Abstract
Purpose
Depression and anxiety are common mental health comorbidities found among women living with breast cancer. The presence of these mental health comorbidities results in decreased quality of life among patients. However, the indirect effects of depression and anxiety on quality of life have not been fully established. This study therefore examined the direct and indirect effects of depression and anxiety on quality of life through social support and religiosity.
Methods
Using a cross-sectional survey, 205 purposively selected participants were administered measures of depression and anxiety, social support, religiosity and quality of life. The statistical package for the social sciences (SPSS) with PROCESS Macro was used for mediation analyses.
Results
Findings showed that there were significant direct negative effects of depression and anxiety on quality of life. Whereas depression had a significant negative indirect effect on quality of life through social support (b = − 0.247, 95% CI = − 0.482 to − 0.071), anxiety had a significant positive indirect effect on quality of life through social support (b = 0.142, 95%CI = 0.011 to 0.324). However, depression and anxiety did not have any significant indirect effect on quality of life through religiosity.
Conclusion
These findings suggest that there is the need to examine the mental health of women living with breast cancer as part of the routine healthcare, and social support ties should be strengthened to improve their quality of life.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00520-019-05027-1/MediaObjects/520_2019_5027_Fig1_HTML.png)
Similar content being viewed by others
References
Stewart BW, Wild C (2014) World cancer report 2014. international agency for research on cancer. World Health Organization, 505
Brunault P, Champagne AL, Huguet G, Suzanne I, Senon JL, Body G, Rusch E, Magnin G, Voyer M, Réveillère C (2016) Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients. Psycho-Oncology 25(5):513–520
Gold M, Dunn LB, Phoenix B, Paul SM, Hamolsky D, Levine JD, Miaskowski C (2016) Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life. Eur J Oncol Nurs 20:97–105
Association AP (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub
Fatiregun OA, Olagunju AT, Erinfolami AR, Fatiregun OA, Arogunmati OA, Adeyemi JD (2016) Anxiety disorders in breast cancer: prevalence, types, and determinants. J Psychosoc Oncol 34(5):432–447
Reece JC, Chan YF, Herbert J, Gralow J, Fann JR (2013) Course of depression, mental health service utilization and treatment preferences in women receiving chemotherapy for breast cancer. Gen Hosp Psychiatry 35(4):376–381
Kagee A, Roomaney R, Knoll N (2018) Psychosocial predictors of distress and depression among South African breast cancer patients. Psycho-Oncology 27(3):908–914
Reyes-Gibby CC, Anderson KO, Morrow PK, Shete S, Hassan S (2012) Depressive symptoms and health-related quality of life in breast cancer survivors. J Women's Health 21(3):311–318
So WK, Marsh G, Ling W, Leung F, Lo JC, Yeung M, Li GK (2010) Anxiety, depression and quality of life among Chinese breast cancer patients during adjuvant therapy. Eur J Oncol Nurs 14(1):17–22
Cohen S, Wills TA (1985) Stress, social support, and the buffering hypothesis. Psychol Bull 98(2):310–357
Haugland T, Wahl AK, Hofoss D, DeVon HA (2016) Association between general self-efficacy, social support, cancer-related stress and physical health-related quality of life: a path model study in patients with neuroendocrine tumors. Health Qual Life Outcomes 14(1):11
Michael YL, Berkman LF, Colditz GA, Holmes MD, Kawachi I (2002) Social networks and health-related quality of life in breast cancer survivors: a prospective study. J Psychosom Res 52(5):285–293
Gesselman AN, Bigatti SM, Garcia JR, Coe K, Cella D, Champion VL (2017) Spirituality, emotional distress, and post-traumatic growth in breast cancer survivors and their partners: an actor–partner interdependence modeling approach. Psycho-oncology 26(10):1691–1699
Wilson C, Forchheimer M, Heinemann A, Warren A, McCullumsmith C (2017) Assessment of the relationship of spiritual well-being to depression and quality of life for persons with spinal cord injury. Disabil Rehabil 39(5):491–496
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 16(17):7721–7725
