Mediating effect of resilience on the influence of insomnia and pain severity on depressive symptoms in patients with cancer

Sleep Biol Rhythms. 2026 Feb 15;24(3):315-323. doi: 10.1007/s41105-026-00634-y. eCollection 2026 Jul.

ABSTRACT

We explored whether resilience mediates the relationship between insomnia, pain, and depression in patients with cancer. This retrospective medical records review study included cancer patients aged 18-79 years who visited a Stress Management Clinic between July 1, 2021, and June 30, 2022. Demographic information; responses to rating scales such as Patient Health Questionnaire-9 items (PHQ-9), State subcategory of the State-Trait Anxiety Inventory (STAI-S), Insomnia Severity Index (ISI), Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), Connor-Davidson Resilience Scale-2 (CD-RISC2); and single items for pain and fatigue symptoms were collected. The mean age of the sample was 56.1 ± 13.1 years, and 67.2% were female. Positive correlations were observed between the PHQ-9 and ISI scores (r = 0.47, p < 0.01), as well as with pain (r = 0.30, p < 0.01). Conversely, negative correlations were observed between CD-RISC2 and PHQ-9 (r=-0.29, p < 0.01), CD-RISC2 and ISI (r = - 0.14, p < 0.01), as well as CD-RISC2 and pain (r=-0.13, p < 0.01). Linear regression analysis identified ISI, STAI-S, CD-RISC2, pain, and fatigue as factors significantly associated with PHQ-9 score. Mediation analysis showed that the associations between insomnia/pain and depression were partially mediated through resilience. Both insomnia (β=-0.12, p = 0.007) and pain (β=-0.11, p = 0.014) were associated with lower resilience, which in turn was negatively associated with depression (β=-0.21, p < 0.001). The indirect effects of resilience were statistically significant (insomnia: β = 0.02, p = 0.016; pain: β = 0.05, p = 0.025). Total associations: ISI→PHQ-9: β = 0.42 (p < 0.001); pain→PHQ-9: β = 0.22 (p < 0.001). Lower resilience partially mediated the association between insomnia/pain and depression in patients with cancer. Longitudinal studies are further required to confirm causality.

PMID:42367616 | PMC:PMC13304038 | DOI:10.1007/s41105-026-00634-y