Discussion
The results showed that anxiety and depression were the influencing
factors of quality of life. Foreign scholars also pointed out that
depression, anxiety and other emotions have a stronger impact on
psychological level than physical function [40]. Patients with
gynecological tumor do not understand the disease and treatment, leading
to more anxiety. Anxiety can reduce the quality of life by affecting
physical function [41,42]. For cancer patients, depression can
aggravate the side effects of cancer treatment, affect the therapeutic
effect, and even promote the recurrence and metastasis of tumor
[43]. Therefore, anxiety and depression are risk factors of quality
of life in patients with gynecological tumor. This study showed that
hypertension had no effect on quality of life, which was different from
previous studies [44], it may be caused by different populations or
other unknown factors. However, hypertension and anxiety or hypertension
and depression had additive interaction on the quality of life. The
effect of two factors at the same time is greater than that of single
factor. Carroll et al. found that the patients with anxiety and
depression were significantly correlated with the incidence of
hypertension [45]. Hamer et al. also found that anxiety and
depression patients are more likely to cause varying degrees of blood
pressure rise [46]. At present, many studies also suggested that
hypertension itself may lead to anxiety and depression [47].
Research showed that in patients receiving anti-hypertensive treatment,
3/4 of them suffer from long-term illness, and most of them have anxiety
and depression [48]. Hypertension will cause depression, anxiety,
cognitive impairment, physical discomfort and sleep disorders. On the
contrary, this psychological state will aggravate the condition of
hypertension, resulting in a vicious circle between hypertension and
anxiety, depression, which affected the prognosis of the disease, caused
serious physical and mental consequences, and reduced the quality of
life of patients.
In this study, anxiety and depression were negatively correlated with
PSS, and PSS was positively correlated with quality of life, consistent
with previous findings [49,50]. PSS moderates the effects of anxiety
or depression on quality of life of patients. Social support can be used
as an individual and internal resource to cope with and adapt to stress
situations, enabling people to explain and deal with cancer,
difficulties, hope and rehabilitation [29]. Studies have confirmed
that social support was strongly positively correlated with the
physiological and psychological aspects of long-term survival of cancer
[51,52]. Hence, social support is an important factor to predict the
quality of life of cancer patients [50]. The key factor of social
support as a stress buffer is that the individual perceives that others
will provide appropriate support, which will reduce the emotional and
physiological reactions of individual stress. This can explain why the
more social support patients feel during treatment, the more beneficial
it is to improve depression and anxiety symptoms [53]. Study also
showed that only when social support is needed can social support buffer
the symptoms of anxiety and depression in cancer patients [54]. This
can explain why lower social support is not obvious in alleviating the
relationship between depression, anxiety and quality of life in our
study. Social support is associated with reduced cancer-related stress
and depression symptoms, positive psycho-social changes, and lower
mortality [51,52,55]. Based on the above theory, it is concluded
that when patients have depression or anxiety, social support has a
positive effect on improving the quality of life, reducing the
possibility of depression or anxiety, thus changing the relationship
between depression or anxiety and quality of life.