# The Mediating Role of Depression in the Association Between Death Anxiety and Quality of Life in Elderly Prostate Cancer Patients

## TL;DR

This study shows that death anxiety affects the quality of life of elderly prostate cancer patients both directly and indirectly through depression.

## Contribution

The study identifies depression as a mediator between death anxiety and quality of life in elderly prostate cancer patients.

## Key findings

- Death anxiety was positively correlated with depression and negatively with quality of life.
- Depression partially mediated the negative effect of death anxiety on quality of life.
- Factors like chronic illnesses and caregiver status influenced depression and death anxiety levels.

## Abstract

A decreased quality of life is commonly observed in elderly patients with prostate cancer (PCa), and psychological changes in these patients require particular attention. This study aimed to investigate factors influencing depression, death anxiety, and quality of life in elderly PCa patients and to explore the mediating role of depression in the relationship between death anxiety and quality of life.

A total of 120 valid questionnaires from PCa patients at Lu'an Hospital of Anhui Medical University were collected between October 2021 and July 2024. The Templer Death Anxiety Scale (T-DAS), Zung Self-Rating Depression Scale (SDS), and Functional Assessment of Cancer Therapy for PCa (FACT-P) were used to assess death anxiety, depression, and quality of life, respectively. Influencing factors and the mediating role of depression between death anxiety and quality of life were analyzed.

(1) Patients had a mean SDS score of 56.93 ± 4.47, T-DAS score of 44.83 ± 7.18 and FACT-P score of 103.52 ± 6.22; (2) Univariate analyses showed that patients' depression levels were associated with occupational status, average monthly income, length of illness, primary caregiver, and number of chronic illnesses (p < 0.05); death anxiety levels were associated with age, length of illness, primary caregiver, and number of chronic illnesses (p < 0.05); and quality of life was associated with age, BMI, and number of primary caregivers and chronic illnesses (p < 0.05); (3) Correlation analysis showed that depression was negatively correlated with quality of life (ρ = –0.360, p < 0.001), death anxiety was negatively correlated with quality of life (ρ = –0.456, p < 0.001), and death anxiety was positively correlated with depression (ρ = 0.493, p < 0.001); (4) Death anxiety had a significant negative effect on quality of life, with a direct effect of –0.262 and a total effect of –0.429. Depression significantly mediated the relationship between death anxiety and quality of life, with a mediating effect of –0.167 (95% CI: –0.331 to –0.045).

Depressive symptoms and death anxiety are prevalent among elderly PCa patients. Death anxiety directly impacts the quality of life of patients and also mediates an indirect effect through depression, further reducing patients' quality of life.