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Prevalence and Associated Positive Psychological Variables of Depression and Anxiety among Chinese Cervical Cancer Patients: A Cross-Sectional Study
Open accessAbstract
BACKGROUND: The prevalence of depression and anxiety and its associated factors in cervical cancer are not well evaluated in China. Meanwhile, with increasing attention given to positive psychological variables in oncology field, there is a need to conduct a study to explore the integrative effects of positive psychological variables on depression/anxiety so as to provide patients a more holistic cancer care. The aim of this study was to assess the prevalence of depression/anxiety as well as the integrative effects of hope, optimism and general self-efficacy on depression/anxiety among Chinese cervical cancer patients. METHODS: A multi-centre, cross-sectional study was conducted of consecutive inpatients at the Liaoning Cancer Hospital & Institute and the Shengjing Hospital of China Medical University in Liaoning Province, northeast China. A total of 224 cervical cancer patients eligible for this study completed questionnaires on demographic and clinic variables, Hospital Anxiety and Depression Scale, Herth Hope Index, Life Orientation Scale-Revised, and General Self-Efficacy Scale during February and August 2013. RESULTS: The prevalence of depression and anxiety was 52.2% and 65.6% in cervical cancer patients. The anxiety score was significantly higher in patients at the period of 4-6 months after diagnose and at cancer stage II. Hierarchical regression analyses indicated that hope, optimism and general self-efficacy as a whole accounted for 31.3% variance of depression and 35.6% variance of anxiety. Under standardized estimate (β) sequence, hope, optimism and general self-efficacy significantly associated with depression, respectively; hope and optimism were also significant individual predictors of anxiety. CONCLUSIONS: The high prevalence of depression and anxiety among cervical cancer patients should receive more attention in Chinese medical settings. More importantly, efforts to develop the integrated psychosocial interventions are effective and necessary to alleviate depression/anxiety in cervical cancer patients by synthesizing and integrating the individual protective effects of hope, optimism and general self-efficacy.
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“For instance, hope is negatively associated with depression, anxiety, and psychological distress among cancer patients [19–22].”
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Cited by
Sorted by citations
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“40 50 51 The remaining studies involved participants diagnosed with haemolymph neoplasm,(52) nasopharyngeal carcinoma,(15) colorectal cancer,(35) oral cavity cancer,(39) oesophageal cancer(53) and cervical cancer.(54) Almost all studies (N=31) involved various cancer stages; only one study exclusively involved patient…”
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MethodZhang, A. (2021) · Research on Social Work Practice · doi:10.1177/10497315211062508 · Cited by 17
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“Cervical cancer patients showed the prevalence of depression and anxiety at about 52 and 66% respectively (Yang et al., 2014).”
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Herth Hope Index: A Psychometric Evaluation Study within a Sample of Greek Patients with Cancer
Nikoloudi, M., Tsilika, E., Parpa, E., Kostopoulou, S., Tentolouris, A., Psarros, C., Mantoudi, A., & Mystakidou, K. (2021) · Indian Journal of Palliative Care · doi:10.25259/ijpc_364_20 · Cited by 15
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“So depression and anxiety are at higher levels in cervical cancer patients [17].”
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“Although a lack of hope is associated with depression and anxiety, hope as a multidimensional concept represents more than the absence of clinically-relevant depressive and anxious symptoms [11, 12].”
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“A relationship between hope, self-esteem, and life satisfaction has also been noted [6,7].”
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“Additionally, a spectrum of mental disorders and severe psychiatric conditions may develop after a stroke that can lead to self-harm, suicide, or other social issues, significantly affecting patients’ quality of life (6, 7) and imposing a heavy burden both on their family and society (4, 8).”
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“Moreover, anxiety is higher at the period of 4 - 6 months after diagnosis (7).”
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Predictors of quality of life among older patients with cancer during treatment
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“Previous studies have also found that the majority of their sample of patients with cancer had moderate to severe depression that corresponds with the findings in this study [19,42].”
ResultWang, J., Wu, Y.-F., Zhou, J., Li, S.-M., & She, L.-P. (2024) · Scientific Reports · doi:10.1038/s41598-024-59885-9 · Cited by 7
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Depression and health‐related quality of life among Cambodian patients with cancer
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Jurišová, E., Pivková, L., Ráczová, L., Sollár, T., & Romanová, M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1151027 · Cited by 8
“The perspective of hope and optimism are two different constructs presented in several other studies (Yang et al., 2014; Rand, 2018; Wider et al., 2022).”
BackgroundMethodHope and Anxiety: A Meta‐analytic Review
Richardson, A. L., Long, L. J., & Gallagher, M. W. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70068 · Cited by 8
“Studies examining hope and optimism concurrently found that not only are they best modeled as distinct latent constructs, but they are uniquely linked to components of well ‐ being, depression, and anxiety (Gallagher and Lopez 2009; Yang et al. 2014).”
