UUnniivveerrssiittyy ooff SSoouutthh FFlloorriiddaa SScchhoollaarr CCoommmmoonnss Graduate Theses and Dissertations Graduate School 3-1-2010 DDeepprreessssiioonn iinn LLuunngg CCaanncceerr PPaattiieennttss:: RRoollee ooff PPeerrcceeiivveedd SSttiiggmmaa Brian D. Gonzalez University of South Florida Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the American Studies Commons SScchhoollaarr CCoommmmoonnss CCiittaattiioonn Gonzalez, Brian D., "Depression in Lung Cancer Patients: Role of Perceived Stigma" (2010). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/1645 This Thesis is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. Depression in Lung Cancer Patients: Role of Perceived Stigma by Brian D. Gonzalez A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts Department of Psychology College of Arts & Sciences University of South Florida Major Professor: Paul B. Jacobsen, Ph.D. Jennifer Bosson, Ph.D. Thomas Brandon, Ph.D. Date of Approval: March 1, 2010 Keywords: psycho-oncology, mood disorders, thoracic oncology, smoking, tobacco © Copyright 2010, Brian D. Gonzalez Dedication To my loving wife Rebecca, whose support and understanding throughout this process has been invaluable. I love you forever. Table of Contents List of Tables ii List of Figures iii Abstract iv Introduction 1 Lung Cancer 1 Depression in Lung Cancer Patients 2 Correlates of Depression in Lung Cancer Patients 3 Demographic Factors 4 Clinical Factors 4 Psychosocial Factors 5 Smoking Behavior 6 Stigma and Lung Cancer Patients 7 Dyadic Adjustment and Dysfunctional Attitudes 9 Aims 10 Hypotheses 11 Method 11 Participants 11 Procedure 11 Measures 12 i Statistical Analyses 16 Results 20 Participants 20 Relationship of Perceived Stigma and Depressive Symptomatology 24 Relationship of Other Psychosocial Variables with Depressive Symptomatology 25 Relationships of Demographic and Clinical Variables with Depressive Symptomatology 26 Regression Analyses of Depressive Symptomatology 29 Relationships of Demographic and Clinical Variables with Perceived Stigma 36 Mediational Analyses 40 Discussion 43 Summary of Results 43 Theoretical and Clinical Implications 45 Limitations 48 Future Directions 49 References 51 ii List of Tables Table 1 Demographic Characteristics of the Sample 23 Table 2 Clinical Characteristics of the Sample 24 Table 3 Mean, Standard Deviations, and Internal Consistency Reliabilities of Psychosocial Scales 25 Table 4 Correlations Between Depressive Symptomatology and Perceived Stigma 26 Table 5 Correlations Between Depressive Symptomatology and Psychosocial Variables 27 Table 6 Relationships Between Depressive Symptomatology and Demographic Variables 28 Table 7 Relationships Between Depressive Symptomatology and Clinical Variables 29 Table 8 Summary of Hierarchical Regression Analysis for Variables Predicting Depressive Symtpomatology 31 Table 9 Summary of Hierarchical Regression Analysis for Variables Predicting Depressive Symtpomatology (CES-D) Among Participants Living With a Spouse or Partner 33 Table 10 Summary of Hierarchical Regression Analysis for Variables Predicting Depressive Symtpomatology (CES-D) 35 iii Table 11 Summary of Hierarchical Regression Analysis for Variables Predicting Depressive Symtpomatology (CES-D) 36 Table 12 Relationships Between Perceived Stigma and Demographic Variables 38 Table 13 Relationships Between Perceived Stigma and Clinical Variables 39 Table 14 Summary of Stepwise Regression Analysis for Variables Predicting Perceived Stigma (SIS) 40 Table 15 Correlations Between Perceived Stigma and Psychosocial Variables 41 iv List of Figures Figure 1 Path Diagram for the Indirect Effect of a Predictor on a Dependent Variable through a Mediator 18 Figure 2 Participant Flow Chart 21 Figure 3 Proposed Model of Social Support (ESSI) as a Mediator Between Perceived Stigma (SIS) and Depressive Symptomatology (CES-D) 42 Figure 4 Proposed Model of Dyadic Adjustment (DAS-4) as a Mediator Between Perceived Stigma (SIS) and Depressive Symptomatology (CES-D) 43 Figure 5 Proposed Models of Dysfunctional Attitudes (DAS) as a Mediator Between Perceived Stigma (SIS) and Depressive Symptomatology (CES-D) 44 v Depression in Lung Cancer Patients: Role of Perceived Stigma Brian D. Gonzalez ABSTRACT Previous research suggests that lung cancer patients are at an increased risk for depressive symptomatology; however, little is known about the possible etiology or correlates of depression among these patients. This study examined the relationship between perceived stigma and depressive symptomatology among lung cancer patients, and sought to find potential mediators of this relationship. It was hypothesized that more perceived stigma would be related to greater depressive symptomatology and that perceived stigma would contribute unique variance to depressive symptomatology above and beyond that contributed by clinical, demographic, and psychosocial variables. A sample of 95 participants receiving chemotherapy for stage II-IV non-small cell lung cancer was recruited during routine outpatient chemotherapy visits. A medical chart review was conducted to assess clinical factors and participants completed a standard demographic questionnaire as well as measures of perceived stigma, depressive symptomatology, and other psychosocial variables. As hypothesized, there was a positive association of perceived stigma to depressive symptomatology. Perceived stigma contributed significant unique variance to depressive symptomatology. In addition dyadic adjustment and dysfunctional attitudes mediated this relationship. Future research should aim to replicate and extend these findings in longitudinal analyses and attempt to vi ameliorate lung cancer patients’ depressive symptomatology by targeting perceived stigma. vii