The multiple mediating effects of cancer threat appraisal and quality of life on the association between mindfulness and depression for colorectal cancer survivors

Abstract

Objective This study explored the multiple mediating effects of cancer threat appraisal, functional status, and symptom distress on the association between mindfulness and depression in colorectal cancer (CRC) patients at the transition stage after completing cancer treatments. Methods A total of 90 CRC survivors who received cancer treatments within 3 months participated in this cross‐sectional study. The functional status and symptom distress (EORTC‐C30 and EORTC CR29), dispositional mindfulness (Five Facet Mindfulness Questionnaire), cancer threat appraisal ( Constructed Meaning Scale), and depressive symptoms (Beck Depression Inventory‐II scale) were collected. The mediation and moderation analyses were conducted using the PROCESS macros for SPSS. Results Survivors' dispositional mindfulness (γ = −0.49, p < 0.001) and cancer threat appraisal (γ = −0.59, p < 0.001) were significantly associated with depressive symptoms. Simple mediation analysis indicated that cancer threat appraisal mediated the relationship between dispositional mindfulness and depression (β = −0.02, 95% CI = −0.04 to −0.001). The multiple mediated analysis identified the path between dispositional mindfulness and depression via cancer threat appraisal and colorectal symptom distress (β = −0.01, 95% CI = −0.03 to −0.01). In the mediated moderation model, the path between dispositional mindfulness and depression via colorectal function was moderated by cancer threat appraisal (β = −0.02, 95% CI = −0.05 to −0.004). Conclusions The two cognitive mechanisms of reducing CRC survivors' depression are as follows: (1) dispositional mindfulness reducing the appraisal of cancer as a threat and increasing positive perceptions of CRC symptoms and (2) the cancer threat appraisal buffered the impacts of CRC's mindfulness and colorectal function on depressive symptoms. Developing mindfulness with cognitive training is recommended for improving depressive symptoms among CRC patients in the transition period.

Stress appraisal and emotion regulation mediate the association between mindfulness and affect in cancer patients: Differential mechanisms for positive and negative affect

“…Results suggest that less mindful cancer patients reported more negative affect, through greater stress appraisal and more use of rumination. This results is in line with previous studies showing that more mindful cancer patients may experience less negative affect, as they are less likely to perceive events as stressful and threatening (i.e., lower stress appraisal) 23 and are less likely to ruminate 37 . Additionally, Mindfulness‐to‐Meaning Theory suggests that the decentering aspect of mindfulness hinders perseverative cognition, such as rumination, by facilitating the release or “letting go” of negative thoughts and emotions, which in turns, alleviates psychological distress 32 .…”

“…For example, a cross-sectional study in colorectal cancer patients found that mindfulness was related to lower threat appraisal of cancer, subsequently related to less depressive symptoms. 23 To the best of our knowledge, this is the first study in cancer patients that aims to examine the role of both stress appraisal and several adaptive and maladaptive coping strategies as mechanisms in the relationship between mindfulness and affect. As differential relationships have been found between mindfulness and positive and negative affect, 24 separate analyses were conducted for positive and negative affect.…”

“…Only few studies in cancer patients investigated the role of stress appraisal and coping as mediators in the association of mindfulness with affect. For example, a cross‐sectional study in colorectal cancer patients found that mindfulness was related to lower threat appraisal of cancer, subsequently related to less depressive symptoms 23 …”

Comorbidity Patterns in Patients Newly Diagnosed With Colorectal Cancer: Network-Based Study

“…The use of regional hospitalizations to identify the prevalence of clinically significant anxiety as well as other mental disorders might lead to underestimates, because estimated prevalence is generally higher when questionnaires are used [63,64]. Considering the well-known underestimated prevalence of mental disorders, especially in low-and middle-income countries [65], and their negative effects on quality of life, scanning for symptoms of anxiety and depression, implementation of dietary and physical activity interventions, and implementation of social support are of utmost importance among CRC patients at diagnosis and even years after treatment [66][67][68].…”