Protective Factors against Depressive Symptoms in Female American Indian Cancer Survivors: The Role of Physical and Spiritual Well-being and Social Support

BACKGROUND: This exploratory study examined how perceived physical well-being, spiritual well-being and social support relate to depressive symptoms among American Indian (AI) female cancer survivors. METHODS: Cross-sectional data were obtained from 73 AI female cancer survivors between 32 to 77 years of age in the Midwest of the United States. Standardized measures were used to assess for depression (Center for Epidemiologic Studies Depressive Symptoms Scale Short Form), spiritual well-being (Functional Assessment of Chronic Illness Therapy, Spiritual Well-being Scale), and social support (Medical Outcomes Study of Social Support Questionnaire). A single item measured physical well-being. After univariate and bivariate analyses, hierarchical multiple regression (HMR) was used for modeling. RESULTS: Approximately 47% of the sample scored higher than 10 on the depressive symptoms scale. HMR results indicated that perceived physical well-being, spiritual well-being, and social support were negatively associated with depressive symptoms, accounting for 47% of the variance in the final model (adjust R(2) = 0.47). CONCLUSIONS: A high percentage of the sample exceeded the cut point for probable depression, highlighting the importance of addressing mental health in the aftermath of cancer treatments for AI women. Results suggest that perceived physical well-being, spiritual well-being, and social support serve as protective factors and possible levers to reduce depression in this population. Interventions designed to bolster existing social support and spirituality could improve the mental health of AI women in the aftermath of cancer treatment. Community-based, culturally appropriate health education programs should be developed to enhance AI women’s physical health.