Cancer Res Treat.  2025 Jan;57(1):159-164. 10.4143/crt.2024.188.

Grit and the Relationships among Psychological Distress and Suicidality in Female Patients with Breast Cancer

Affiliations
  • 1Department of Psychiatry, Asan Medical Center, Seoul, Korea
  • 2Department of Psychology, Chung-Ang University, Seoul, Korea

Abstract

Purpose
The risk of suicide is approximately two times higher in patients with breast cancer compared to the general population. Suicide risk factors are widely investigated but research on the protective factors is lacking. We investigated whether each subscale of grit, consistency of interest, and perseverance of effort, could serve as a protective factor against suicidality.
Materials and Methods
Participants were recruited at the Stress Clinic for Cancer Patients, a psycho-oncology clinic at Asan Medical Center from May 2019 to March 2021. A total of 140 female patients with breast cancer completed self-administered questionnaires including Grit scale, Distress thermometer, and Mini International Neuropsychiatric Interview (MINI) suicidality module. We used PROCESS macro for analyzing the mediation model to identify the protective factors for suicidality.
Results
Our findings showed that perseverance of effort showed statistically non-significant associations with psychological distress (p=0.403) and suicidality (p=0.945), however, consistency of interest decreased suicidality through psychological distress (β=–0.015; 95% confidence interval, –0.035 to –0.002).
Conclusion
The result shows that consistency of interest can be a protective factor against suicidality by reducing psychological distress.

Keyword

Depression; Anxiety; Stress; Suicide; Protective factors

Figure

  • Fig. 1. Mediating effects of psychological distress on associations between consistency of interest and suicidality. Adjusted for age and cancer treatment within two months. Thick lines connecting latent variables indicate significant path estimates (p < 0.05). CI, confidence interval.


Reference

References

1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136:E359–86.
2. Ng CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA, et al. Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS One. 2017; 12:e0172975.
Article
3. Alagizy HA, Soltan MR, Soliman SS, Hegazy NN, Gohar SF. Anxiety, depression and perceived stress among breast cancer patients: single institute experience. Middle East Curr Psychiatry. 2020; 27:29.
4. National Comprehensive Cancer Network. Distress management: clinical practice guidelines. J Natl Compr Canc Netw. 2003; 1:344–74.
5. Knapp TR. Stress versus strain: a methodological critique. Nurs Res. 1988; 37:181–4.
6. Burnette JL, Knouse LE, Vavra DT, O’Boyle E, Brooks MA. Growth mindsets and psychological distress: a meta-analysis. Clin Psychol Rev. 2020; 77:101816.
7. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001; 10:19–28.
Article
8. Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol. 2008; 26:4731–8.
Article
9. Diaz-Frutos D, Baca-Garcia E, Mahillo-Fernandez I, Garcia-Foncillas J, Lopez-Castroman J. Suicide ideation among oncologic patients in a Spanish ward. Psychol Health Med. 2016; 21:261–71.
10. Smailyte G, Jasilionis D, Kaceniene A, Krilaviciute A, Ambrozaitiene D, Stankuniene V. Suicides among cancer patients in Lithuania: a population-based census-linked study. Cancer Epidemiol. 2013; 37:714–8.
Article
11. Saad AM, Gad MM, Al-Husseini MJ, AlKhayat MA, Rachid A, Alfaar AS, et al. Suicidal death within a year of a cancer diagnosis: a population-based study. Cancer. 2019; 125:972–9.
12. Duckworth AL, Peterson C, Matthews MD, Kelly DR. Grit: perseverance and passion for long-term goals. J Pers Soc Psychol. 2007; 92:1087–101.
13. Liu RT, Lawrence HR, Burke TA, Sanzari CM, Levin RY, Maitlin C, et al. Passive and active suicidal ideation among left-behind children in rural China: an evaluation of intrapersonal and interpersonal vulnerability and resilience. Suicide Life Threat Behav. 2021; 51:1213–23.
Article
14. Kannangara CS, Allen RE, Waugh G, Nahar N, Khan SZ, Rogerson S, et al. All that glitters is not grit: three studies of grit in university students. Front Psychol. 2018; 9:1539.
15. Musumari PM, Tangmunkongvorakul A, Srithanaviboonchai K, Techasrivichien T, Suguimoto SP, Ono-Kihara M, et al. Grit is associated with lower level of depression and anxiety among university students in Chiang Mai, Thailand: a cross-sectional study. PLoS One. 2018; 13:e0209121.
Article
16. Sharkey CM, Bakula DM, Gamwell KL, Mullins AJ, Chaney JM, Mullins LL. The role of grit in college student health care management skills and health-related quality of life. J Pediatr Psychol. 2017; 42:952–61.
Article
17. Hewitt DB, Chung JW, Ellis RJ, Cheung EO, Moskowitz JT, Hu YY, et al. National evaluation of surgical resident grit and the association with wellness outcomes. JAMA Surg. 2021; 156:856–63.
Article
18. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998; 59 Suppl 20:22–33.
19. Zhao Y, Liu X, Xiao Z. Effects of perceived stigma, unemployment and depression on suicidal risk in people with epilepsy. Seizure. 2021; 91:34–9.
20. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008; 40:879–91.
Article
21. Masuyama A, Kubo T, Sugawara D, Chishima Y. Interest consistency can buffer the effect of COVID-19 fear on psychological distress. Int J Ment Health Addict. 2022; 20:3044–55.
Article
22. Zhang MX, Mou NL, Tong KK, Wu AM. Investigation of the effects of purpose in life, grit, gratitude, and school belonging on mental distress among Chinese emerging adults. Int J Environ Res Public Health. 2018; 15:2147.
Article
23. Duckworth A. Grit: the power of passion and perseverance. New York: Scribner;2016.
24. Zhu J, Xu L, Sun L, Li J, Qin W, Ding G, et al. Chronic disease, disability, psychological distress and suicide ideation among rural elderly: results from a population survey in Shandong. Int J Environ Res Public Health. 2018; 15:1604.
25. Wu CY, Lee MB, Liao SC, Chan CT, Liu LD, Chen CY. Psychological distress of suicide attempters predicts one-year suicidal deaths during 2007-2016: a population-based study. J Formos Med Assoc. 2020; 119:1306–13.
Article
26. Eskin M, Sun JM, Abuidhail J, Yoshimasu K, Kujan O, Janghorbani M, et al. Suicidal behavior and psychological distress in university students: a 12-nation study. Arch Suicide Res. 2016; 20:369–88.
Article
27. Rainbow C, Baldwin P, Hosking W, Gill P, Blashki G, Shand F. Psychological distress and suicidal ideation in Australian online help-seekers: the mediating role of perceived burdensomeness. Arch Suicide Res. 2023; 27:439–52.
Article
28. Clement DN, Wingate LR, Cole AB, O’Keefe VM, Hollingsworth DW, Davidson CL, et al. The common factors of grit, hope, and optimism differentially influence suicide resilience. Int J Environ Res Public Health. 2020; 17:9588.
Article
29. Anestis MD, Kleiman EM, Lavender JM, Tull MT, Gratz KL. The pursuit of death versus escape from negative affect: an examination of the nature of the relationship between emotion dysregulation and both suicidal behavior and non-suicidal self-injury. Compr Psychiatry. 2014; 55:1820–30.
Article
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2025 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr