Supportive Care in Cancer

, Volume 26, Issue 8, pp 2571–2579 | Cite as

Religious coping and death depression in Iranian patients with cancer: relationships to disease stage

  • Saeed Pahlevan Sharif
  • Rebecca H. Lehto
  • Hamid Sharif Nia
  • Amir Hossein Goudarzian
  • Ali Akbar Haghdoost
  • Ameneh Yaghoobzadeh
  • Bahram Tahmasbi
  • Roghieh Nazari
Original Article



The study investigated relationships among the extent of disease, religious coping, and death depression in Iranian patients with cancer.


A descriptive cross-sectional study was conducted with a convenience sample of 482 Iranian cancer patients. Participants completed demographic and health, death depression, and religious coping surveys.


After controlling for demographic and health characteristics, positive and negative religious coping behaviors were significantly related to the experience of death depression. There was an interaction effect between negative religious coping and extent of disease with significant positive relationships to the experience of death depression.


Negative religious coping was found to be more closely associated with death depression in patients with earlier stage disease than those with advanced stages of cancer in this sample of patients with cancer from Iran. Findings support assessing patients for use of religious coping strategies. Muslim patients who are religiously alienated and have existential anguish may be vulnerable and need heightened support following diagnosis and during treatment of early stage cancer.


Cancer Culture Death depression Religious coping Muslim 



The authors would also like to thank patients and officials of selected hospitals for their participation in this study.

Funding information

The research committee of Mazandaran University of medical sciences (Sari, Iran) financially supported this study.

Compliance with ethical standards

All study procedures were approved by the Ethics Committee (Ethical Code: IR.MAZUMS.REC.1396.10189) of Mazandaran University of Medical Sciences, Sari, Iran. Prior to obtaining written informed consent, patients were apprised relative to the study purpose, what the investigation entailed, and voluntary nature. The confidentiality of patients’ information was ensured with no identifiers used in any surveys and all data were collected in private locations.

