Factors Influencing Resilience of Patients with Hematologic Malignancy

So Young Kwak; Young Soon Byeon

doi:10.7475/KJAN.2013.25.1.95

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Factors Influencing Resilience of Patients with Hematologic Malignancy

So Young Kwak¹, Young Soon Byeon²

Korean Journal of Adult Nursing 2013;25(1):95-104.
Published online: February 18, 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.1.95

¹Division of Hematology, Yonsei University Health System, Severance Hospital, Seoul

²Division of Nursing Science, College of Health Science, Ewha Womans University, Seoul, Korea

Corresponding author: Byeon, Young Soon Division of Nursing Science, College of Health Science, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-2884, Fax: +82-2-3277-2850, E-mail: ysbyeon@ewha.ac.kr

• Received: October 2, 2012 • Accepted: February 21, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to investigate the level of resilience, family support, anxiety and depression in patients with hematologic malignancy, and to determine modifiable psychosocial factors that affect their resilience.
Methods
Data were collected from 104 patients undergoing curative therapy at 'S' hospital in Seoul. The data were collected from April to May, 2012. The questionnaires included Korean Version of Connor-Davidson Resilience Scale, Family Support Scale and Hospital Anxiety-Depression Scale. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation and stepwise multiple regression.
Results
Resilience had statistically significant correlation with family support (r=.43, p<.001), anxiety (r=-.49, p<.001) and depression (r=-.52, p<.001). Factors influencing resilience were depression, family support, anxiety and time since diagnosis with R-sq. value of 36%.
Conclusion
The results of the study show that family support, anxiety and depression have important influences on resilience of patients with hematologic malignancy. Thus, family support needs to be reinforced when developing and implementing nursing intervention, and nurses need to intervene to reduce anxiety and depression of patients with hematologic malignancy.
Key Words: Hematologic neoplasms; Psychological resilience; Social support; Anxiety; Depression

Table 1.

Resilience, Family Support, Anxiety, and Depression (N=104)

Variables	Score	n (%) or M±SD	Min	Max	Possible score range
Resilience		71.07±13.25	28	97	0~100
Family support		47.43±7.51	24	55	11~55
Anxiety		6.04±3.33	0	18	0~21
	0~7 (Normal)	81 (77.9)
	8~10 (Mild)	16 (15.4)
	11~21 (Moderate~severe)	7 (6.7)
Depression		7.10±3.68	0	20	0~21
	0~7 (Normal)	58 (55.8)
	8~10 (Mild)	31 (29.8)
	11~21 (Moderate~severe)	15 (14.4)

Table 2.

Differences of Resilience, Family Support, Anxiety, and Depression according to Demographic and Medical Characteristics (N=104)

