Zhang ZY, Yong XJ, Jiang S. Correlations between anxiety/depression, self-efficacy, and social support in patients with gastric cancer and analysis of risk factors. World J Psychiatry 2025; 15(12): 109328 [PMID: 41357918 DOI: 10.5498/wjp.v15.i12.109328]
Corresponding Author of This Article
Shen Jiang, MD, Associate Chief Physician, Department of Oncology Treatment Center of Traditional Chinese Medicine, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. frankjiang2@cqu.edu.cn
Research Domain of This Article
Psychology
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 19, 2025 (publication date) through Dec 12, 2025
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World Journal of Psychiatry
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2220-3206
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang ZY, Yong XJ, Jiang S. Correlations between anxiety/depression, self-efficacy, and social support in patients with gastric cancer and analysis of risk factors. World J Psychiatry 2025; 15(12): 109328 [PMID: 41357918 DOI: 10.5498/wjp.v15.i12.109328]
Zhong-Yan Zhang, Xue-Jiao Yong, Shen Jiang, Department of Oncology Treatment Center of Traditional Chinese Medicine, Chongqing University Cancer Hospital, Chongqing 400030, China
Co-first authors: Zhong-Yan Zhang and Xue-Jiao Yong.
Author contributions: Zhang ZY and Yong XJ designed the research and wrote the first manuscript; Zhang ZY, Yong XJ and Jiang S contributed to conceiving the research and analyzing data; Zhang ZY and Yong XJ conducted the analysis and provided guidance for the research; All authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Chongqing University Cancer Hospital.
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 declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shen Jiang, MD, Associate Chief Physician, Department of Oncology Treatment Center of Traditional Chinese Medicine, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. frankjiang2@cqu.edu.cn
Received: July 15, 2025 Revised: August 25, 2025 Accepted: October 9, 2025 Published online: December 19, 2025 Processing time: 135 Days and 0.4 Hours
Abstract
BACKGROUND
Patients with gastric cancer (GC) frequently experience notable psychological distress, which often manifests as anxiety and depression. Identifying key contributing factors is essential for developing effective interventions to improve mental health outcomes.
AIM
To investigate the relationships between anxiety/depression, self-efficacy, and social support in patients with GC and identified significant risk factors.
METHODS
We enrolled 124 patients with GC undergoing treatment at Chongqing University Cancer Hospital between May 2021 and May 2024. Information regarding the patients’ anxiety and depression evaluated by the hospital anxiety and depression scale (HADS), [including a subscale for anxiety (HADS-A) and a separate subscale for depression (HADS-D)] self-efficacy, measured by the general self-efficacy scale (GSES), and social support, assessed by the perceived social support scale (PSSS), was gathered. Relationships among HADS, GSES, and PSSS scores were determined through Pearson correlation analysis. Risk factors for anxiety and depression among patients with GC were identified using univariate and multivariate analyses, specifically binary logistic regression.
RESULTS
The obtained data demonstrated mild psychological distress (mean HADS-A: 8.74 ± 3.70; mean HADS-D: 10.26 ± 3.84), suboptimal self-efficacy levels (GSES: 17.81 ± 5.45), and moderate social support (PSSS: 56.27 ± 11.28). Correlational analysis revealed significant inverse relationships between psychological distress (anxiety and depression) and both social support and self-efficacy (P < 0.01), with self-efficacy showing a strong positive association with social support (P < 0.01). Univariate analysis revealed that gender, age, clinical stage, tumor size, GSES, and PSSS were closely associated with anxiety and depression in patients with GC. Multivariate logistic regression identified three independent predictors of these mood disturbances: Advanced age (≥ 60), large tumor size (≥ 3 cm), and diminished GSES scores (< 18).
CONCLUSION
Our findings suggest that patients with GC generally experience mild anxiety and depression, which are closely related to low self-efficacy and insufficient social support. Age, tumor size, and low self-efficacy are independent predictors of anxiety and depression. In clinical practice, psychosocial interventions should be integrated, with a focus on high-risk populations, to improve patients’ mental health.
Core Tip: Focusing on patients with gastric cancer, this study investigates how anxiety, depression, self-efficacy, and social support interact, identifying key risk factors. The findings indicate a prevalence of mild anxiety depression symptoms among such patients, coupled with diminished self-efficacy and intermediate social support levels. Enhanced hospital anxiety and depression scale screening is recommended for high-risk subgroups (age ≥ 60, tumor ≥ 3 cm, general self-efficacy scale < 18) to improve psychological risk stratification and thus facilitate early intervention.
