# The relationship between perceived stress and depression in colorectal cancer patients: the mediating role of illness perception and the moderating role of self-efficacy

## TL;DR

This study explores how stress leads to depression in colorectal cancer patients, showing that illness perception mediates this link and self-efficacy plays a moderating role.

## Contribution

The study reveals illness perception as a mediator and self-efficacy as a moderator in the stress-depression relationship among colorectal cancer patients.

## Key findings

- Perceived stress is strongly correlated with depression in colorectal cancer patients.
- Illness perception partially mediates the relationship between stress and depression.
- Higher self-efficacy strengthens the link between perceived stress and illness perception.

## Abstract

Numerous studies have demonstrated a close association between perceived stress and depression in colorectal cancer patients; however, the underlying mechanisms remain incompletely understood. This study aims to investigate the impact of perceived stress on depression in this population, as well as the mediating role of illness perception and the moderating role of self-efficacy.

A cross-sectional design was employed. From May to November 2024, a questionnaire survey was conducted among 290 colorectal cancer patients at two Grade A tertiary hospitals in Shenyang and Jinzhou, Liaoning Province, China. The questionnaire comprised sections on general demographics, perceived stress, illness perception, self-efficacy, and depression. Descriptive statistics and correlation analyses were performed using SPSS 25.0 and the PROCESS 3.5 macro. Mediation and moderation effects were tested using bootstrap resampling.

A significant positive correlation was found between perceived stress and depression (β = 0.483, P < 0.001) and this relationship was partially mediated by illness perception (β = 0.083). Self-efficacy moderated the association between perceived stress and illness perception (β = 0.024, P < 0.001), with higher levels of self-efficacy strengthening the relationship between perceived stress and illness perception.

This study identifies illness perception as a mediating pathway in the association between perceived stress and depression, while self-efficacy moderates the relationship between perceived stress and illness perception. Accordingly, a multidimensional clinical approach may be considered for addressing depressive symptoms in colorectal cancer patients. Such an approach could concurrently target perceived stress reduction, modification of illness perception, and enhancing self-efficacy.