Protective factors of depressive symptoms in adult cancer patients: The role of sense of coherence and posttraumatic growth in different time spans since diagnosis

Abstract

Purpose: The purpose of this study was to investigate the impact of posttraumatic growth (PTG) and sense of coherence (SOC) as protective factors on depressive symptoms at different time spans after cancer diagnosis.

Design: In a cross-sectional study, adult cancer patients were recruited from the tumor clinics of the University Hospital in Erlangen (Germany) and from peer-support groups for cancer survivors.

Sample: Participants included 157 adult patients with primary cancer or in remission (53.5% female; mean age: 58.0 ± 14.1 years; mean time since diagnosis: 46.7 ± 72.8 months) with various forms of cancer.

Methods: Multiple linear regression analyses were conducted. The patients were divided into two groups (≤1 year and >1 year since diagnosis) to test the impact of PTG and SOC on depressive symptoms at different time intervals after diagnosis. The Posttraumatic Growth Inventory (PTGI), Sense of Coherence Scale (SOC-13), and Hospital Anxiety and Depression Scale (HADS) were applied.

Findings: After controlling for major demographic and clinical variables, SOC (β = –.489, p < .001) was found to be the only significant predictor for depressive symptoms ≤ 1 year after diagnosis; >1 year after diagnosis, SOC (β = –.571, p < .001), PTG (β = –.318, p = .002), and metastatic cancer (β = .231, p = .023) were significant predictors of depressive symptoms (high levels of SOC as well as PTG, and having no metastatic cancer were associated with low manifestations of depressive symptoms).

Conclusions: These findings suggest that SOC may be a protective factor against depressive symptoms in both the short as well as in the long term after cancer diagnosis, but PTG only in the long term.

Implications for psychosocial providers or policy: To prevent the development of depressive symptoms in cancer patients, individuals with a low SOC should be detected and should receive psychological assistance.

Keywords:

• sense of coherence
• posttraumatic growth
• depression
• cancer

Acknowledgments

The authors would like to thank the following departments at Erlangen University Hospital: the Department of Dermatology, the Department of Oral and Maxillofacial Surgery, the Ear, Nose, and Throat Clinic, the Department of Surgery, the Department of Hematology, the Department of Internal Medicine, the radiation clinic, the Departments of Gastroenterology, Pneumology, and Endocrinology, and the psycho-oncological service of Erlangen University Hospital and Erbach District Hospital, as well as the following peer-support groups for cancer survivors: SHG Prostatakrebs-Betroffene Erlangen und urogenitale Tumore (for prostate cancer and urogenital tumors), SHG Blasenkrebs Essen (for bladder cancer), Frauenselbsthilfe nach Krebs (for women after cancer), Berg & Tal e.V. (for hematological tumors), Deutsche ILCO e.V. (for bowel cancer), and the peer-support groups for cancer survivors from the North Rhine region, for their kind support in the recruitment process.

Conflicts of interest

No conflict of interests have been declared by the authors.