{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T12:23:25Z","timestamp":1771935805884,"version":"3.50.1"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Numerous studies have demonstrated a close association between perceived stress and depression in colorectal cancer patients; however, the underlying mechanisms remain incompletely understood. This study aims to investigate the impact of perceived stress on depression in this population, as well as the mediating role of illness perception and the moderating role of self-efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A cross-sectional design was employed. From May to November 2024, a questionnaire survey was conducted among 290 colorectal cancer patients at two Grade A tertiary hospitals in Shenyang and Jinzhou, Liaoning Province, China. The questionnaire comprised sections on general demographics, perceived stress, illness perception, self-efficacy, and depression. Descriptive statistics and correlation analyses were performed using SPSS 25.0 and the PROCESS 3.5 macro. Mediation and moderation effects were tested using bootstrap resampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant positive correlation was found between perceived stress and depression (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 0.483,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) and this relationship was partially mediated by illness perception (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 0.083). Self-efficacy moderated the association between perceived stress and illness perception (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 0.024,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), with higher levels of self-efficacy strengthening the relationship between perceived stress and illness perception.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identifies illness perception as a mediating pathway in the association between perceived stress and depression, while self-efficacy moderates the relationship between perceived stress and illness perception. Accordingly, a multidimensional clinical approach may be considered for addressing depressive symptoms in colorectal cancer patients. Such an approach could concurrently target perceived stress reduction, modification of illness perception, and enhancing self-efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1746202","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T05:33:08Z","timestamp":1771392788000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between perceived stress and depression in colorectal cancer patients: the mediating role of illness perception and the moderating role of self-efficacy"],"prefix":"10.3389","volume":"16","author":[{"given":"Fuzhuo","family":"Wang","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiashuang","family":"Xu","sequence":"additional","affiliation":[{"name":"Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Sun","sequence":"additional","affiliation":[{"name":"Liaoning Cancer Hospital & Institute","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuli","family":"Wang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongguang","family":"Che","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye","family":"Huang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32319-0","article-title":"Colorectal cancer","volume":"394","author":"Dekker","year":"2019","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s10555-023-10158-3","article-title":"Colorectal cancer: a comprehensive review of carcinogenesis, diagnosis, and novel strategies for classified treatments","volume":"43","author":"Abedizadeh","year":"2024","journal-title":"Cancer Metast Rev"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29110689","article-title":"Colorectal cancer and onset of anxiety and depression: A systematic review and meta-analysis","volume":"29","author":"Cheng","year":"2022","journal-title":"Curr Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.7330","article-title":"Association between anxiety, depression, and symptom burden in patients with advanced colorectal cancer: A multicenter cross-sectional study","volume":"13","author":"Song","year":"2024","journal-title":"Cancer Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s00384-024-04619-6","article-title":"Prognostic value of depression and anxiety on colorectal cancer-related mortality: a systematic review and meta-analysis based on univariate and multivariate data","volume":"39","author":"Xia","year":"2024","journal-title":"Int J Colorect Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s11920-018-0893-z","article-title":"Psychological pain, depression, and suicide: recent evidences and future directions","volume":"20","author":"Conejero","year":"2018","journal-title":"Curr Psychiatry Rep"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1037\/a0025242","article-title":"The different roles of perceived stress in the association between older adults\u2019 physical activity and physical health","volume":"31","author":"Rueggeberg","year":"2012","journal-title":"Health Psychol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1063","article-title":"Stress, self-efficacy and quality of life in cancer patients","volume":"16","author":"Kreitler","year":"2007","journal-title":"Psycho-Oncology"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-06880-3","article-title":"Cognitive appraisal of the disease and stress level in lung cancer patients. 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