Relationship Between Resilience, Social Support, Existential Well-Being and Negative Emotions in Cervical Cancer Patients: a Mediation Analysis

Abstract

Background: The patients of cervical cancer have more negative emotions and lower quality of life. The aim of this study was to explore the relationships between existential well-being (EWB), social support, resilience, negative emotions in patients with cervical cancer, and to examine whether resilience mediates the associations between EWB or social support and negative emotions. Material and methods: This study enrolled patients with cervical cancer who were treated at the Tianjin Medical University Cancer Institute and Hospital in China during 2012-2019. The Hospital Anxiety and Depression Scale (HADS), the Resilience Scale of 14 items (RS-14) and the McGill Quality of Life Questionnaire (MQOL) were utilized to assess patient's anxiety, depression, resilience, social support and EWB via telephone. Spearman's correlation analyses were used to assess bivariate correlations, and mediation analyses were applied to examine whether resilience mediated the relationship between social support or EWB and negative emotions. Results: A total of 150 (92.0%) out of 163 eligible patients completed the questionnaires. EWB and social support were negatively correlated with anxiety (r=-0.560 and r=-0.561) and depression (r=-0.508 and r=-0.526), and positively correlated with resilience (r=0.691 and r=0.652). Resilience was negatively associated with anxiety (r=-0.545) and depression (r=-0.505). Negative direct effects of social support on anxiety and EWB on anxiety and depression were statistically significant (P<0.05). Resilience played a partial mediating role in the relationship between EWB and depression (β=-0.085, 95%CI: -0.150 to -0.020), accounting for 37.12% of the total effect. It also served as a partial mediator in the association between EWB and anxiety (β=-0.061, 95%CI: -0.107 to -0.015), explaining 34.46% of the overall effect. Additionally, resilience partially mediated the connection between social support and depression (β=-0.173, 95%CI: -0.312 to -0.053), explicating 57.48% of the total effect. Conclusions: A combination of existential, supportive and resilient interventions may help reduce psychological distress and improve quality of life among cervical cancer patients, thereby promoting both physical and psychological health.

Keywords: cervical cancer; existential well-being; mediation analysis; negative emotions; resilience; social support.

Figure 1

Mediating effects ^a of resilience on the relationship between social support or existential well-being and depression (N=150). ^a Both Model 1 [Y ~ X + ... (adjusted variables) ] and Model 2 [Y ~ M + X + ... (adjusted variables) ] were utilized for the analysis of indirect effects, with Y indicating depression, X indicating social support or existential well-being, M indicating resilience and adjusted variables including age, living place, education level, family income, physical activity and family relationships. ^*P<0.05, ^**P<0.001.

Figure 2

Mediating effects ^a of resilience on the relationship between social support or existential well-being and anxiety (N=150). ^a Both Model 1 [Y ~ X + ... (adjusted variables) ] and Model 2 [Y ~ M + X + ... (adjusted variables) ] were utilized for the analysis of indirect effects, with Y indicating anxiety, X indicating social support or existential well-being, M indicating resilience and adjusted variables including age, living place, physical activity and family relationships. ^*P<0.05, ^**P<0.001.