The moderating effect of self-efficacy between social constraints, social isolation, family environment, and depressive symptoms among breast cancer patients in China: a cross-sectional study

Abstract

Background: For female breast cancer patients, the psychological status after surgery, especially the social and family psychological-related factors, deserves more attention. This study analyzed the influence of social constraints, social support, social isolation, family conflict, and family emotion expression on depression. At the same time, this study conducted the relationship between the variables and the mechanism of action.

Methods: We conducted a cross-sectional study and 522 breast cancer patients finished questionnaires consisting of Self-Rating Depression Scale (SDS), General Self-Efficacy Scale (GSES), Multi-Dimensional Scale of Perceived Social Support (MSPSS), Social Constraints Scale-5 (SCS-5), Family Environment Scale (FES), and Lubben Social Network Scale (LSNS-6). Multivariable logical regression was used to explore influencing factors. Pearson's correlation, hierarchical regression, and simple slope analysis were conducted to verify the role of self-efficacy.

Results: 71.6% of patients had depressive symptoms. Family contradiction (OR = 10.086), social constraints (OR = 2.522), social isolation (OR = 2.507), and high blood glucose (OR = 2.156) were risk factors of depressive symptoms. Family emotional expression (OR = 0.480), family intimacy (OR = 0.235), and self-efficacy (OR = 0.246) were protective factors against depressive symptoms. The interactive items interpretation quantity were as follows: Contradiction*Self-efficacy (ΔR² = 2.3%, P < 0.001), Emotional expression*Self-efficacy (ΔR² = 2.6%, P < 0.001), Intimacy*Self-efficacy (ΔR² = 1.0%, P = 0.018), Social constraints*Self-efficacy (ΔR² = 1.0%, P = 0.008), Social networks*Self-efficacy (ΔR² = 1.0%, P = 0.010), Blood Glucose*Self-efficacy (ΔR² = 0.6%, P = 0.023). The influence of independent variables on depressive symptoms was gradually decreased in the low, mean, and high groups of self-efficacy.

Conclusion: Postoperative Chinese breast cancer survivors reported higher depressive symptoms. Social, family, and physiological factors could affect depressive symptoms, in which self-factor played moderator roles.

Keywords: Blood glucose; Family environment; Self-efficacy; Social constraints; Social isolation.