Abbas, Q., Kanwal, U., Khan, M. U., Saeed, W., Shahzadi, M., & Admin (2020) · Journal of the Pakistan Medical Association · doi:10.47391/jpma.1013 · Cited by 6
Wu, C.-Y., Chan, T., Shi, H.-Y., & Kuo, Y.-L. (2021) · Taiwanese Journal of Obstetrics & Gynecology · doi:10.1016/j.tjog.2021.03.015 · Cited by 5
Stress and fear in women living with cancer: An argumentation towards the adaptation theory
Sari, N. P. W. P. (2020) · International Journal of Public Health Science (IJPHS) · doi:10.11591/ijphs.v9i3.20413 · Cited by 7
“at stage II of the disease which may be predicted by hope and optimism; in the other hand, depression was also correlated with hope, optimism, and general self-efficacy [30].”
BackgroundWomen experience with newly diagnosed cervical cancer in Indonesia
Nastiti, A. A., Pradanie, R., Susanti, E., & Tristiana, R. D. (2020) · Médecine Palliative · doi:10.1016/j.medpal.2019.08.012 · Cited by 5
Jin, X., Liu, X., & Huang, H. (2025) · BMC Psychology · doi:10.1186/s40359-025-03323-6 · Cited by 4
“Patients with CIN grade 3 certainly experience anxiety, which is normal, especially for women [60–62].”
The sexuality of women with cervical cancer undergoing definitive radiotherapy in Ghana
Kyei, K. A., Daniels, J., Broni, R., Anim-Sampong, S., Kitson-Mills, D., Amoabeng, K. A., Tackie, J. N. O., Obeng-Mensah, T., Scott, P. A. A., & Owusu, A. B. (2023) · Radiography · doi:10.1016/j.radi.2023.11.024 · Cited by 4
Teshale, M. M., Kebede, W. M., Sahilu, W. T., Wondmu, K. S., Ayele, H., Ayenew, T., Mekonen, G. B., Gete, M., Laikemariam, M., Mihiret, G. T., et al. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-08211-w · Cited by 3
“Although this is not a meta-analysis, the study on Chinese cervical patients reported a depression prevalence of 65.6%, suggesting our overall pooled prevalence is lower than this individual figure [1].”
InfluentialAlegbeleye, J. O., & Biyi-Olutunde, O. A. (2023) · Journal of Biosciences and Medicines · doi:10.4236/jbm.2023.117009 · Cited by 3
Adriani, R. B., Martono, M., & Sulistyowati, E. C. (2016) · Indonesian Journal of Medicine · doi:10.26911/theijmed.2016.01.02.06 · Cited by 3
Surviving Cervical Cancer: Experiences of Women in the Accra Metropolis
Hobenu, K. A. (2015) · Cited by 3
Han, Z., Fang, Y., Lin, J., Wu, T., & Ma, X. (2025) · BMC Palliative Care · doi:10.1186/s12904-025-01934-9 · Cited by 2
“Life orientation averaged 14.13 ± 4.82, below a cervical cancer comparator (19.86 ± 3.03) [24]; social support averaged 33.58 ± 8.00, lower than SDMs of hematologic malignancies (40.33 ± 6.78) [23]; illness uncertainty averaged 57.21 ± 14.87, lower than oncology caregiver reports (66.43 ± 12.54)…”
InfluentialXie, Z.-J., Zhang, H., Ma, R., & Su, H.-L. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i12.111761 · Cited by 2
Psychiatric morbidities in patients of carcinoma cervix
Srivastava, A. S., Shukla, A., Pandey, S., Asthana, A., Tripathi, M. N., Pandit, B., & Yadav, J. S. (2017) · Open Journal of Psychiatry & Allied Sciences · doi:10.5958/2394-2061.2018.00011.3 · Cited by 2
“Lau et al,[20] have reported 86% patients in early stage and Yang et al.[21] have reported 70.”
BackgroundInfluentialKwete, X. J., Kane, K., Liu, Y., & Krakauer, E. L. (2023) · PLOS Global Public Health · doi:10.1371/journal.pgph.0001642 · Cited by 2
Zhao, M., Liu, D., Gao, M., Zhang, M., Ma, G.-Y., Ding, S.-R., Luo, L., Gu, R.-Y., Zhang, X.-L., & Li, Z. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102273 · Cited by 2
“While anxiety and depression that are not recognized and treated promptly can lead to decreased patient treatment compliance, further affecting treatment outcomes (Yang et al., 2014).”
