Association Between Perceived Stress, Loneliness and Sleep Disorders Among Breast Cancer Patients: the Moderating Roles of Resilience

Abstract

Purpose: Sleep disorders are prevalent and often neglected among breast cancer patients. This study aimed to identify the association among perceived stress, loneliness, resilience and sleep disorders, and to further explore whether resilience could be a moderator in the association between perceived stress, loneliness and sleep disorders among Chinese female breast cancer patients.Methods: A cross-sectional study was conducted at a tertiary hospital in Anshan, China from October 2019 to October 2020. 492 valid questionnaires were collected. Patients were asked in response to the questionnaires including the Pittsburgh Sleep Quality Index, Perceived Stress Scale-10, the Three-Item Loneliness Scale and Resilience Scale-14. The association among perceived stress, loneliness, resilience and perceived stress/loneliness × resilience interaction with sleep disorders were examined by hierarchical multiple regression analysis. The interaction was visualized by using simple slope analysis. Results: In our study, 36.58% of the female breast cancer patients reported sleep disorders. Perceived stress and loneliness were related to sleep disorders. Resilience could moderate the relationship between them and sleep disorders. When resilience was higher, perceived stress and loneliness had a weaker impact on sleep disorders.Conclusions: There was a high prevalence of sleep disorders and this study implied an adverse effect of perceived stress, loneliness on the sleep quality. However, resilience could moderate the association between perceived stress, loneliness and sleep disorders. More positive psychological interventions should be integrated into the prevention of sleep disorders among cancer patients.

Various types of stress and greater use of disengagement coping are associated with worse sleep disturbance in oncology patients undergoing chemotherapy

“…While the PSS does not have a clinically meaningful cutoff score, our patients reported scores that were similar to those reported by oncology patients receiving radiation therapy (Ravindran et al., 2019) and cancer survivors who underwent chemotherapy within the previous year (Zhang et al., 2022). In addition, our findings are consistent with previous studies of patients with digestive (Lv, Zhao, Xie, et al., 2022) and breast (Ban Y, 2022) cancer that found significant positive associations between sleep disturbance and perceived global stress.…”

“…In addition, our findings are consistent with previous studies of patients with digestive (Lv, Zhao, Xie, et al, 2022) and breast (Ban Y, 2022) cancer that found significant positive associations between sleep disturbance and perceived global stress.…”

“…Of note, both the High and Very High classes had resilience scores that were below the normative score for the general population of the United States (Campbell-Sills et al, 2009). This finding is not surprising given that resilience levels in patients with cancer tend to decrease as the number and/or severity of symptoms and levels of stress increase (Ban Y, 2022). Specifically, in a study of patients with breast cancer (Lai et al, 2020), worse sleep quality was associated with lower levels of resilience.…”