Cognitive Appraisal and Depression in Cancer Patients Undergoing Chemotherapy: Mediation by Perceived Stress and Self-Efficacy

Background: 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. Findings: 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]). Interpretation: This study suggests that medical staff could prevent or relieve depression through improving self-efficacy or reducing perceived stress on cancer patients undergoing chemotherapy. Funding Statement: National Natural Science Fund of China [Grant Number: 81401863]; Fujian Science and Technology Innovation Joint Fund [Grant Number: 2017Y9107]. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The study was approved by Ethics Review Committee for Biomedical Research of Fujian Medical University.