Characteristic	Categories	n (%)	Resilience		Family support		Anxiety		Depression
Characteristic	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	56 (53.8)	72.05±12.77	-0.82	47.34±7.56	0.14	5.25±2.98	2.69	7.38±3.55	-0.83
Gender	Female	48 (46.2)	69.92±13.83	(.415)	47.54±7.53	(.892)	6.96±3.50	(.008)	6.77±3.84	(.407)
Age (year)	≤29	10 (9.6)	70.90±9.40	1.00	49.10±5.45	0.68	5.70±2.21	1.01	6.60±3.06	1.58
	30~39	16 (15.4)	74.38±12.13	(.411)	49.19±4.64	(.610)	4.81±1.94	(.408)	5.19±2.76	(.186)
	40~49	21 (20.2)	74.38±12.47		45.95±9.51		6.95±4.17		8.00±3.83
	50~59	32 (30.8)	69.69±13.25		47.81±7.04		6.25±2.97		7.50±3.98
	≥60	25 (24.0)	68.00±15.58		46.40±8.46		5.92±3.95		7.24±3.69
Education	≤High school	63 (60.6)	70.27±14.48	-0.76	46.59±8.49	-1.56	6.10±3.66	0.22	6.84±4.03	-0.88
Education	≥College	41 (39.4)	72.29±11.16	(.449)	48.73±5.54	(.122)	5.95±2.78	(.830)	7.49±3.08	(.384)
Religion	No	29 (27.9)	67.28±13.23	-1.84 4	4 47.38±7.56	-0.05	6.21±3.41	0.32	8.03±3.37	1.63
Religion	Yes	75 (72.1)	72.53±13.05	(.069)	47.45±7.54	(.964)	5.97±3.32	(.750)	6.73±3.75	(.106)
Marital status	Married	78 (75.0)	71.81±13.48	-0.99	47.13±8.19	0.91	6.21±3.47	-0.88	7.38±3.76	-1.39
Marital status	Single	26 (25.0)	68.86±12.52	(.326)	48.35±4.94	(.367)	5.54±2.87	(.379)	6.23±3.35	(.167)
Occupation^†	Employed^a ^b	47 (45.2)	73.68±11.42	2.94	48.17±6.95	0.37	5.23±2.47	2.39	6.66±3.17	0.83
	None^b ^c	23 (22.1)	64.22±14.98	(.037)	46.52±8.03	(.775)	6.13±3.52	(.073)	8.13±3.33	(.481)
	Housewife^c	30 (28.8)	72.43±13.87	a＞b	46.80±8.46		7.27±4.11		7.00±4.62
	Student^d	4 (3.8)	71.07±13.25		48.75±2.87		5.75±2.63		7.00±3.46
Average monthly household income^† (10,000 won)	＜100^a	14 (13.5)	64.43±15.29	2.36	50.43±6.69	1.82	6.57±4.35	1.10	9.07±4.94	1.36
	100~200^b	20 (19.2)	71.35±13.21	(.045)	43.45±9.55	(.115)	6.70±3.81	(.367)	7.35±3.51	(.245)
	200~300^c	21 (20.2)	66.90±9.80	a＜d, f	47.00±6.43		6.48±3.66		7.29±3.85
	300~400^d	19 (18.3)	77.16±11.58		48.11±7.09		4.53±2.32		5.95±2.82
	400~500^e	14 (13.5)	70.71±13.44		48.71±5.85		5.93±2.84		6.36±3.52
	≥500^f	16 (15.4)	75.06±14.37		48.44±7.39		6.06±3.33		6.81±3.19
Primary caregiver	Yes	88 (84.6)	70.19±13.29	1.59	47.66±7.27	-0.72	6.06±3.47	-0.13	7.11±3.78	-0.11
Primary caregiver	None	16 (15.4)	75.88±12.34	(.115)	46.19±8.87	(.474)	5.94±2.46	(.896)	7.00±3.16	(.910)
Diagnosis	ML	50 (48.1)	72.88±10.83	1.34	48.70±7.05	2.13	5.68±2.84	1.04	6.60±3.19	0.92
	AML	20 (19.2)	67.20±14.98	(.265)	47.85±5.16	(.124)	6.95±3.52	(.356)	7.75±4.84	(.403)
	MM, SAA, MDS	34 (32.7)	70.68±15.73		45.32±8.93		6.03±3.84		7.44±3.59
Time since diagnosis	＜1 year	62 (59.6)	73.58±12.22	2.41	49.34±5.45	3.00	6.05±3.32	0.04	7.03±3.50	-0.21
Time since diagnosis	≥1 year	42 (40.4)	67.36±13.96	(.018)	44.62±9.16	(.004)	6.02±3.38	(.971)	7.19±3.98	(.831)
Previous treatment	Chemotherapy	75 (72.1)	72.09±13.17	1.27	48.59±6.30	2.18	5.91±3.35	-0.65	6.84±3.77	-1.14
Previous treatment	CMT	29 (27.9)	68.41±13.30	(.206)	44.45±9.47	(.036)	6.38±3.30	(.518)	7.76±3.40	(.256)
Relapse	Yes	24 (23.1)	71.38±13.68	0.13	45.79±9.03	-1.22	6.88±3.85	1.41	8.79±4.27	2.65
Relapse	No	80 (76.9)	70.97±13.20	(.898)	47.93±6.98	(.224)	5.79±3.14	(.161)	6.59±3.35	(.009)

ML=malignant lymphoma; AML=acute myelogenous leukemia; MM=multiple myeloma; SAA=severe aplastic anaemia; MDS=myelodysplastic; CMT=combined modality treatment (Chemotherapy+radiotherapy, Chemotherapy+hematopoietic stem cell transplantation, Chemotherapy+radiotherapy+hematopoietic stem cell transplantation).

^†Scheffé test.

Table 3.

Correlation between Resilience and Family Support, Anxiety and Depression (N=104)

Variables	Resilience	Family support	Anxiety
Variables	r (p)	r (p)	r (p)
Family support	.43 (＜.001)
Anxiety	-.49 (＜.001)	-.34 (＜.001)
Depression	-.52 (＜.001)	-.38 (＜.001)	.68 (＜.001)

Table 4.