Jang JE, Kim SW, Kim SY, Kim JM, Park MH, Yoon JH, Shin HY, Kang HJ, Bae KY, Shin IS (2013) Religiosity, depression, and quality of life in Korean patients with breast cancer: a 1-year prospective longitudinal study. Psycho-Oncology 22(4):922–929
McLaughlin B, Yoo W, D'angelo J, Tsang S, Shaw B, Shah D, Baker T, Gustafson D (2013) It is out of my hands: how deferring control to God can decrease quality of life for breast cancer patients. Psycho-Oncology 22(12):2747–2754
Zhang H, Zhao Q, Cao P, Ren G (2017) Resilience and quality of life: exploring the mediator role of social support in patients with breast cancer. Med Sci Monit 23:5969–5979
Manning-Walsh J (2005) Social support as a mediator between symptom distress and quality of life in women with breast cancer. J Obstet Gynecol Neonatal Nurs 34(4):482–493
Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15(3):974–986
Kugbey N, Meyer-Weitz A, Oppong Asante K (2018) Mental adjustment to cancer and quality of life among women living with breast cancer in Ghana. Int J Psychiatry Med 0091217418805087
Kugbey N, Oppong Asante K, Meyer-Weitz A (2018) Doctor–patient relationship mediates the effects of shared decision making on health-related quality of life among women living with breast cancer. S Afr J Psychol 0081246318801159
Zimet GD, Dahlem NW, Zimet SG, Farley GK (1988) The multidimensional scale of perceived social support. J Pers Assess 52(1):30–41
Oppong Asante K (2015) The health and wellbeing of homeless youth in Ghana. Durban, South Africa: PhD thesis, University of KwaZulu-Natal
Plante TG, Boccaccini MT (1997) The Santa Clara strength of religious faith questionnaire. Pastor Psychol 45(5):375–387
Zigmond A, Snaith R (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370
West SG, Finch JF, Curran PJ (1995) Structural equation models with nonnormal variables: problems and remedies
Hayes AF (2017) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford Publications
Ng GC, Mohamed S, See MH, Harun F, Dahlui M, Sulaiman AH, Zainal NZ, Taib NA (2015) Anxiety, depression, perceived social support and quality of life in Malaysian breast cancer patients: a 1-year prospective study. Health Qual Life Outcomes 13(1):205
Lim J-w, Zebrack B (2008) Different pathways in social support and quality of life between Korean American and Korean breast and gynecological cancer survivors. Qual Life Res 17(5):679–689
Matthews EE, Cook PF (2009) Relationships among optimism, well-being, self-transcendence, coping, and social support in women during treatment for breast cancer. Psycho-Oncology 18(7):716–726
Sammarco A, Konecny L (2008) Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncol Nurs Forum 2008:844–849
Vallurupalli M, Lauderdale K, 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 2(10):81–87
Drageset S, Lindstrøm T (2003) The mental health of women with suspected breast cancer: the relationship between social support, anxiety, coping and defence in maintaining mental health. J Psychiatr Ment Health Nurs 10(4):401–409
Rao D, Chen W, Pearson C, Simoni J, Fredriksen-Goldsen K, Nelson K, Zhao H, Zhang F (2012) Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China. Int J STD AIDS 23(7):481–484
Meisenhelder JB, Schaeffer NJ, Younger J, Lauria M (2013) Faith and mental health in an oncology population. J Relig Health 2(52):505–513
Simms L, Grös D, Watson D, O'Hara M (2008) Parsing the general and specific components of depression and anxiety with bifactor modeling. Depress Anxiety 25(7):E34–E46
Xie J, Bi Q, Shang W, Yan M, Yang Y, Miao D, Zhang H (2012) Positive and negative relationship between anxiety and depression of patients in pain: a bifactor model analysis. PLoS One 7(10):e47577
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval for this study was obtained from the Humanities and Social Sciences Ethical Committee of the University of KwaZulu-Natal, South Africa, and clearance was also obtained from the Institutional Review Board of the Teaching Hospital in Ghana.
Conflict of interest
The authors declare that they have no conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kugbey, N., Oppong Asante, K. & Meyer-Weitz, A. Depression, anxiety and quality of life among women living with breast cancer in Ghana: mediating roles of social support and religiosity. Support Care Cancer 28, 2581–2588 (2020). https://doi.org/10.1007/s00520-019-05027-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-019-05027-1