Factors influencing social avoidance and distress after radical lung cancer resection: a mediation analysis

To investigate factors influencing social avoidance and distress (SAD) in patients following radical resection of lung cancer (RRLC) and analyze the mediating effects among these factors.

Clinical data from 320 patients who underwent RRLC between January 2022 and December 2023 at the General Hospital of Western Theater Command PLA were analyzed. Data were collected using the General Information Questionnaire, Social Avoidance and Distress Scale (SADS), Hospital Anxiety and Depression Scale (HADS), Perceived Social Support Scales (PSSS), General Self-Efficacy Scale (GSES), and Consumer Experiences of Stigma Questionnaire (CESQ). Spearman correlation analysis explored the relationships between SAD, anxiety and depression, social support, self-efficacy, and stigma. Multiple linear regression identified factors influencing SAD. The PROCESS tool was used to test the mediating effects of these factors.

The mean SADS score was 16.73±4.69. SAD was positively correlated with anxiety, depression, and stigma (r=0.662, P<0.001; r=0.687, P<0.001) and negatively correlated with self-efficacy and social support (r=-0.682, P<0.001; r=-0.705, P<0.001). Multiple linear regression indicated that anxiety, depression, social support, self-efficacy, and stigma were significant influencers of SAD (β=0.132, P<0.001; β=-0.078, P<0.001; β=-0.178, P<0.001; β=0.115, P=0.002). Mediation analysis revealed that anxiety and depression directly affected SAD and indirectly influenced SAD through social support, stigma, and self-efficacy, both independently and via chain mediation (P<0.05).

Patients post-RRLC generally exhibit moderate SAD levels. Anxiety and depression directly influence SAD and also indirectly through the mediating effects of social support, stigma, and self-efficacy. Therefore, reducing depression and stigma while enhancing social support and self-efficacy is crucial for alleviating SAD in these patients.