Abstract
Objectives
An adaptive role of self-compassion for psychological functioning in cancer patients has been highlighted, yet less is known about the underlying mechanisms. This study aimed to examine the mediating role of cancer patients’ illness perceptions in the relations between self-compassion and psychological symptoms.
Methods
This cross-sectional study focused on 301 people with heterogeneous types of cancer. A self-reported questionnaire was used to collect participants’ levels of self-compassion, illness perceptions, and symptoms of depression and anxiety. Parallel mediation analyses were performed to examine the research questions.
Results
The relation between self-compassion and depressive symptoms was mediated by perceived consequences and a timeline cyclical of cancer. Perceived consequences also mediated the relation between self-compassion and symptoms of anxiety, with an additional mediating role of personal control.
Conclusions
These findings suggest that both self-compassion and illness perceptions were closely linked with cancer patients’ psychological symptoms. Particularly, cancer patients who feel more self-compassionate perceive fewer negative consequences of cancer, a less timeline cyclical, and more personal control over their life and report fewer psychological symptoms.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arambasic, J., Sherman, K. A., & Elder, E. (2019). Attachment styles, self-compassion, and psychological adjustment in long-term breast cancer survivors. Psycho-Oncology, 28(5), 1134–1141. https://doi.org/10.1002/pon.5068.
Arimitsu, K., & Hofmann, S. G. (2015). Cognitions as mediators in the relationship between self-compassion and affect. Personality and Individual Differences, 74, 41–48. https://doi.org/10.1016/j.paid.2014.10.008.
Brenner, R. E., Heath, P. J., Vogel, D. L., & Credé, M. (2017). Two is more valid than one: examining the factor structure of the Self-Compassion Scale (SCS). Journal of Counseling Psychology, 64(6), 696–707. https://doi.org/10.1037/cou0000211.
Brown, S. L., Hughes, M., Campbell, S., & Cherry, M. G. (2020). Could worry and rumination mediate relationships between self-compassion and psychological distress in breast cancer survivors? Clinical Psychology & Psychotherapy, 27(1), 1–10. https://doi.org/10.1002/cpp.2399.
Cabassa, L. J., Lagomasino, I. T., Dwight-Johnson, M., Hansen, M. C., & Xie, B. (2008). Measuring Latinos’ perceptions of depression: a confirmatory factor analysis of the illness perception questionnaire. Cultural Diversity and Ethnic Minority Psychology, 14(4), 377–384. https://doi.org/10.1037/a0012820.
Chen, S.-L., Tsai, J.-C., & Lee, W.-L. (2008). Psychometric validation of the Chinese version of the illness perception questionnaire-revised for patients with hypertension. Journal of Advanced Nursing, 64(5), 524–534. https://doi.org/10.1111/j.1365-2648.2008.04808.x.
Chen, W., Zheng, R., Baade, P. D., Zhang, S., Zeng, H., Bray, F., Jemal, A., Yu, X. Q., & He, J. (2016). Cancer statistics in China, 2015. CA: a Cancer Journal for Clinicians, 66(2), 115–132. https://doi.org/10.3322/caac.21338.
Dempster, M., Howell, D., & McCorry, N. K. (2015). Illness perceptions and coping in physical health conditions: a meta-analysis. Journal of Psychosomatic Research, 79(6), 506–513. https://doi.org/10.1016/j.jpsychores.2015.10.006.
Diedrich, A., Burger, J., Kirchner, M., & Berking, M. (2017). Adaptive emotion regulation mediates the relationship between self-compassion and depression in individuals with unipolar depression. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 247–263. https://doi.org/10.1111/papt.12107.
Diefenbach, M. A., & Leventhal, H. (1996). The common-sense model of illness representation: theoretical and practical considerations. Journal of Social Distress and Homeless, 5(1), 11–38. https://doi.org/10.1007/BF02090456.
Finlay-Jones, A. L., Rees, C. S., & Kane, R. T. (2015). Self-compassion, emotion regulation and stress among Australian psychologists: testing an emotion regulation model of self-compassion using structural equation modeling. PLoS One, 10(7), e0133481. https://doi.org/10.1371/journal.pone.0133481.
Gillanders, D. T., Sinclair, A. K., MacLean, M., & Jardine, K. (2015). Illness cognitions, cognitive fusion, avoidance and self-compassion as predictors of distress and quality of life in a heterogeneous sample of adults, after cancer. Journal of Contextual Behavioral Science, 4(4), 300–311. https://doi.org/10.1016/j.jcbs.2015.07.003.
