Hirschmiller Judith, Schwinn Tamara, Fischbeck Sabine, Tibubos Ana Nanette, Wiltink Jörg, Zwerenz Rüdiger, Zeissig Sylke R, Brähler Elmar, Beutel Manfred E, Ernst Mareike
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
Department of Nursing Science, Diagnostic in Healthcare and eHealth, University of Trier, Trier, Germany.
BMC Psychol. 2025 Apr 12;13(1):376. doi: 10.1186/s40359-025-02704-1.
Optimism and pessimism are stable, overarching dispositions that influence mental health, especially in stressful life situations, such as cancer survival. They have been associated with more specific coping strategies. This study sought to investigate a theoretically-based model of their interplay in shaping depressive and anxiety symptoms to inform prevention and intervention efforts.
The registry-based study included 689 survivors of malignant melanoma. We assessed sociodemographic and disease-related variables, optimism/pessimism (LOT-R), coping strategies (BC), depressive (PHQ-9), and anxiety symptoms (GAD-7). A structural equation model was conducted to analyse the hypothesized associations, modelling coping strategies (denial/self-blame, seeking external support, active coping) as mediators of the relationship of optimism/pessimism with depressive and anxiety symptoms. As a sensitivity analysis, gender-stratified models were tested.
The proposed model fit the data well. In the full sample, optimism was directly related to depression and anxiety, and the effects of optimism and pessimism were mediated via denial/self-blame. This indirect effect accounted for 60.8% of the total effect of pessimism on depression, and for 79.55% on anxiety. Stratified analyses showed different patterns of associations by gender, in the sense that the mediation effect was more relevant among men.
This study shows the relevance and need of gender-sensitive psychosocial-care. Especially in men, psychosocial interventions should target maladaptive coping strategies. Within women, fostering optimism seems to be particularly important. As the model did not fit as well for women, more gender-sensitive research is needed to understand potentially different risk/protective factors and needs of support.
乐观和悲观是稳定的、总体性的性格倾向，会影响心理健康，尤其是在诸如癌症康复等压力较大的生活情境中。它们与更具体的应对策略相关。本研究旨在探究一个基于理论的模型，以了解它们在塑造抑郁和焦虑症状过程中的相互作用，为预防和干预工作提供信息。
这项基于登记处的研究纳入了689名恶性黑色素瘤幸存者。我们评估了社会人口统计学和疾病相关变量、乐观/悲观情绪（生活取向测验修订版）、应对策略（应对方式问卷）、抑郁症状（患者健康问卷-9）和焦虑症状（广泛性焦虑障碍量表-7）。进行了结构方程模型分析以检验假设的关联，将应对策略（否认/自责、寻求外部支持、积极应对）建模为乐观/悲观情绪与抑郁和焦虑症状关系的中介变量。作为敏感性分析，对按性别分层的模型进行了检验。
所提出的模型与数据拟合良好。在全样本中，乐观情绪与抑郁和焦虑直接相关，乐观和悲观情绪的影响通过否认/自责介导。这种间接效应占悲观情绪对抑郁总效应的60.8%，对焦虑总效应的79.55%。分层分析显示了按性别不同的关联模式，即中介效应在男性中更为显著。
本研究表明了对性别敏感的心理社会护理的相关性和必要性。特别是对于男性，心理社会干预应针对适应不良的应对策略。对于女性而言，培养乐观情绪似乎尤为重要。由于该模型对女性的拟合效果不佳，需要更多对性别敏感的研究来了解潜在的不同风险/保护因素以及支持需求。
