Zhao SY, Guo C, He JY, Liang HS, Fan YW, Liu QQ, Hu L, Liu K. Anxiety, depression, psychological resilience, and illness uncertainty in lung cancer patients undergoing thoracoscopic surgery: Correlations and associated factors. World J Psychiatry 2026; 16(8): 119793 [DOI: 10.5498/wjp.119793]
Corresponding Author of This Article
Kai Liu, MD, Department of General Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628 Zhenyuan Road, Xinhu Street, Guangming District, Shenzhen 518107, Guangdong Province, China. liuk97@mail.sysu.edu.cn
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Psychology
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Zhao SY, Guo C, He JY, Liang HS, Fan YW, Liu QQ, Hu L, Liu K. Anxiety, depression, psychological resilience, and illness uncertainty in lung cancer patients undergoing thoracoscopic surgery: Correlations and associated factors. World J Psychiatry 2026; 16(8): 119793 [DOI: 10.5498/wjp.119793]
World J Psychiatry. Aug 19, 2026; 16(8): 119793 Published online Aug 19, 2026. doi: 10.5498/wjp.119793
Anxiety, depression, psychological resilience, and illness uncertainty in lung cancer patients undergoing thoracoscopic surgery: Correlations and associated factors
Si-Yuan Zhao, Chang Guo, Jia-Yi He, Hong-Sen Liang, You-Wen Fan, Qian-Qian Liu, Liu Hu, Kai Liu
Si-Yuan Zhao, Jia-Yi He, Hong-Sen Liang, Liu Hu, Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, Guangdong Province, China
Chang Guo, Department of Nursing, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen 518107, Guangdong Province, China
You-Wen Fan, Kai Liu, Department of General Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, Guangdong Province, China
Qian-Qian Liu, Department of Hepatology, Shenzhen Bao’an Traditional Chinese Medicine Hospital Group, Shenzhen 518100, Guangdong Province, China
Co-first authors: Si-Yuan Zhao and Chang Guo.
Co-corresponding authors: Liu Hu and Kai Liu.
Author contributions: Zhao SY and Guo C designed the research and wrote the first manuscript, have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; He JY, Liang HS, Fan YW and Liu QQ contributed to conceiving the research and analyzing data; Hu L and Liu K conducted the analysis and provided guidance for the research, have played important and indispensable roles in the manuscript preparation as the co-corresponding authors; all authors reviewed and approved the final manuscript.
Institutional review board statement: The study protocol was approved by the Ethics Committee of The Seventh Affiliated Hospital, Sun Yat-sen University (No. KY-2026-057-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no potential conflicts of interest to report relevant to this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Kai Liu, MD, Department of General Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628 Zhenyuan Road, Xinhu Street, Guangming District, Shenzhen 518107, Guangdong Province, China. liuk97@mail.sysu.edu.cn
Received: February 6, 2026 Revised: March 15, 2026 Accepted: April 21, 2026 Published online: August 19, 2026 Processing time: 162 Days and 2.3 Hours
Abstract
BACKGROUND
Patients with lung cancer (LC) undergoing thoracoscopic surgery, or video-assisted thoracic surgery (VATS), may experience different degrees of anxiety or depression, which are not conducive to clinical management or smooth postoperative recovery.
AIM
To explore the correlations of anxiety and depression with psychological resilience and illness uncertainty in VATS-treated patients with LC and to analyze their influencing factors.
METHODS
A total of 297 patients with LC undergoing VATS were enrolled from January 2022-October 2025. Data on the Self-Rating Anxiety/Depression Scale (SAS/SDS), Connor-Davidson Resilience Scale (CD-RISC), Mishel Uncertainty in Illness Scale (MUIS), and clinical characteristics were collected. Pearson’s correlation analysis was used to assess the associations of SAS and SDS scores with CD-RISC and MUIS scores. Determinants associated with anxiety and depression were also investigated.
RESULTS
Among the cohort, 39.06% and 42.09% of the patients experienced anxiety and depression, respectively, mostly with mild symptoms. The mean CD-RISC score was 46.67 ± 8.11, and the MUIS score was 83.98 ± 9.45. Correlation analysis showed that anxiety and depression in VATS-treated LC patients correlated negatively with psychological resilience but positively with illness uncertainty, while psychological resilience correlated negatively with illness uncertainty. Univariate and multivariate analyses identified preoperative forced expiratory volume in one second as a percentage of the predicted value (FEV1%), clinical staging, educational level, monthly household income (MHI), psychological resilience, and illness uncertainty as independent correlates of anxiety or depression in patients with LC undergoing VATS.
CONCLUSION
Patients with LC undergoing VATS commonly experience preoperative anxiety and depression. These psychological states are significantly associated with levels of resilience and illness uncertainty. In addition, preoperative FEV1%, clinical staging, educational level, MHI, psychological resilience, and illness uncertainty are independent predictors of anxiety or depression in these patients.
Core Tip: This study included 297 patients undergoing thoracoscopic surgery for lung cancer and investigated the correlations of anxiety and depression with psychological resilience and illness uncertainty while identifying influencing factors. Analyses of clinical data revealed that preoperative anxiety and depression correlated negatively with psychological resilience and positively with illness uncertainty. Forced expiratory volume in one second as a percentage of the predicted value < 70%, clinical staging, educational level, monthly household income, psychological resilience, and illness uncertainty independently influenced anxiety or depression development. Clinically, psychological interventions should be provided preoperatively for patients with these factors to enhance psychological resilience, reduce illness uncertainty, and relieve adverse emotional states.