Hale, E. D., Treharne, G. J., & Kitas, G. D. (2007). The common-sense model of self-regulation of health and illness: how can we use it to understand and respond to our patients’ needs? Rheumatology, 46(6), 904–906. https://doi.org/10.1093/rheumatology/kem060.
Hayes, A. F. (2009). Beyond baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. https://doi.org/10.1080/03637750903310360.
Hinz, A., Mehnert, A., Kocalevent, R.-D., Brähler, E., Forkmann, T., Singer, S., & Schulte, T. (2016). Assessment of depression severity with the PHQ-9 in cancer patients and in the general population. BMC Psychiatry, 16(1), 22. https://doi.org/10.1186/s12888-016-0728-6.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118.
Huang, W., Zhang, L., & Yan, J. (2019). Psychometric evaluation of the Chinese version of the revised illness perception questionnaire for breast cancer-related lymphedema. European Journal of Cancer Care, 28(1), e12900. https://doi.org/10.1111/ecc.12900.
Kenny, D. A., Kaniskan, B., & McCoach, D. B. (2015). The performance of RMSEA in models with small degrees of freedom. Sociological Methods & Research, 44(3), 486–507. https://doi.org/10.1177/0049124114543236.
Krieger, T., Altenstein, D., Baettig, I., Doerig, N., & Holtforth, M. G. (2013). Self-compassion in depression: associations with depressive symptoms, rumination, and avoidance in depressed outpatients. Behavior Therapy, 44(3), 501–513. https://doi.org/10.1016/j.beth.2013.04.004.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9 validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
Lennon, J., Hevey, D., & Kinsella, L. (2018). Gender role conflict, emotional approach coping, self-compassion, and distress in prostate cancer patients: a model of direct and moderating effects. Psycho-Oncology, 27(8), 2009–2015. https://doi.org/10.1002/pon.4762.
Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A., Patrick-Miller, L., & Robitaille, C. (1997). Illness representations: theoretical foundations. In K. J. Petrie & J. A. Weinman (Eds.), Perceptions of health and illness: Current research and applications (pp. 19–45). Harwood Academic Publishers.
Leventhal, H., Brissette, I., & Leventhal, E. A. (2003). The common-sense model of self-regulation of health and illness. In L. D. Cameron & H. Leventhal (Eds.), The Self-regulation of Health and Illness Behavior (pp. 42–65). Routledge.
Leventhal, H., Diefenbach, M., & Leventhal, E. A. (1992). Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16(2), 143–163. https://doi.org/10.1007/BF01173486.
López, A., Sanderman, R., Smink, A., Zhang, Y., van Sonderen, E., Ranchor, A., & Schroevers, M. J. (2015). A reconsideration of the self-compassion scale’s total score: self-compassion versus self-criticism. PLoS One, 10(7), e0132940. https://doi.org/10.1371/journal.pone.0132940.
Lu, Y., Tang, C., Liow, C. S., Ng, W. W. N., Ho, C. S. H., & Ho, R. C. M. (2014). A regressional analysis of maladaptive rumination, illness perception and negative emotional outcomes in Asian patients suffering from depressive disorder. Asian Journal of Psychiatry, 12, 69–76. https://doi.org/10.1016/j.ajp.2014.06.014.
MacBeth, A., & Gumley, A. (2012). Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. https://doi.org/10.1016/j.cpr.2012.06.003.
Marteau, T. M., & Bekker, H. (1992). The development of a six-item short-form of the state scale of the Spielberger State—Trait Anxiety Inventory (STAI). British Journal of Clinical Psychology, 31(3), 301–306. https://doi.org/10.1111/j.2044-8260.1992.tb00997.x.
Mausbach, B. T., Schwab, R. B., & Irwin, S. A. (2015). Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Research and Treatment, 152(2), 239–246. https://doi.org/10.1007/s10549-015-3471-7.
Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44. https://doi.org/10.1037/1082-989X.12.1.23.
Meng, R., Yu, Y., Chai, S., Luo, X., Gong, B., Liu, B., Hu, Y., Luo, Y., & Yu, C. (2019). Examining psychometric properties and measurement invariance of a Chinese version of the Self-Compassion Scale – Short Form (SCS-SF) in nursing students and medical workers. Psychology Research and Behavior Management, 12, 793–809. https://doi.org/10.2147/PRBM.S216411.
Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. The Lancet Oncology, 12(2), 160–174. https://doi.org/10.1016/S1470-2045(11)70002-X.
Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., & Buick, D. (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17(1), 1–16. https://doi.org/10.1080/08870440290001494.
Muris, P., & Petrocchi, N. (2017). Protection or vulnerability? A meta-analysis of the relations between the positive and negative components of self-compassion and psychopathology. Clinical Psychology & Psychotherapy, 24(2), 373–383. https://doi.org/10.1002/cpp.2005.