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Gonen G, Kaymak SU, Cankurtaran ES, Karslioglu EH, Ozalp E, Soygur H (2012) The factors contributing to death anxiety in cancer patients. J Psychosoc Oncol 30(3):347–358. CrossRefPubMedGoogle Scholar
  2. 2.
    Sharif Nia H, Pahlevan Sharif S, Esmaeili R, Goudarzian AH, Tahmasbi B, Yaghoobzadeh A, Kaveh O (2017) Factors influencing the level of death depression in patients with cancer: a path analysis. J Mazandaran Univ Med Sci 26(145):318–331Google Scholar
  3. 3.
    Mashhadi MA, Shakiba M, Zakeri Z (2013) Evaluation of depression in patients with cancer in South of Iran (Zahedan). Iran J Cancer Prev 6(1):12–16PubMedPubMedCentralGoogle Scholar
  4. 4.
    Pasquini M, Biondi M (2007) Depression in cancer patients: a critical review. Clin Pract Epidemiol Ment Health 3(1):2–2. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ng GC, Mohamed S, Sulaiman AH, Zainal NZ (2017) Anxiety and depression in cancer patients: the association with religiosity and religious coping. J Relig Health 56(2):575–590. CrossRefPubMedGoogle Scholar
  6. 6.
    Lavery ME, O’Hea EL (2010) Religious/spiritual coping and adjustment in individuals with cancer: unanswered questions, important trends, and future directions. Ment Health Relig Cult 13(1):55–65. CrossRefGoogle Scholar
  7. 7.
    Braam AW, Schrier AC, Tuinebreijer WC, Beekman AT, Dekker JJ, de Wit MA (2010) Religious coping and depression in multicultural Amsterdam: a comparison between native Dutch citizens and Turkish, Moroccan and Surinamese/Antillean migrants. J Affect Disord 125(1–3):269–278. CrossRefPubMedGoogle Scholar
  8. 8.
    Rand KL, Cripe LD, Monahan PO, Tong Y, Schmidt K, Rawl SM (2012) Illness appraisal, religious coping, and psychological responses in men with advanced cancer. Support Care Cancer 20(8):1719–1728. CrossRefPubMedGoogle Scholar
  9. 9.
    Zamanian H, Eftekhar-Ardebili H, Eftekhar-Ardebili M, Shojaeizadeh D, Nedjat S, Taheri-Kharameh Z, Daryaafzoon M (2015) Religious coping and quality of life in women with breast cancer. Asian Pac J Cancer Prev: APJCP 16(17):7721–7725. CrossRefPubMedGoogle Scholar
  10. 10.
    Trevino KM, Balboni M, Zollfrank A, Balboni T, Prigerson HG (2014) Negative religious coping as a correlate of suicidal ideation in patients with advanced cancer. Psycho-Oncology 23(8):936–945. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Templer DI, Lavoie M, Chalgujian H, Thomas-Dobson S (1990) The measurement of death depression. J Clin Psychol 46(6):834–839.<834::AID-JCLP2270460623>3.0.CO;2-0 CrossRefPubMedGoogle Scholar
  12. 12.
    Baetz M, Toews J (2009) Clinical implications of research on religion, spirituality, and mental health. Can J Psychiatr 54(5):292–301. CrossRefGoogle Scholar
  13. 13.
    Peteet JR, Balboni MJ (2013) Spirituality and religion in oncology. CA Cancer J Clin 63(4):280–289. CrossRefPubMedGoogle Scholar
  14. 14.
    Crane JN (2009) Religion and cancer: examining the possible connections. J Psychosoc Oncol 27(4):469–486. CrossRefPubMedGoogle Scholar
  15. 15.
    Thune-Boyle IC, Stygall J, Keshtgar MR, Davidson TI, Newman SP (2013) Religious/spiritual coping resources and their relationship with adjustment in patients newly diagnosed with breast cancer in the UK. Psycho-Oncology 22(3):646–658. CrossRefPubMedGoogle Scholar
  16. 16.
    Saarelainen S-M (2017) Emerging Finnish adults coping with cancer: religious, spiritual, and secular meanings of the experience. Pastoral Psychol 66(2):251–268. CrossRefGoogle Scholar
  17. 17.
    Hill PC, Pargament KI (2003) Advances in the conceptualization and measurement of religion and spirituality: implications for physical and mental health research. Am Psychol 58(1):64–74. CrossRefPubMedGoogle Scholar
  18. 18.
    Lee M, Nezu AM, Nezu CM (2014) Positive and negative religious coping, depressive symptoms, and quality of life in people with HIV. J Behav Med 37(5):921–930. CrossRefPubMedGoogle Scholar
  19. 19.
    Vallurupalli MM, Lauderdale MK, Balboni MJ, Phelps AC, Block SD, Ng AK, Kachnic LA, VanderWeele TJ, Balboni TA (2012) The role of spirituality and religious coping in the quality of life of patients with advanced cancer receiving palliative radiation therapy. J Support Oncol 10(2):81–87. CrossRefPubMedGoogle Scholar
  20. 20.
    Perez JE, Rex Smith A (2015) Intrinsic religiousness and well-being among cancer patients: the mediating role of control-related religious coping and self-efficacy for coping with cancer. J Behav Med 38(2):183–193. CrossRefPubMedGoogle Scholar
  21. 21.
    Hebert R, Zdaniuk B, Schulz R, Scheier M (2009) Positive and negative religious coping and well-being in women with breast cancer. J Palliat Med 12(6):537–545. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Pargament KI, Koenig HG, Perez LM (2000) The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol 56(4):519–543.<519::AID-JCLP6>3.0.CO;2-1 CrossRefPubMedGoogle Scholar
  23. 23.
    Gaston-Johansson F, Haisfield-Wolfe ME, Reddick B, Goldstein N, Lawal TA (2013) The relationships among coping strategies, religious coping, and spirituality in African American women with breast cancer receiving chemotherapy. Oncol Nurs Forum 40(2):120–131. CrossRefPubMedGoogle Scholar
  24. 24.
    Pargament KI, Tarakeshwar N, Ellison CG, Wulff KM (2001) Religious coping among the religious: the relationships between religious coping and well-being in a National Sample of Presbyterian Clergy, Elders, and Members. J Sci Study Relig 40(3):497–513. CrossRefGoogle Scholar
