Sleep disturbance, anxiety, and depression in postoperative ovarian cancer patients: prevalence, associated factors, and symptom interrelationships

Abstract

This study aimed to investigate the prevalence, associated factors, and interrelationships of sleep disturbance, anxiety, and depression in postoperative ovarian cancer patients. A cross-sectional study was conducted among 302 postoperative patients with epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. Sleep disturbance, anxiety, and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), respectively. Spearman correlation analyses were used to examine associations among symptoms. Binary logistic regression analyses identified factors independently associated with each symptom. Among 302 postoperative ovarian cancer patients, sleep disturbance was the most prevalent psychological symptom, affecting 72.5% of participants, followed by depression (40.1%) and anxiety (26.5%). Co-occurrence of all three symptoms was observed in 18.2% of patients. In multivariable analyses, depressive symptoms were independently associated with sleep disturbance (OR = 1.33, 95% CI: 1.16–1.51), while disease recurrence (OR = 2.34, 95% CI: 1.15–4.77) and chemotherapy exposure were additionally associated with sleep disturbance. For anxiety symptoms, depressive symptoms remained independently associated with anxiety (OR = 1.37, 95% CI: 1.21–1.55), whereas urban residence was associated with lower odds of anxiety symptoms (OR = 0.49, 95% CI: 0.25–0.99). For depressive symptoms, anxiety symptoms (OR = 1.40, 95% CI: 1.24–1.58), sleep disturbance (OR = 1.16, 95% CI: 1.06–1.27), and cancer-related fatigue (OR = 1.45, 95% CI: 1.18–1.79) remained independent correlates. In addition, patients with average satisfaction with family life had higher odds of depressive symptoms compared with those reporting very high satisfaction (OR = 3.95, 95% CI: 1.41–11.03). Postoperative ovarian cancer patients experience a substantial burden of psychological symptoms, with sleep disturbance being the most prevalent. Distinct sociodemographic, clinical, and psychological factors were independently associated with sleep disturbance, anxiety, and depressive symptoms, which were also closely interrelated. Routine psychological screening and comprehensive supportive care integrating psychological, physical, and social interventions may help improve symptom management.