School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, ROC.
Psychooncology. 2021 Jun;30(6):853-862. doi: 10.1002/pon.5644. Epub 2021 Feb 20.
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.
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.
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).
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.
本研究探讨了癌症威胁评估、功能状态和症状困扰在正念与完成癌症治疗后处于过渡期的结直肠癌（CRC）患者抑郁之间的关系中的多重中介作用。
本横断面研究共纳入 90 名在 3 个月内接受癌症治疗的 CRC 幸存者。收集了功能状态和症状困扰（EORTC-C30 和 EORTC CR29）、特质正念（五因素正念量表）、癌症威胁评估（建构意义量表）和抑郁症状（贝克抑郁量表- II 量表）。使用 SPSS 的 PROCESS 宏进行中介和调节分析。
幸存者的特质正念（γ=-0.49，p<0.001）和癌症威胁评估（γ=-0.59，p<0.001）与抑郁症状显著相关。简单中介分析表明，癌症威胁评估中介了特质正念与抑郁之间的关系（β=-0.02，95%CI=-0.04 至-0.001）。多中介分析确定了特质正念和抑郁通过癌症威胁评估和结直肠症状困扰的路径（β=-0.01，95%CI=-0.03 至-0.01）。在中介调节模型中，特质正念和抑郁通过结直肠功能的路径被癌症威胁评估所调节（β=-0.02，95%CI=-0.05 至-0.004）。
降低 CRC 幸存者抑郁的两种认知机制如下：（1）特质正念降低了对癌症的威胁评估，增加了对 CRC 症状的积极感知；（2）癌症威胁评估缓冲了 CRC 正念和结直肠功能对抑郁症状的影响。建议对 CRC 患者在过渡阶段进行正念认知训练，以改善抑郁症状。
