Hope and depression: the mediating role of social support and spiritual coping in advanced cancer patients

BACKGROUND: Depression is the most common mental disorder in patients with advanced cancer, which may lead to poor prognosis and low survival rate. This study aims to explore the serial multiple mediating roles of social support and spiritual coping between hope and depression among patients with advanced cancer. METHODS: A cross-sectional study was conducted in China between May and August 2020. A total of 442 advanced cancer patients were investigated by the following self-reported questionnaires: Herth Hope Index (HHI), Spiritual Coping Questionnaire (SCQ, Chinese version), Social Support Rating Scale (SSRS), Hospital Anxiety and Depression Scale (HADS). RESULTS: Depression was negatively correlated with hope, social support, and positive spiritual coping (P < 0.01), and positively correlated with negative spiritual coping (P < 0.01). Hope explained 16.0% of the variance in depression. Bootstrap analyses of the hope--social support--positive spiritual coping--depression showed that there were direct [B = -0.220, 95%CI(− 0.354, − 0.072)] and indirect effects of hope on depression mediated solely by social support [B = -0.122, 95%CI(− 0.200, − 0.066)] and positive spiritual coping [B = -0.112, 95%CI(− 0.217,-0.025)], or by both together [B = -0.014, 95%CI(− 0.038,-0.003)]. Similarly, the hope--social support--negative spiritual coping--depression showed that there were direct [B = -0.302, 95%CI(− 0.404, − 0.190)] and indirect effects of hope on depression mediated solely by social support [B = -0.126, 95%CI(− 0.205, − 0.071)] and negative spiritual coping [B = -0.033, 95%CI(− 0.080,-0.002)], or by both together [B = -0.010, 95%CI(− 0.030,-0.001)]. CONCLUSIONS: This study proves the hypothesis that social support and spiritual coping play intermediary roles between hope and depression. Interventions established through hope, social support and spiritual coping can effectively prevent depression from occurring.