Stress, Coping Appraisal and Health Outcomes in Women After Cancer: Testing Competing Models

Background: Stress is a physical and emotional response that occurs when an individual is exposed to a specific threat or hazard (Koolhaas et al., 2011). To some extent, stress is a normal part of life and can increase motivation and alertness. In contrast, exposure to chronic stress influences production of glucocorticoids, immune function indicators, and can also affect the structure and function of part of the brain (Lupien, McEwen, Gunnar, & Heim, 2009; Bruce S. McEwen & Morrison, 2013; McGregor & Antoni, 2009). These alterations then impact on the cardiovascular, autonomic, and immune systems, impair metabolic function, and potentially lead to dysregulation, changes in lifestyle behaviours, and ongoing health problems (Cohen et al., 2009; B. S. McEwen, 2008). In female cancer survivors specifically, life stressors have been linked to cancer outcomes by contributing to poor psychological adaptation to cancer diagnosis, (McGregor & Antoni, 2009), altering health behaviour and delaying cancer treatment (Lehto, Ojanen, & Kellokumpu-Lehtinen, 2005; Low, Stanton, Thompson, Kwan, & Ganz, 2006). Stressors in women after cancer have also been linked with increased depression risk, reduced quality of life, and influencing survival rates (Chida, Hamer, Wardle, & Steptoe, 2008; Helgeson, Snyder, & Seltman, 2004). While there is evidence to suggest that exposure to stress can adversely affect health, the extent to which stress contributes to poor health outcomes is often difficult to determine because of methodological, operational, and population differences across existing studies.

Aims: The aims of the paper are to: (1) examine past and current life stressors reported by women after cancer, and; (2) determine their relationship with stress appraisal and resilience, and increased anxiety and depressive symptoms.

Methods: This paper presents baseline data from 324 women participating in the multisite lifestyle intervention, Women’s Wellness After Cancer Program or WWACP. To ensure rigorous and comparable result, 27 women with incomplete data on anxiety and depressive symptoms (outcome variables), stressful life events (predictor), perceived stress and resilience (mediators) were excluded from the analysis.

Results: Over one-quarter (26%) of women reported adverse/stressful life events other than their cancer diagnosis and treatment in the 6 months prior to interview, most commonly related to the illness/injury of a close relative (10%), death of a close family friend or second-degree relative (9%), our interpersonal relationship issues (7%). Similar trends were noted for life stressors over a longer timeframe. Serial mediation models analysed the effect of stressful life events (mediated by stress appraisal and coping, and anxiety and depressive symptoms (outcome variables). Regression coefficients were calculated for each pathway and significance of parameter estimates (B) and bias-corrected 95% confidence intervals (95% CI) for the indirect effects were generated using bootstrapping (10,000 iterations) (Preacher & Hayes, 2004). Results showed that perceived stress fully mediated the relationships between life stress, anxiety (ab = 0.09, Bias-corrected bootstrap 95% CI 0.02 – 0.16, P_M = 0.52) and depressive symptoms (ab = 0.10, Bias-corrected bootstrap 95% CI 0.02 – 0.19, P_M = 0.68) and accounted for more than half of the relationship between predictor and outcome.