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Cognitive appraisal and depression in cancer patients undergoing chemotherapy: mediation by perceived stress and self-efficacy

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Abstract

Purpose

Cancer patients undergoing chemotherapy are prone to suffering a higher incidence rate of depression, leading to poor quality of life. However, how cancer affects depression is unclear. This study aimed to examine whether the relationship between cognitive appraisal and depression is mediated by perceived stress and self-efficacy in cancer patients undergoing chemotherapy.

Methods

A total of 421 cancer patients undergoing chemotherapy participated in this cross-sectional survey. Cognitive appraisal of cancer, perceived stress, self-efficacy, and depression were measured with the Perceived Life Threat Scale, Perceived Stress Scale, General Self-efficacy Scale and Hospital Anxiety, and Depression Scale-Depression Scale, respectively. Path analysis was performed to analyze the mediating effects of perceived stress and self-efficacy on the relationship between cognitive appraisal of cancer and depression.

Results

Cognitive appraisal of cancer exerted direct (b = 0.066, SE = 0.020, p < 0.001, bias-corrected 95% CI = [0.027, 0.106]) and indirect (mediated by depression and insomnia) (b = 0.136, SE = 0.015, p < 0.001, bias-corrected 95% CI = [0.107, 0.167]) effects on depression. Perceived stress and self-efficacy were significant in mediating the relationship between cognitive appraisal of cancer and depression (b = 0.101, SE = 0.014, p < 0.001, bias-corrected 95% CI = [0.074, 0.132]; b = 0.021, SE = 0.006, p < 0.001, bias-corrected 95% CI = [0.006, 0.028], respectively). Additionally, a sequential mediating effect of perceived stress via self-efficacy was found, and the mediating effect size was 0.014 (p < 0.01, bias-corrected 95% CI = [0.010,0.034]).

Conclusions

This study suggests that medical staff could prevent or relieve depression through improving self-efficacy or reducing perceived stress in cancer patients undergoing chemotherapy.

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Data Availability

The data are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the patients for participating in our study, and we thank Mr. Shaowei Lin for his assistance with data analysis.

Funding

This work was supported by the National Natural Science Fund of China [Grant Number: 81401863] and the Fujian Science and Technology Innovation Joint Fund [Grant Number: 2017Y9107].

Author information

Author notes

  1. Ying Liu and Shuang-Shuang Wen contributed equally to this work.

Authors and Affiliations

  1. School of Nursing, Fujian Medical University, Fuzhou, China

    Ying Liu, Shuang-Shuang Wen, Ying Chen & Hui-Min Xiao

  2. Internal Medicine-Oncology Department, Fujian Medical University Union Hospital, Fuzhou, China

    Jian-Wei Zheng

  3. Research Center for Nursing Humanity, Fujian Medical University, Fuzhou, China

    Hui-Min Xiao

Authors
  1. Ying Liu
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  2. Shuang-Shuang Wen
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Contributions

Ying Liu and Shuangshuang Wen was responsible for the acquisition of data and manuscript drafting, and they contributed equally to this manuscript. Huimin Xiao was responsible for conception and design of the study, critical revision of the manuscript, and supervision. Jianwei Zheng was responsible for recruiting participants, data analysis, and supervision. Huimin Xiao and Jianwei Zheng contributed equally to this manuscript. Ying Chen was responsible for analysis and interpretation of data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hui-Min Xiao.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Fujian Medical University Review Board ([2014] No.114). Consent has been received from all participants in this study. During the research, all members strictly adhered to the principle of bioethics proposed by Beauchamp and Childress, including independent principle, confidentiality principle, and inoffensive principle.

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These data have not been presented or published elsewhere.

Competing interests

The authors declare no competing interests.

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Liu, Y., Wen, SS., Chen, Y. et al. Cognitive appraisal and depression in cancer patients undergoing chemotherapy: mediation by perceived stress and self-efficacy. Support Care Cancer 31, 614 (2023). https://doi.org/10.1007/s00520-023-08075-w

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