BackgroundSaab, R., Salvo, G., Gonzales, N. R., Munsell, M. F., Shinn, E. H., Jhingran, A., Bhosale, P., Ramalingam, P., & Frumovitz, M. (2023) · Gynecologic Oncology · doi:10.1016/j.ygyno.2023.08.014 · Cited by 2
Psychiatric Aspects of Obstetrics and Gynecology Patients
Ho, P. (2018) · Springer eBooks · doi:10.1007/978-3-319-99774-2_14 · Cited by 2
Chowdhury, S. R., Bohara, A. K., & Drope, J. M. (2021) · Journal of Health Research · doi:10.1108/jhr-01-2021-0034 · Cited by 2
Efeito do relaxamento com imagem guiada na ansiedade no câncer cervical: ensaio clínico randomizado
Santana, E. D. O., Silva, L. D. S., da Silva, L. A. A., Lemos, J. L. D. A., Marcondes, L., Guimarães, P. R. B., & Kalinke, L. P. (2023) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2021-0874pt · Cited by 2
García, J. C., Maraver, F. M., Ríos‐Pena, L., Rubio, C., & Jiménez, I. R. (2023) · Indian Journal of Gynecologic Oncology · doi:10.1007/s40944-023-00753-1 · Cited by 1
Vernon, M., Datta, B. K., & Coughlin, S. S. (2025) · Cancer Epidemiology · doi:10.1016/j.canep.2025.102795 · Cited by 1
Moreira, E. C. D. M., Dendasck, C. V., de Aguiar, C. P., de Alencar, S. M. F., Pinheiro, D. N., de Oliveira, E., & Pinheiro, M. D. C. N. (2019) · Revista Científica Multidisciplinar Núcleo do Conhecimento · doi:10.32749/nucleodoconhecimento.com.br/saude/estrategias-psicoemocionais · Cited by 1
Sarman, A., KÖSE, H., & Sarman, E. (2022) · Yaşlı sorunları araştırma dergisi · doi:10.46414/yasad.1061036 · Cited by 1
Validity of a questionnaire on self-efficacy for Pap test adherence screening
María Teresa Urrutia, S., & Padilla, O. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.979799 · Cited by 1
“Regarding cervical cancer (CC), its relationship with adherence to the human papillomavirus vaccine (13, 14), adherence to the Papanicolaou (Pap) test—also called Pap smear or Pap—and to colposcopy (15), to educational interventions (16–21) and to depressive symptoms in women with the disease (22) has been studied.”
BackgroundQUALIDADE DE VIDA, ANSIEDADE E DEPRESSÃO EM PACIENTES COM CÂNCER DE COLO DO ÚTERO AVANÇADO
Oliveira, L. M. D. S., Barbosa, L. N. F., Filho, B. A. B. D. S., Figueirôa, J. N., de Mello, M. J. G., & de Azevedo, C. R. A. S. (2023) · Psicologia e Saúde em Debate · doi:10.22289/2446-922x.v9n1a27 · Cited by 1
Nguyen, K. T., Chan, D. N. S., Cheung, A. T., Hoang, H. T. X., Anh, T. T., Chow, K. M., Choi, K. C., & Chan, C. W. H. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09281-4 · Cited by 1
Body image and the level of stress in cervical cancer patients
Rejeki, S. T., Agustyaningrum, E., Macmudah, Khayati, N., Hartiti, T., Safitri, D. N. R. P., & Olina, Y. B. (2022) · Bali Medical Journal · doi:10.15562/bmj.v11i3.3769 · Cited by 1
Kačmár, P., Baranyiová, D., & Zentková, L. (2023) · Psychologie a její kontexty (Psychology & Its Contexts) · doi:10.15452/psyx.2022.13.0012 · Cited by 1
Ärztliches Handeln in der Psychoonkologie: zur Vermittlung von Hoffnung
Geiser, F. (2015) · Ärztliche Psychotherapie und Psychosomatische Medizin
Metadata
- Authors
- Yang, Y.-L., Liu, L., Wang, X.-X., Wang, Y., & Wang, L.
- Affiliations
- China Medical University (CN)
- Corresponding author
- Wang, Lie
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-04-10
- Volume
- 9
- Issue
- 4
- Pages
- e94804
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3983270
- OpenAlex
- W2072487399
- Cited by
- 108
- References
- 62
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 9 · 2023: 16 · 2022: 12 · 2021: 12 · 2020: 9 · 2019: 7 · 2018: 6 · 2017: 8 · 2016: 9 · 2015: 4 · 2014: 2
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- China Medical University
- Shengjing Hospital
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Applied Psychology › Optimism, Hope, and Well-being
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- cervical cancer, depression, anxiety, hope, optimism, general self-efficacy, prevalence, psychosocial interventions, Chinese patients, tumor stage, time since diagnosis
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Anxiety, Uterine Cervical Neoplasms, China, Cross-Sectional Studies, Depression, Female, Humans, Middle Aged, Psychiatric Status Rating Scales, Quality of Life, Prevalence, Self Efficacy, Young Adult, Hope
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