Citation: Zhang ZY, Yong XJ, Jiang S. Correlations between anxiety/depression, self-efficacy, and social support in patients with gastric cancer and analysis of risk factors. World J Psychiatry 2025; 15(12): 109328
Gastric cancer (GC) represents a major global health challenge, ranking as the fifth most prevalent malignancy globally and standing as the third leading cause of cancer-induced fatalities[1]. The disease burden is substantial, with epidemiological data from 2018 documenting over 1 million newly diagnosed GC cases and approximately 780000 deaths annually[2]. GC development results from numerous factors, including Helicobacter pylori infection, dietary habits, environmental factors, and genetic predisposition[3]. Characterized by a brief disease course, rapid progression, early metastasis, and dismal prognosis, GC exerts a detrimental impact on patients’ lives, health status, and overall quality of life[4]. Beyond its considerable physical morbidity, GC imposes profound psychological distress on affected individuals. The diagnostic and therapeutic journey frequently precipitates clinically significant anxiety and depressive symptoms stemming from multiple sources: Apprehensions regarding the disease, surgical procedures, and mortality, unavoidable adverse physiological responses, and concerns about postoperative complications[5]. While these psychological comorbidities impair treatment effectiveness, they also substantially compromise quality of life and impede recovery trajectories[6,7]. The pathophysiological mechanisms underlying this mind-body connection remain unclear. GC-induced chronic stress triggers sustained activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, triggering the release of catecholamines. These stress mediators subsequently promote tumor proliferation and migration, enhance metastatic potential, and suppress antitumor immunity through various molecular pathways, thereby accelerating disease progression[8].
Furthermore, emerging evidence suggests a bidirectional relationship between depression and GC. While depression frequently emerges as a consequence of cancer diagnosis and treatment, it may also actively contribute to tumor progression by modulating the neuroendocrine and inflammatory pathways and altering gut microbiota composition via the microbiota-gut-brain axis[9]. In this context, psychological resilience factors assume critical importance. Self-efficacy reflects an individual’s perceived stress-coping ability and confidence in overcoming challenges. Higher self-efficacy correlates with improved pain tolerance and enhanced adoption of health-promoting behaviors. To some extent, it further helps with easing mental disturbances such as anxiety and depression, thus ameliorating suicidal ideation risk[10]. Notably, Liu et al[11] demonstrated that self-efficacy partially mediates the relationship between anxiety/depressive symptoms and academic burnout in Chinese adolescents, suggesting its potential relevance in other stress-related contexts. Equally important is social support, which is defined as the material or emotional aid an individual receives through their social network. Robust social support systems can enhance physical and mental well-being, whether during periods of stress or not, mitigate perceived stress, and buffer against anxiety and depression across various illness trajectories[12,13].
Despite growing recognition of these psychosocial dimensions in oncology, research examining the interrelationships among anxiety, depression, self-efficacy, and social support in individuals with GC remains limited. This study addresses the research gap by analyzing key factors influencing anxiety and depression alleviation in individuals with GC, contributing to improved treatment efficacy and enhanced prognostic outcomes.
MATERIALS AND METHODS
Study population
Inclusion criteria: (1) Histopathologically confirmed GC diagnosis[14]; (2) Treatment with radical gastrectomy; (3) First-time cancer diagnosis; and (4) Complete clinical records available.
Exclusion criteria: (1) Comorbid immune disorders or cardiovascular/cerebrovascular diseases; (2) History of other malignancies; (3) Severe dysfunction of major organs (heart, lungs, brain, or kidneys); (4) Recent major traumatic life events (e.g., divorce and bereavement); and (5) Pregnancy or lactation. After meticulous screening based on these inclusion and exclusion criteria, 124 patients with GC admitted to Chongqing University Cancer Hospital between May 2021 and May 2024 were selected as the research cohort.
Assessment measures
Psychological distress assessment: The hospital anxiety and depression scale (HADS) was administered to evaluate psychological distress[15], specifically measuring anxiety and depression levels. This validated instrument comprises two distinct 7-item subscales (14 items total) that separately assess anxiety and depressive symptoms. Based on established clinical cutoffs, subscale scores were interpreted as follows: 0-7 indicated no clinically significant symptoms (negative); 8-10 represented subclinical or borderline symptoms (suspected positive); 11-21 demonstrated clinically significant symptoms (positive).
Self-efficacy evaluation: The general self-efficacy scale (GSES)[16], a well-validated 10-item instrument, was used to quantify patients’ perceived self-efficacy. Each item was rated on a 4-point Likert scale ranging from 1 (“not at all true”) to 4 (“exactly true”), yielding a total score range of 10-40 points. Higher cumulative scores on this standardized measure indicated stronger perceived self-efficacy in coping with disease-related challenges.
Social support measurement: We employed the perceived social support scale (PSSS) for assessment[17], given its documented psychometric soundness in measuring patient-perceived social support. Comprising 12 items categorized into intra-familial and extra-familial support subscales, the instrument utilizes a 7-grade Likert scoring system (total range: 12-84), where increased composite scores reflected enhanced social support accessibility. This standardized assessment tool has been extensively validated in related research fields.
