Lake CityUSA
  3. 3.Department of PsychiatrySt. Paul’s Hospital, The Catholic University of KoreaSeoulSouth Korea
  4. 4.Division of Gastrointestinal Surgery, Department of SurgerySeoul St. Mary’s Hospital, The Catholic University of KoreaSeoulSouth Korea

Personalised recommendations