Demoralization and sleep in breast cancer: A casual and computer-simulated network analysis

Purpose

There is evidence in studies with patients diagnosed with breast cancer that suggests demoralization, which is described as a sense of hopelessness and inability to cope, is associated with a decline in sleep. However, there are limited studies that fully explain the association. The purpose of this study was to further explore demoralization and sleep in patients.

Methods

In the "Be Resilient to Breast Cancer" study, self-report data were collected on sleep and demoralization. Sleep was measured with the Pittsburgh Sleep Quality Index for a total sleep quality score and 7 sleep domains. The Demoralization Scale provides 16 items. Gaussian network analysis was employed to identify core symptoms and bridge symptoms. A Bayesian network was used to examine how these symptoms are causally related to each other. Computer-simulated interventions were used to identify targets for intervention.

Results

The distress item of the Demoralization Scale was the core symptom (Str = 1.17, Bet = 52, Clo = 0.003), while the daytime dysfunction domain of sleep was considered the bridge symptom. Sleep quality was the key parent node. Computer-simulated intervention suggests targeting distress and loss of emotional control.

Conclusions

Sleep may contribute to demoralization from the findings of casual networking analysis. Distress and loss of emotional control should be targeted to decrease the adverse interaction with sleep.