Research Article| Volume 62, 102268, February 2023

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Proposing and evaluating a model of depression, stress, resilience and spirituality in relation to pain in women with breast cancer: Investigating the mediating role of mindfulness

Published:January 05, 2023DOI:


      • Pain is considered as one of the side effects of chemotherapy.
      • In this study, we evaluate and propose a model of pain in Brest cancer patients based on psychological components.
      • Depression, stress, mindfulness and resilience have an effective role on the experience of pain during chemotherapy.



      Pain experience is one of the most common symptoms of women with breast cancer receiving chemotherapy. It may cause physical and psychological problems and interfere with the treatment process.


      This study aimed to examine the relationship between depression, stress, resilience and spirituality on the pain symptoms of breast cancer patients during chemotherapy and explore the potential mediating role of mindfulness in this association.


      Two hundred and forty women with breast cancer receiving chemotherapy from Shiraz University Hospital, were selected and evaluated by a purposive sampling method. The research instruments were Perceived Stress Scale, Beck Depression Questionnaire-2, Mindfulness, Resilience, Spirituality and Pain Questionnaires. The obtained data was analyzed by SPSS software and MPLUS using Spearman correlation coefficient and path analysis.


      Based on the findings of direct path analysis, depression, stress, and spirituality showed a significant relationship with mindfulness, but resilience had no significant relationship with mindfulness (p < 0.01). Furthermore, depression, stress, resilience, and mindfulness showed a significant relationship with pain, while spirituality had no significant relationship with pain (p < 0.01). Finally, indirect path analysis revealed mindfulness is a significant mediator of stress and pain (p < 0.05).


      The present study suggested a model can be useful in better understanding of the psychological components affecting pain in breast cancer patients, after and during their treatments. It also provided an effective framework to develop and investigate pain-focused and non-pharmacological interventions.


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