Clinical and demographic data collection: A comprehensive set of clinical and sociodemographic variables was systematically collected, including gender, age, marital status, educational attainment, tumor characteristics (location and size), and clinical staging. These parameters were analyzed to identify potential predictors of psychological distress in the study population.
Statistical analysis
Continuous variables were expressed as mean values ± SE of the mean to account for sampling variability, while categorical variables were presented as frequency distributions (percentages). χ2 testing enabled between-group comparisons of categorical data. All statistical computations were executed using SPSS Statistics version 22.0 (IBM Corp.). Bivariate correlations between psychological distress (HADS), self-efficacy (GSES), and social support (PSSS) were examined using Pearson correlation coefficients. Potential risk factors for anxiety and depression were initially screened through univariate analyses, followed by multivariate binary logistic regression modeling to identify independent predictors while controlling for potential confounders. A P value < 0.05 was established as the threshold for statistical significance throughout all analyses.
RESULTS
Psychological distress assessment (HADS) in patients with GC
The HADS anxiety subscale analysis demonstrated that 42 (33.87%) of the 124 patients were asymptomatic, while 46 (37.10%) and 36 (29.03%) exhibited mild and moderate-to-severe anxiety symptoms, respectively, with a mean anxiety score of 8.74 ± 3.70. Similarly, the depression subscale identified 26 patients (20.97%) as asymptomatic, compared to 47 patients (37.90%) with mild symptoms and 51 patients (41.13%) with moderate-to-severe symptoms, yielding a mean depression score of 10.26 ± 3.84. These findings collectively indicate a mild level of psychological distress in our cohort (Table 1).
Table 1 Psychological distress assessment (hospital anxiety and depression scale) in gastric cancer patients, mean ± SE/n (%).
Assessment using the GSES uncovered concerning patterns in patients’ coping abilities. The cohort demonstrated a mean GSES score of 17.81 ± 5.45, significantly below the established normative values. Detailed stratification showed 86 patients (69.35%) scoring in the low self-efficacy range, and 35 patients (29.84%) achieved moderate scores, while only 1 patient (0.81%) attained scores indicative of high self-efficacy (Table 2).
The PSSS assessment yielded a mean score of 56.27 ± 11.28, positioning most patients within moderate support parameters. Quantitative analysis revealed 3 patients (2.42%) with inadequate support systems, contrasting with 76 patients (61.29%) receiving moderate support and 45 patients (36.29%) benefiting from robust support networks (Table 3).
Table 3 Social support network analysis (perceived social support scale), mean ± SE/n (%).
Pearson correlation analysis revealed significant interrelationships among HADS, GSES, and PSSS. Anxiety and depression exhibited significant inverse correlations with social support and self-efficacy (P < 0.001). Conversely, self-efficacy showed a strong positive association with social support (P < 0.001) (Table 4).
Table 4 Correlations among hospital anxiety and depression scale, general self-efficacy scale, and perceived social support scale.
Univariate analysis for anxiety and depression predictors in patients with GC
Using a clinical cutoff score of at least 11 on either HADS subscale, we identified 73 patients with clinically significant anxiety and depression (anxiety-depression group) and 51 cases in the non-anxiety-depression group. Univariate logistic regression revealed significant associations with gender, age, clinical stage, tumor size, GSES scores, and PSSS scores (P < 0.05). Nonsignificant variables included marital status, educational attainment, and tumor location (all P > 0.05) (Table 5).
Table 5 Univariate analysis for predictors of anxiety and depression in gastric cancer patients, n (%).
Multivariate analysis for anxiety and depression predictors in patients with GC
Multivariate logistic regression incorporating all significant univariate predictors identified three independent risk factors: Age, tumor size, and GSES scores (P < 0.05). Gender, clinical stage, and PSSS scores lost significance in the adjusted model (P > 0.05) (Table 6).
Table 6 Multivariate analysis for predictors of anxiety and depression in gastric cancer patients.
The current study provides valuable insights into the psychological profile of patients with GC, revealing several clinically significant findings. Our comprehensive assessment demonstrated that the cohort exhibited mild levels of psychological distress, with anxiety and depression affecting 66.13% and 79.03% of the patients, respectively. This indicates that while most patients with GC experience psychological distress, the severity tends to be mild. These findings corroborate the existing literature, particularly the work by Li and Ma[18], which established a robust association between exacerbated postoperative anxiety and depression and diminished survival outcomes in gastrointestinal malignancies. This finding underscores the significance and the pressing need to alleviate patients’ negative emotional states to enhance prognosis. The comparable depression rates observed across different cancer types 78.0% in lung cancer and 75.81% in esophageal cancer (Hong and Tian[19]) further validate our results and underscore the transdiagnostic nature of cancer-related psychological distress.