Stepwise Multiple Linear Regression of Resilience (N=104)

Variables	Resilience
Variables	B	SE	β	t	p	Tolerance	VIF
(Constant)	69.75	9.24		7.55	＜.001
Depression	-1.02	0.40 -	-.28	-2.57	.012	.51	1.97
Family support	0.34	0.16	.19	2.11	.038	.75	1.34
Anxiety	-0.94	043 -	-.24	-2.16	.033	.52	1.91
Time since Diagnosis^†	-4.49	2.25 -	-.17	-2.00	.048	.89	1.13
R²=.39, Adjusted R²=.36, F=15.53, p＜.001, Durbin-Watson=2.15

^†Time since diagnosis (0=less than 1 year, 1=greater than or equal to 1 year).

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Factors Influencing Resilience of Patients with Hematologic Malignancy

Korean J Adult Nurs. 2013;25(1):95-104. Published online February 28, 2013

DOI: https://doi.org/10.7475/kjan.2013.25.1.95

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Factors Influencing Resilience of Patients with Hematologic Malignancy

Korean J Adult Nurs. 2013;25(1):95-104. Published online February 28, 2013

DOI: https://doi.org/10.7475/kjan.2013.25.1.95

Factors Influencing Resilience of Patients with Hematologic Malignancy

Table 1.

Resilience, Family Support, Anxiety, and Depression (N=104)

Variables	Score	n (%) or M±SD	Min	Max	Possible score range
Resilience		71.07±13.25	28	97	0~100
Family support		47.43±7.51	24	55	11~55
Anxiety		6.04±3.33	0	18	0~21
	0~7 (Normal)	81 (77.9)
	8~10 (Mild)	16 (15.4)
	11~21 (Moderate~severe)	7 (6.7)
Depression		7.10±3.68	0	20	0~21
	0~7 (Normal)	58 (55.8)
	8~10 (Mild)	31 (29.8)
	11~21 (Moderate~severe)	15 (14.4)

Table 2.

Differences of Resilience, Family Support, Anxiety, and Depression according to Demographic and Medical Characteristics (N=104)

