The mediating effect of distress disclosure and recovery experiences on perceived social support and psychological distress in patients with lung cancer and COPD

  • Qiyu Liu General Practice Department, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi People’s Hospital, Wuxi 214023, China
  • Jiacheng Zhou General Practice Department, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi People’s Hospital, Wuxi 214023, China
  • Xingmei Zhao General Practice Department, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi People’s Hospital, Wuxi 214023, China
  • Jiao Xuan General Practice Department, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi People’s Hospital, Wuxi 214023, China
  • Qi Mo General Practice Department, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi People’s Hospital, Wuxi 214023, China
  • Xiaofen Shi * Department of Internal Medicine, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi People’s Hospital, Wuxi 214023, China
Article ID: 4317
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DOI: https://doi.org/10.18282/po4317
Keywords: Psychological distress; perceived social support; distress disclosure; recovery experience

Abstract

Background: This study examines the factors contributing to psychological distress in elderly patients with lung cancer and comorbid COPD, while also investigating the mediating roles of distress disclosure and recovery experience in the relationship between perceived social support and psychological distress. The findings aim to inform clinical interventions for this population. Methods: From December 2021 to December 2024, 162 elderly patients diagnosed in our hospital with lung cancer accompanied by COPD were recruited as the research subjects. The general information Questionnaire, Perceived Social Support Scale (PSSS), Distress Disclosure Index (DDI), Recovery Experience Questionnaire (REQ) and Kessler Psychological Scale K10 (Kessler10) were used to conduct a cross-sectional survey. The data were statistically analyzed by chi-square test, binary logistics regression and linear regression, and the mediating effect was tested by Hayes’ SPSS-Process program model 6. Results: 162 lung cancer patients with COPD were included in this study, of which 98 patients had psychological distress, accounting for 60.5%. The results showed that self-paid medical treatment, advanced cancer, and the presence of complications were the covariates affecting the psychological distress of patients. Results of the correlation analysis demonstrated that patients is perceived social support exhibited a positive correlation with distress disclosure and recovery experience, while showing a negative correlation with psychological distress. Bootstrap mediating effect test demonstrated that the total effect value of perceived social support on psychological distress in COPD patients with lung cancer was −0.890. Distress disclosure and recovery experience had a partial mediating effect between perceived social support and psychological distress, accounting for 19.3% and 22.9% of the mediating effect, respectively. Conclusion: Negative psychological problems such as psychological distress are still serious in elderly lung cancer patients with COPD. distress disclosure and recovery experience play a chain mediating role between perceived social support and psychological distress in elderly patients. Therefore, by improving distress disclosure and recovery experience, our efforts can enable them to better recognize the role of social support in relieving psychological distress and ultimately elevate their mental health status.

Published
2026-01-14
How to Cite
Liu, Q., Zhou, J., Zhao, X., Xuan, J., Mo, Q., & Shi, X. (2026). The mediating effect of distress disclosure and recovery experiences on perceived social support and psychological distress in patients with lung cancer and COPD. Psycho-Oncologie, 20(1), 4317. https://doi.org/10.18282/po4317
Issue
Vol. 20 No. 1 (2026)
Section
Article

Copyright (c) 2026 Qiyu Liu, Jiacheng Zhou, Xingmei Zhao, Jiao Xuan, Qi Mo, Xiaofen Shi

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

References

1. O’Shaughnessy M, Sheils O, Baird AM. The Lung Microbiome in COPD and Lung Cancer: Exploring the Potential of Metal-Based Drugs. International Journal of Molecular Sciences. 2023; 24(15): 12296. doi: 10.3390/ijms241512296

2. Taucher E, Mykoliuk I, Lindenmann J, et al. Implications of the Immune Landscape in COPD and Lung Cancer: Smoking Versus Other Causes. Frontiers in Immunology. 2022; 13. doi: 10.3389/fimmu.2022.846605

3. Wang G, Ma A, Zhang L, et al. Acute exacerbations of chronic obstructive pulmonary disease in a cohort of Chinese never smokers goes along with decreased risks of recurrent acute exacerbation, emphysema and comorbidity of lung cancer as well as decreased levels of circulating eosinophils and basophils. Frontiers in Medicine. 2022; 9. doi: 10.3389/fmed.2022.907893

4. de Alencar VTL, Figueiredo AB, Corassa M, et al. Lung cancer in never smokers: Tumor immunology and challenges for immunotherapy. Frontiers in Immunology. 2022; 13. doi: 10.3389/fimmu.2022.984349

5. Huang R, Wei Y, Hung RJ, et al. Associated Links Among Smoking, Chronic Obstructive Pulmonary Disease, and Small Cell Lung Cancer: A Pooled Analysis in the International Lung Cancer Consortium. EBioMedicine. 2015; 2(11): 1677–1685. doi: 10.1016/j.ebiom.2015.09.031

6. Yohannes AM, Roomi J, Baldwin RC, et al. Depression in elderly outpatients with disabling chronic obstructive pulmonary disease. Age and Ageing. 1998; 27(2): 155–160. doi: 10.1093/ageing/27.2.155

7. Schneider C, Jick SS, Bothner U, et al. COPD and the Risk of Depression. Chest. 2010; 137(2): 341–347. doi: 10.1378/chest.09-0614

8. Kunik ME. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest. 2005; 127: 1205–1211. doi: 10.1016/S0012-3692(15)34468-8

9. Spitzer C, Gläser S, Grabe HJ, et al. Mental health problems, obstructive lung disease and lung function: Findings from the general population. Journal of Psychosomatic Research. 2011; 71(3): 174–179. doi: 10.1016/j.jpsychores.2011.03.005