  25. 25.
    Neimeyer RA, Currier JM, Coleman R, Tomer A, Samuel E (2011) Confronting suffering and death at the end of life: the impact of religiosity, psychosocial factors, and life regret among hospice patients. Death studies 35(9):777–800. CrossRefPubMedGoogle Scholar
  26. 26.
    Biegler K, Cohen L, Scott S, Hitzhusen K, Parker P, Gilts CD, Canada A, Pisters L (2012) The role of religion and spirituality in psychological distress prior to surgery for urologic cancer. Integr Cancer Ther 11(3):212–220. CrossRefPubMedGoogle Scholar
  27. 27.
    Paiva CE, Paiva BS, de Castro RA, Souza Cde P, de Paiva Maia YC, Ayres JA, Michelin OC (2013) A pilot study addressing the impact of religious practice on quality of life of breast cancer patients during chemotherapy. J Relig Health 52(1):184–193. CrossRefPubMedGoogle Scholar
  28. 28.
    Pahlevan Sharif S, Khanekharab J (2017) External locus of control and quality of life among Malaysian breast cancer patients: the mediating role of coping strategies. J Psychosoc Oncol 35(6):1–20. CrossRefGoogle Scholar
  29. 29.
    Barber N (2011) A cross-national test of the uncertainty hypothesis of religious belief. Cross Cult Res 45(3):318–333. CrossRefGoogle Scholar
  30. 30.
    Abernethy AD, Chang HT, Seidlitz L, Evinger JS, Duberstein PR (2002) Religious coping and depression among spouses of people with lung cancer. Psychosomatics 43(6):456–463. CrossRefPubMedGoogle Scholar
  31. 31.
    Sharif Nia H, Pahlevan Sharif S, Lehto RH, Boyle C, Yaghoobzadeh A, Kaveh O, Goudarzian AH (2017) Development and psychometric evaluation of a Persian version of the death depression scale-revised: a cross-cultural adaptation for patients with advanced cancer. Jpn J Clin Oncol 47(8):1–7. CrossRefGoogle Scholar
  32. 32.
    Templer DI, Harville M, Hutton S, Underwood R, Tomeo M, Russell M, Mitroff D, Arikawa H (2002) Death depression scale-revised. Omega 44(2):105–112. CrossRefGoogle Scholar
  33. 33.
    Sharif Nia H, Pahlevan Sharif S, Goudarzian AH, Allen KA, Jamali S, Heydari Gorji MA (2017) The relationship between religious coping and self-care behaviors in Iranian medical students. J Relig Health 56(6):2109–2117. CrossRefPubMedGoogle Scholar
  34. 34.
    Nesami MB, Goudarzian AH, Zarei H, Esameili P, Pour MD, Mirani H (2015) The relationship between emotional intelligence with religious coping and general health of students. Mater Sociomed 27(6):412–416. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Sherman AC, Plante TG, Simonton S, Latif U, Anaissie EJ (2009) Prospective study of religious coping among patients undergoing autologous stem cell transplantation. J Behav Med 32(1):118–128. CrossRefPubMedGoogle Scholar
  36. 36.
    Pahlevan Sharif S, Mahdavian V (2015) Structural equation modeling by the use of AMOS. Fazel, TehranGoogle Scholar
  37. 37.
    Fornell C, Larcker DF (1981) Evaluating structural equation models with unobservable variables and measurement error. J Mark Res 18(1):39–50. CrossRefGoogle Scholar
  38. 38.
    Hayes AF (2013) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach, 1st edn. Guilford Press, New YorkGoogle Scholar
  39. 39.
    Malhotra NK, Dash S (2011) Marketing research an applied orientation (paperback). Pearson Publishing, LondonGoogle Scholar
  40. 40.
    Babapour J, Sh Z, Zarezade F, Nejati B (2016) The structural association of religious attitude and soping style with quality of life and fatigue in cancer patients. J Health Care 18(1):45–54Google Scholar
  41. 41.
    D’Souza CA, Antony S, Thomas B, Murthy SG (2016) Coping strategies used by cancer patients to deal with physical and psychological problems of chemotherapy. Int J Innov Res Dev 5(3):36–41Google Scholar
  42. 42.
    Bloomer MJ, Al-Mutair A (2013) Ensuring cultural sensitivity for Muslim patients in the Australian ICU: considerations for care. Aust Crit Care 26(4):193–196. CrossRefPubMedGoogle Scholar
  43. 43.
    Kaliampos A, Roussi P (2015) Religious beliefs, coping, and psychological well-being among Greek cancer patients. J Health Psychol 22(6):754–764. CrossRefPubMedGoogle Scholar
  44. 44.
    Murata H (2003) Spiritual pain and its care in patients with terminal cancer: construction of a conceptual framework by philosophical approach. Palliat Support Care 1(1):15–21. CrossRefPubMedGoogle Scholar
  45. 45.
    Balboni TA, Paulk ME, Balboni MJ, Phelps AC, Loggers ET, Wright AA, Block SD, Lewis EF, Peteet JR, Prigerson HG (2009) Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol 28(3):445–452. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Saeed Pahlevan Sharif
    • 1
  • Rebecca H. Lehto
    • 2
  • Hamid Sharif Nia
    • 3
  • Amir Hossein Goudarzian
    • 4
  • Ali Akbar Haghdoost
    • 5
  • Ameneh Yaghoobzadeh
    • 6
  • Bahram Tahmasbi
    • 3
  • Roghieh Nazari
    • 3
  1. 1.Taylor’s Business SchoolTaylor’s University MalaysiaSubang JayaMalaysia
  2. 2.College of NursingMichigan State UniversityEast LansingUSA
  3. 3.School of Nursing and Midwifery AmolMazandaran University of Medical SciencesSariIran
  4. 4.Student Research CommitteeMazandaran University of Medical SciencesSariIran
  5. 5.Modeling in Health Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  6. 6.School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran

Personalised recommendations