The observed deficits in self-efficacy among our participants warrant particular attention. Our data revealed pervasive difficulties in disease management confidence, with mean scores significantly below population norms, findings consistent with Qiao et al[20]. Qian and Yuan[21] provided mechanistic insights showing that self-efficacy in colorectal cancer operates within a complex psychosocial matrix negatively associated with depression and positively linked to physical functioning, social support, and vitality. Their identification of depression as the strongest predictor of self-efficacy suggests a potential bidirectional relationship that can create a vicious cycle of psychological distress and maladaptive coping. Further correlation analysis confirmed a significant inverse connection between anxiety/depression and self-efficacy in patients with GC. Existing literature supports the idea that higher self-efficacy in such patients correlates with reduced symptom frequency and severity, highlighting the significance and clinical value of boosting self-efficacy in this population[22]. Further research indicates that self-efficacy can facilitate resilience in patients with GC prior to their first chemotherapy session[23]. A longitudinal study by Chen et al[24] demonstrated significant negative correlations between return-to-work self-efficacy and anxiety depression in patients with renal cancer, mirroring the current study’s outcomes. In addition, increased self-efficacy in patients with esophageal and GC is associated with lower psychological distress. Notably, self-efficacy appears to mediate the link between proactive coping and distress levels, reinforcing the present study’s outcomes[25].
Additionally, social support levels were moderate in 61.29% of the patients, indicating that while current support is satisfactory, additional interventions could be beneficial. The correlation matrix demonstrated robust negative associations between social support and anxiety depression while revealing a strong positive correlation between social support and self-efficacy. These findings suggest a complex psychosocial dynamic wherein: (1) Diminished social support serves as a potential risk marker for emotional distress; and (2) Social support networks may function as a modifiable therapeutic target for enhancing self-efficacy. These observations find strong support in the existing literature, particularly Hu et al’s work demonstrating consistent negative correlations across all social support dimensions in patients with lung cancer[26]. Social isolation behaviors, including interpersonal avoidance and emotional concealment, have also been observed among patients with inadequate social support. This pattern of isolation often intensifies pre-existing emotional burdens and depressive symptoms[27]. Furthermore, a strong self-efficacy/social support nexus in oncology populations was previously reported by Lotfi-Kashani et al[28], consistent with our study.
The univariate analysis yielded several clinically relevant associations with anxiety/depression symptomatology, namely, gender, age, clinical stage, tumor size, GSES scores (self-efficacy), and PSSS scores (social support). These findings corroborate Liu and Wang’s report of progressive postoperative psychological distress in patients with GC influenced by gender, clinical stage, and tumor size[29]. The multivariate model refined our understanding by identifying three independent clinical predictors age ≥ 60 years, tumor size ≥ 3 cm, and GSES scores < 18 which can elevate anxiety depression risk in patients with GC. The current literature also provides robust validation for our findings regarding psychological distress predictors in such patients. Our identification of advanced age (> 60 years) and larger tumor size as independent risk factors for anxiety and depression finds strong corroboration in the work of Han[30], whose surgical cohort analysis yielded nearly identical results. Complementary evidence from Hong and Tian[19] confirmed advanced age as an independent determinant of depression in Chinese cancer patients, while also implicating poor functional status, pain symptoms, and limited educational attainment as additional independent correlates findings that partially converge with our observations. Notably, Xu et al’s investigation identified distinct preoperative predictors for preoperative anxiety and depression in patients with GC[31], including maladaptive coping strategies, type D personality traits, and elevated neutrophil-to-lymphocyte ratios, collectively highlighting the complex, multidimensional etiology of psychological morbidity in such patients.
CONCLUSION
This study revealed that patients with GC frequently experience clinically relevant anxiety and depressive symptoms of mild severity, coupled with substantially diminished self-efficacy and moderate social support levels. These findings have important clinical implications: First, self-efficacy enhancement represents a promising therapeutic target for alleviating psychological distress, as evidenced by its robust protective association with emotional well-being. Second, inadequate social support appears to function as both a risk factor and potential exacerbating element in developing and maintaining anxiety and depressive symptoms. Our risk stratification analysis suggests implementing enhanced HADS screening protocols for patients meeting any of the following high-risk criteria: Age ≥ 60 years, tumor diameter ≥ 3 cm, or GSES scores < 18. This evidence-based screening approach would facilitate the early identification of patients at elevated risk for clinically significant anxiety and depression, enabling timely psychosocial interventions that could potentially improve mental health outcomes and treatment adherence in this vulnerable population.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade C, Grade C
P-Reviewer: Chisamore N, PhD, Canada; Postolache TT, PhD, Italy S-Editor: Fan M L-Editor: A P-Editor: Wang WB
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