10. Pitman A, Suleman S, Hyde N, et al. Depression and anxiety in patients with cancer. BMJ. 2018; k1415. doi: 10.1136/bmj.k1415

11. Sarason BR, Pierce GR, Shearin EN, et al. Perceived social support and working models of self and actual others. Journal of Personality and Social Psychology. 1991; 60(2): 273–287. doi: 10.1037/0022-3514.60.2.273

12. Cohen S. Social Relationships and Health. American Psychologist. 2004; 59(8): 676-684. doi: 10.1037/0003-066x.59.8.676

13. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: A meta-analytic review. PLoS Medicine. 2010; 7(7). doi: 10.1371/journal.pmed.1000316

14. Tian X, Jin YF, Chen H, et al. Relationships among social support.coping style,perceived stress, and psychological distress in chineselung cancer patients. Asia-Pacific Journal of Oncology Nursing. 2021; 8(2): 172–179. doi: 10.4103/apjon.apjon_59_20

15. Hamsyah F, Miyanaka D, Tokita M, et al. Validation of the Indonesian version of the Recovery Experience Questionnaire. Industrial Health. 2024; 62(2): 90–101. doi: 10.2486/indhealth.2023-0070

16. Steed LB, Swider BW, Keem S, et al. Leaving Work at Work: A Meta-Analysis on Employee Recovery from Work. Journal of Management. 2019; 47(4): 867–897. doi: 10.1177/0149206319864153

17. Tamir DI, Mitchell JP. Disclosing information about the self is intrinsically rewarding. Proceedings of the National Academy of Sciences. 2012; 109(21): 8038–8043. doi: 10.1073/pnas.1202129109

18. Du X, Wang D, Du H, et al. The correlation between intimate relationship, self-disclosure, and adaptability among colorectal cancer enterostomy patients. Medicine. 2021; 100(19): e25904. doi: 10.1097/md.0000000000025904

19. Laschober TC, Serovich JM, Brown MJ, et al. Mediator and moderator effects on the relationship between HIV-positive status disclosure concerns and health-related quality of life. AIDS Care. 2019; 31(8): 994–1000. doi: 10.1080/09540121.2019.1595511

20. Ong HL, Vaingankar JA, Abdin E, et al. Resilience and burden in caregivers of older adults: moderating and mediating effects of perceived social support. BMC Psychiatry. 2018; 18(1). doi: 10.1186/s12888-018-1616-z

21. Gregory Zimet, Nancy W Dahlem, Sara G Zimet, et al. The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment. 1988； 52(1):30–41. doi:10.1207/s15327752jpa52012

22. Andrews G, Slade T. Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health. 2001; 25(6): 494–497. doi: 10.1111/j.1467-842x.2001.tb00310.x

23. Kazlauskas E, Dumarkaite A, Gelezelyte O, et al. Validation of the Recovery Experience Questionnaire in a Lithuanian Healthcare Personnel. International Journal of Environmental Research and Public Health. 2023; 20(3): 2734. doi: 10.3390/ijerph20032734

24. Kahn J H, Hucke B E, Bradley A M, et al. The Distress Disclosure Index: A research review and multitrait-multimethod examination. Journal of Counseling Psychology. 2012; 59(1), 134–149. doi: 10.1037/a0025716

25. You X, Wen Q, Gu J, et al. Assessing the mediating role of self-disclosure between mental health literacy and psychological distress: a cross-sectional study among HIV-positive young and middle-aged men who have sex with men in China. BMJ Open. 2025; 15(2): e095735. doi: 10.1136/bmjopen-2024-095735

26. GBD 2019 Chronic Respiratory Diseases Collaborators Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the global burden of Disease Study 2019. E Clinical Medicine. 2023; 59: 101936. doi:10.1016/j.eclinm.2023.101936.

27. Rades D, Al-Salool A, Bohnet S, et al. Prevalence of and Risk Factors for Emotional Distress in Patients Undergoing Radiotherapy for Lung Cancer. Anticancer Research. 2023; 43(5): 2111–2118. doi: 10.21873/anticanres.16372

28. Hamer M, Chida Y, Molloy GJ. Psychological distress and cancer mortality. Journal of Psychosomatic Research. 2009; 66(3): 255–258. doi: 10.1016/j.jpsychores.2008.11.002

29. Tsuchiya M, Adachi K, Kumagai K, et al. Cancer disclosure to friends: Survey on psychological distress and perceived social support provision. European Journal of Cancer Care. 2020; 31(5). doi: 10.1111/ecc.13332

30. Han DY, Lin YY, Liao SC, et al. Analysis of the barriers of mental distress disclosure in medical inpatients in Taiwan. International Journal of Social Psychiatry. 2014; 61(5): 446–455. doi: 10.1177/0020764014552865

31. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors. Medicine & Science in Sports & Exercise. 2010; 42(7): 1409–1426. doi: 10.1249/mss.0b013e3181e0c112

32. Ding J, Gehrman PR, Liu S, et al. Recovery Experience as the Mediating Factor in the Relationship Between Sleep Disturbance and Depressive Symptoms Among Female Nurses in Chinese Public Hospitals: A Structural Equation Modeling Analysis Psychology Research and Behavior Management. 2020; 13: 303–311. doi: 10.2147/prbm.s243864

33. Li Y, Yang Y, Yuan J, et al. Differences in medical costs among urban lung cancer patients with different health insurance schemes: a retrospective study. BMC Health Services Research. 2022; 22(1). doi: 10.1186/s12913-022-07957-9