Development And Clinic Assessment The Applicality Of A Path Model Of Cognitive Appraisal On Depression In Cancer Patients Undergoing Chemotherapy

Objectives 1.To identify the risk factors for depression,find the main social psychological risk factors for depresssion and develop a path model of cognitive appraisal on depression in cancer patients undergoing chemotherapy.2.To examine applicality of the path model of cognitive appraisal on depression in cancer patients undergoing chemotherapy.Methods 1.The main social psychological risk factors for depression of chemotherapy patients were identified based on a systematic review.Then,a path model of depression with key social psychological risk factors was developed based on the stress and coping theory and literatures.2.A cross-sectional survey was conducted in 421 participants recruited from a general hospital in Fujian,China.The cognitive appraisal was tested by PLTS,perceiced stress was tested by PSS,depression levels were examined by HADS-D,self-effect was measured by GSES,extend of social support was measured by SSRS,coping style was examined by CSQ,and demography characteristic were collected.Then the path model of cognitive appraisal on depression was examined through medating and moderating analysis.Results 1.Among 5,988 potentially relevant articles,43 studies were eligible,with 17 studies of high quality and 25 studies of moderate quality.A total of 64 factors were extracted,including sociodemographic characteristics(n=20),physiological condition(n=20),disease and treatment(n=12),and psychosocial factors(n=12).Only nutritional status,social support,perceived stress,and self-efficacy were found to be consistently associated with depression in cancer patients.There is not enough evidence to support the link between the other 60 factors and depression in cancer patients undergoing chemotherapy.According to the stress and coping patterns that was developed by Lazarus and relational literatures,the path model of cognitive appraisal on depression in chemotherapy patients was developed by this study.2.Education level,health insurance,satisfaction of income,and occuption were the risk factors for depression(p<0.05).Stress and self-efficacy were significant in mediating the relationship between cognitive apprasial and depression(mediating effect of stress: b= 0.101,SE = 0.014,p<0.001,bias-corrected 95% CI = [0.074,0.132],percentile 95% CI = [0.074,0.031];mediating effect of self-efficacy: b=0.021,SE = 0.006,p < 0.001,bias-corrected 95% CI = [0.006,0.028],percentile 95% CI = [0.005,0.026];mediating effect of “stress→self-efficacy”: b=0.014,SE = 0.005,p < 0.01,bias-corrected 95% CI = [0.010,0.034],percentile 95% CI = [0.009,0.033]).Social support was a moderator between cognitive appraisal and stress(p<0.05).Copying style paly a moderaing role in stress to depression(p<0.05).Conclusions 1.The path model of cognitive on depression in chemotherapy patients that was developed in this study can provides a theoretical framework for depression related studies.2.This study suggests that nursing staffs can prevent or relieve patients’ depressive symptoms by improving self-efficacy of patients or reducing the pressure on patients.Nurses also can encourage cancer patients to participate in social activities or take more active coping strategies to decrease depression levels..