Association Between Perceived Stress, Loneliness and Sleep Disorders Among Breast Cancer Patients: the Moderating Roles of Resilience

Abstract Purpose: Sleep disorders are prevalent and often neglected among breast cancer patients. This study aimed to identify the association among perceived stress, loneliness, resilience and sleep disorders, and to further explore whether resilience could be a moderator in the association between perceived stress, loneliness and sleep disorders among Chinese female breast cancer patients. Methods: A cross-sectional study was conducted at a tertiary hospital in Anshan, China from October 2019 to October 2020. 492 valid questionnaires were collected. Patients were asked in response to the questionnaires including the Pittsburgh Sleep Quality Index, Perceived Stress Scale-10, the Three-Item Loneliness Scale and Resilience Scale-14. The association among perceived stress, loneliness, resilience and perceived stress/loneliness × resilience interaction with sleep disorders were examined by hierarchical multiple regression analysis. The interaction was visualized by using simple slope analysis. Results: In our study, 36.58% of the female breast cancer patients reported sleep disorders. Perceived stress and loneliness were related to sleep disorders. Resilience could moderate the relationship between them and sleep disorders. When resilience was higher, perceived stress and loneliness had a weaker impact on sleep disorders. Conclusions: There was a high prevalence of sleep disorders and this study implied an adverse effect of perceived stress, loneliness on the sleep quality. However, resilience could moderate the association between perceived stress, loneliness and sleep disorders. More positive psychological interventions should be integrated into the prevention of sleep disorders among cancer patients.