Muris, P., van den Broek, M., Otgaar, H., Oudenhoven, I., & Lennartz, J. (2018). Good and bad sides of self-compassion: a face validity check of the self-compassion scale and an investigation of its relations to coping and emotional symptoms in non-clinical adolescents. Journal of Child and Family Studies, 27(8), 2411–2421. https://doi.org/10.1007/s10826-018-1099-z.
Neff, K. D. (2003a). Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032.
Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027.
Neff, K. D., & McGehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9(3), 225–240. https://doi.org/10.1080/15298860902979307.
Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93–115. https://doi.org/10.1037/a0022658.
Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48(6), 757–761. https://doi.org/10.1016/j.paid.2010.01.023.
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702.
Reich, M., Lesur, A., & Perdrizet-Chevallier, C. (2008). Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Research and Treatment, 110(1), 9–17. https://doi.org/10.1007/s10549-007-9706-5.
Richardson, E. M., Schüz, N., Sanderson, K., Scott, J. L., & Schüz, B. (2017). Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis. Psycho-Oncology, 26(6), 724–737. https://doi.org/10.1002/pon.4213.
Shek, D. T. L. (1993). The Chinese version of the state-trait anxiety inventory: its relationship to different measures of psychological well-being. Journal of Clinical Psychology, 49(3), 349–358. https://doi.org/10.1002/1097-4679(199305)49:3<349::AID-JCLP2270490308>3.0.CO;2-J.
Svendsen, J. L., Osnes, B., Binder, P.-E., Dundas, I., Visted, E., Nordby, H., Schanche, E., & Sørensen, L. (2016). Trait self-compassion reflects emotional flexibility through an association with high vagally mediated heart rate variability. Mindfulness, 7(5), 1103–1113. https://doi.org/10.1007/s12671-016-0549-1.
Tang, L., Li, Z., & Pang, Y. (2020). The differences and the relationship between demoralization and depression in Chinese cancer patients. Psycho-Oncology, 29(3), 532–538. https://doi.org/10.1002/pon.5296.
Wang, W., Bian, Q., Zhao, Y., Li, X., Wang, W., Du, J., Zhang, G., Zhou, Q., & Zhao, M. (2014). Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. General Hospital Psychiatry, 36(5), 539–544. https://doi.org/10.1016/j.genhosppsych.2014.05.021.
Wu, X., Lau, J. T. F., Mak, W. W. S., Gu, J., Mo, P. K. H., & Wang, X. (2018). How newly diagnosed HIV-positive men who have sex with men look at HIV/AIDS – validation of the Chinese version of the revised illness perception questionnaire. BMC Infectious Diseases, 18(1), 2. https://doi.org/10.1186/s12879-017-2902-y.
Zhu, L., Ranchor, A. V., van der Lee, M., Garssen, B., Almansa, J., Sanderman, R., & Schroevers, M. J. (2017). Co-morbidity of depression, anxiety and fatigue in cancer patients receiving psychological care. Psycho-Oncology, 26(4), 444–451. https://doi.org/10.1002/pon.4153.
Zhu, L., Yao, J., Wang, J., Wu, L., Gao, Y., Xie, J., Liu, A., Ranchor, A. V., & Schroevers, M. J. (2019). The predictive role of self-compassion in cancer patients’ symptoms of depression, anxiety, and fatigue: a longitudinal study. Psycho-Oncology, 28(9), 1918–1925. https://doi.org/10.1002/pon.5174.
Acknowledgments
The authors would like to thank all the research nurses for their assistance in data collection and all cancer patients for their participation.
Funding
The present study was financially supported by the Project of Humanities and Social Sciences (20YJA190013) and Fundamental Research Funds for the Central Universities (GK201903108).
Author information
Authors and Affiliations
Contributions
LZ designed and executed the study and wrote the paper. JW analyzed the data and wrote the paper. SYL, HYX, and YQH collaborated with the study execution and data collection. JTY, AVR, MJS, and JF collaborated in the study design and editing of the final manuscript. All authors approved the final version of this manuscript.
Corresponding authors
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures were approved by the ethics committee at the Shaanxi Provincial Tumour Hospital and were in accordance with the 1964 Helsinki Declaration and its later amendments.
Informed Consent
Written informed consent was obtained from all cancer patients included in the study.
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
Zhu, L., Wang, J., Liu, S. et al. Self-Compassion and Symptoms of Depression and Anxiety in Chinese Cancer Patients: the Mediating Role of Illness Perceptions. Mindfulness 11, 2386–2396 (2020). https://doi.org/10.1007/s12671-020-01455-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-020-01455-x