A dyadic approach to mindfulness and psychological flexibility on depressive symptoms in couples facing gynecological cancers: A cross-sectional study

Abstract

Background:Gynecologic cancer couples have reported high depressive symptom levels. Mindfulness and psychological flexibility are negatively associated with depressive symptoms, but their beneficial effects have rarely been studied beyond the individual level. Few studies address their associations with depression in patient-spouse dyads facing gynecological cancer.

Objective:Explore dyadic associations among couples regarding mindfulness, its five facets, and psychological flexibility with depressive symptoms.

Study design:A cross-sectional study.

Methods:One hundred dyads with one person diagnosed with gynecological (cervix uteri, corpus uteri, or ovary) cancer and their spouses responded to surveys examining depressive symptoms, mindfulness (observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience), and psychological flexibility. The Actor-Partner Interdependence Model was used to explore dyadic associations.

Results:Patients’ and spouses’ acting with awareness (actor effect: β = −0.440, P < 0.001; β = −0.207, P = 0.045) and Acceptance and Action Questionnaire-II (AAQ-II) scores (actor effect: β = 0.604, P < 0.001; β = 0.370, P < 0.001) were associated with depressive symptoms. Patients’ acting with awareness and AAQ-II scores were associated with spouses’ depressive symptoms (partner effect: β = −0.252, P = 0.015; β = 0.227, P = 0.016). Couple similarity scores in describing and non-judging scores played a significant role in patients’ and spouses’ depressive symptoms (describing: β = 0.197, P = 0.045; β = 0.313, P < 0.001; non-judging: β = 0.336, P < 0.001; β = 0.212, P = 0.033).

Conclusions:Mindfulness and psychological flexibility can affect couples’ psychological distress. Future research should examine whether couples facing gynecological cancers benefit from programs that foster an awareness of attending to the present moment and psychological flexibility.

Keywords

Gynecologic cancer / Depression / Mindfulness / Psychological flexibility / Dyads

Ethics approval

The study followed the principles of the Declaration of Helsinki as revised in 2013. The approval number for this study is 2017-R029. Written informed consent was obtained from all participants. This manuscript has the consent of the participant for the use of his/her data and for the publication of the data that appear in the article.

Funding

This work was supported by the Natural Science Foundation of Shandong Province (grant no. ZR2017MC070).

CRediT authorship contribution statement

Zhang Xuan: Formal analysis, Writing - original draft, Data curation. Zhang Huihui: Methodology, Visualization, Investigation, Conceptualization. Li Jiahuan: Investigation. Shao Di: Methodology, Conceptualization. Li Jie: Methodology, Validation. Jiao Jianfen: Resources. Cao Fenglin: Supervision, Writing - review & editing, Project administration. All authors have read and approved the final version of this manuscript.

Data availability

The dataset utilized and/or analyzed in this study is available from the corresponding author upon reasonable request.

Declaration of Competing Interest

The authors declare that they have no conflicts of interest. Author Fenglin Cao is an editorial board member of Healthcare and Rehabilitation but has not been involved in the journal's review of or decisions related to this manuscript.

Acknowledgment

The authors are grateful to all participants for their time and effort.

Appendix A. Supplementary material

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.hcr.2025.100023.

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