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

BackgroundNumerous 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.MethodA 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.ResultsA 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.ConclusionThis 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.