Characteristic	Categories	n (%)	Resilience		Family support		Anxiety		Depression
Characteristic	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	56 (53.8)	72.05±12.77	-0.82	47.34±7.56	0.14	5.25±2.98	2.69	7.38±3.55	-0.83
Gender	Female	48 (46.2)	69.92±13.83	(.415)	47.54±7.53	(.892)	6.96±3.50	(.008)	6.77±3.84	(.407)
Age (year)	≤29	10 (9.6)	70.90±9.40	1.00	49.10±5.45	0.68	5.70±2.21	1.01	6.60±3.06	1.58
	30~39	16 (15.4)	74.38±12.13	(.411)	49.19±4.64	(.610)	4.81±1.94	(.408)	5.19±2.76	(.186)
	40~49	21 (20.2)	74.38±12.47		45.95±9.51		6.95±4.17		8.00±3.83
	50~59	32 (30.8)	69.69±13.25		47.81±7.04		6.25±2.97		7.50±3.98
	≥60	25 (24.0)	68.00±15.58		46.40±8.46		5.92±3.95		7.24±3.69
Education	≤High school	63 (60.6)	70.27±14.48	-0.76	46.59±8.49	-1.56	6.10±3.66	0.22	6.84±4.03	-0.88
Education	≥College	41 (39.4)	72.29±11.16	(.449)	48.73±5.54	(.122)	5.95±2.78	(.830)	7.49±3.08	(.384)
Religion	No	29 (27.9)	67.28±13.23	-1.84 4	4 47.38±7.56	-0.05	6.21±3.41	0.32	8.03±3.37	1.63
Religion	Yes	75 (72.1)	72.53±13.05	(.069)	47.45±7.54	(.964)	5.97±3.32	(.750)	6.73±3.75	(.106)
Marital status	Married	78 (75.0)	71.81±13.48	-0.99	47.13±8.19	0.91	6.21±3.47	-0.88	7.38±3.76	-1.39
Marital status	Single	26 (25.0)	68.86±12.52	(.326)	48.35±4.94	(.367)	5.54±2.87	(.379)	6.23±3.35	(.167)
Occupation^†	Employed^a ^b	47 (45.2)	73.68±11.42	2.94	48.17±6.95	0.37	5.23±2.47	2.39	6.66±3.17	0.83
	None^b ^c	23 (22.1)	64.22±14.98	(.037)	46.52±8.03	(.775)	6.13±3.52	(.073)	8.13±3.33	(.481)
	Housewife^c	30 (28.8)	72.43±13.87	a＞b	46.80±8.46		7.27±4.11		7.00±4.62
	Student^d	4 (3.8)	71.07±13.25		48.75±2.87		5.75±2.63		7.00±3.46
Average monthly household income^† (10,000 won)	＜100^a	14 (13.5)	64.43±15.29	2.36	50.43±6.69	1.82	6.57±4.35	1.10	9.07±4.94	1.36
	100~200^b	20 (19.2)	71.35±13.21	(.045)	43.45±9.55	(.115)	6.70±3.81	(.367)	7.35±3.51	(.245)
	200~300^c	21 (20.2)	66.90±9.80	a＜d, f	47.00±6.43		6.48±3.66		7.29±3.85
	300~400^d	19 (18.3)	77.16±11.58		48.11±7.09		4.53±2.32		5.95±2.82
	400~500^e	14 (13.5)	70.71±13.44		48.71±5.85		5.93±2.84		6.36±3.52
	≥500^f	16 (15.4)	75.06±14.37		48.44±7.39		6.06±3.33		6.81±3.19
Primary caregiver	Yes	88 (84.6)	70.19±13.29	1.59	47.66±7.27	-0.72	6.06±3.47	-0.13	7.11±3.78	-0.11
Primary caregiver	None	16 (15.4)	75.88±12.34	(.115)	46.19±8.87	(.474)	5.94±2.46	(.896)	7.00±3.16	(.910)
Diagnosis	ML	50 (48.1)	72.88±10.83	1.34	48.70±7.05	2.13	5.68±2.84	1.04	6.60±3.19	0.92
	AML	20 (19.2)	67.20±14.98	(.265)	47.85±5.16	(.124)	6.95±3.52	(.356)	7.75±4.84	(.403)
	MM, SAA, MDS	34 (32.7)	70.68±15.73		45.32±8.93		6.03±3.84		7.44±3.59
Time since diagnosis	＜1 year	62 (59.6)	73.58±12.22	2.41	49.34±5.45	3.00	6.05±3.32	0.04	7.03±3.50	-0.21
Time since diagnosis	≥1 year	42 (40.4)	67.36±13.96	(.018)	44.62±9.16	(.004)	6.02±3.38	(.971)	7.19±3.98	(.831)
Previous treatment	Chemotherapy	75 (72.1)	72.09±13.17	1.27	48.59±6.30	2.18	5.91±3.35	-0.65	6.84±3.77	-1.14
Previous treatment	CMT	29 (27.9)	68.41±13.30	(.206)	44.45±9.47	(.036)	6.38±3.30	(.518)	7.76±3.40	(.256)
Relapse	Yes	24 (23.1)	71.38±13.68	0.13	45.79±9.03	-1.22	6.88±3.85	1.41	8.79±4.27	2.65
Relapse	No	80 (76.9)	70.97±13.20	(.898)	47.93±6.98	(.224)	5.79±3.14	(.161)	6.59±3.35	(.009)

^†Scheffé test.

Table 3.

Correlation between Resilience and Family Support, Anxiety and Depression (N=104)

Variables	Resilience	Family support	Anxiety
Variables	r (p)	r (p)	r (p)
Family support	.43 (＜.001)
Anxiety	-.49 (＜.001)	-.34 (＜.001)
Depression	-.52 (＜.001)	-.38 (＜.001)	.68 (＜.001)

Table 4.

Stepwise Multiple Linear Regression of Resilience (N=104)

Variables	Resilience
Variables	B	SE	β	t	p	Tolerance	VIF
(Constant)	69.75	9.24		7.55	＜.001
Depression	-1.02	0.40 -	-.28	-2.57	.012	.51	1.97
Family support	0.34	0.16	.19	2.11	.038	.75	1.34
Anxiety	-0.94	043 -	-.24	-2.16	.033	.52	1.91
Time since Diagnosis^†	-4.49	2.25 -	-.17	-2.00	.048	.89	1.13
R²=.39, Adjusted R²=.36, F=15.53, p＜.001, Durbin-Watson=2.15

^†Time since diagnosis (0=less than 1 year, 1=greater than or equal to 1 year).

Table 1. Resilience, Family Support, Anxiety, and Depression (N=104)

Table 2. Differences of Resilience, Family Support, Anxiety, and Depression according to Demographic and Medical Characteristics (N=104)

†

Scheffé test.

Table 3. Correlation between Resilience and Family Support, Anxiety and Depression (N=104)

Table 4. Stepwise Multiple Linear Regression of Resilience (N=104)

†

Time since diagnosis (0=less than 1 year, 1=greater than or equal to 1 year).

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