Examination of moderators of expressive writing in patients with renal cell carcinoma: the role of depression and social support

Abstract

Objective To identify groups most likely to benefit from an Expressive Writing (EW) intervention, we examined psychosocial variables as intervention moderators. We hypothesized that EW would be particularly effective for participants with high levels of depressive symptoms and social support at study entry. Methods Patients (n = 277; 60.6% male) with kidney cancer were randomly assigned to either an expressive (EW) or neutral writing (NW) condition. Intervention outcomes included measures of depressive symptoms (CESD), cancer-related symptoms (MDASI), fatigue (BFI), and sleep disturbances (PSQI) assessed at baseline, 1, 4, and 10 months later. Moderators were measured at baseline. Results As hypothesized, depressive symptoms and social support moderated intervention efficacy. When examining both moderators simultaneously, EW appeared to be most effective in terms of cancer-related symptoms (p < 0.05) and depressive symptoms (p < 0.01) for participants with elevated depressive symptoms who received high levels of social support at baseline relative to their counterparts in the NW condition. Moreover, participants in EW with high levels of social support at baseline reported lower levels sleep disturbances (p = 0.005) than their counterparts in NW. Conclusions Recognition of baseline depressive symptoms and social support as intervention moderators may lead to improved patient selection for EW interventions, as EW may be particularly beneficial regarding QOL outcomes for patients that have social support available including participants with depressive symptoms. EW may not be beneficial, or potentially even contraindicated, for participants lacking social support.

Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…132 Secondary analyses from this study showed that the patients who benefited the most from the expressive writing intervention had both greater depressive symptoms and greater social support, as measured at baseline. 133 Interventions incorporating internet support groups have become popular, 134 with a Cochrane review including 6 studies with 492 women with breast cancer showing a small to moderate effect on depression, based on low-quality evidence. 135 None of the 6 studies included in the review assessed emotional distress specifically, and results from 2 studies showed no significant effect on anxiety when comparing the intervention and control groups.…”

Written Emotional Disclosure Can Promote Athletes’ Mental Health and Performance Readiness During the COVID-19 Pandemic

“…Increased social integration and interactions arising as a result of WED have been evidenced in studies outlining that participants assigned to experimental disclosure were more likely than controls to talk about their traumatic experience in the weeks or months following disclosure (e.g., Kovac and Range, 2000). However, it is important to note that expressive writing results in greater health benefits for individuals who perceive that social support is available (Milbury et al, 2017). As such, before athletes initiate WED, it may be prudent to identify and/or establish a supportive social network.…”

The need for supportive mental wellbeing interventions in bladder cancer patients: A systematic review of the literature

“…Four studies were conducted as RCTs [ 8 – 11 ]. Three interventions were group consultations [ 8 , 9 , 12 ], two were individual studies [ 13 , 14 ], two were couple therapy [ 10 , 11 ], two were technology based (via phone or online support) [ 12 , 15 ] and one was a relaxation training [ 16 ].…”

“…Social, relationship and/or familial wellbeing were also well distributed through the majority of the studies. Depression was assessed using different tools: Depressive Symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) in two studies [ 6 , 8 ], with the Hospital Anxiety and Depression Scale (HADS) in three studies [ 17 , 18 , 20 ] and using Patient Reported Outcomes Measurement Information System (PROMIS0 depression itembank CAT in one study [ 11 ] and self-administered Depression Anxiety Stress Scale (DASS-21) in one study [ 16 ].…”