Biological Stress Indicators based on Perceived Stress mediated by Emotional Regulation among Patients with Gastrointestinal Cancer: A Structural Equation Modeling

Document Type : Original Article


1 Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island.

2 Assistant Professor, Department of Clinical Psychology, Kharazmi University, Tehran, Iran.

3 Assistant Professor, Brain and Cognition Clinic, Institute for Cognitive Sciences, Tehran, Iran.


Background: Cancer is a disorder in the rate of cell proliferation and differentiation that can occur in any tissue of the body and at any age, and attacking healthy tissues of the body causes severe disease and consequently death.
Objective: The aim of this study was to analyze the structural equations of biological indicators of stress based on perceived stress mediated by emotional regulation in patients with gastrointestinal cancer.
Methods: In terms of research method, this research is descriptive-correlational research of structural equation type. The statistical population of the present study included all patients with gastrointestinal cancer who were referred to Reza Medical Center-Mashhad and Ibn Sina Hospital-Tehran and were diagnosed with this disease based on the patient's file. The sample of this study included 250 people from the mentioned community, which was done using a non-random and available sampling method. Data in this study were obtained using the Perceived Stress Scale, Cognitive Emotion Regulation Questionnaire, and Biological Indicators of Stress. Data were analyzed by structural equation modeling and Pearson correlation using SPSS.22 and AMOS.22 software.
Results: The results showed that perceived stress (β=-0.37, p <0.001) directly emotional regulation. Also, emotional regulation (β=0.54, p <0.001) had a direct effect on biological stress indices. Emotional regulation played a mediating role in the relationship between perceived stress and biological stress indices (RMSEA:0.001; AGFI:0.93).
Conclusion: It can be concluded that the structural model of biological indicators of stress in patients with gastrointestinal cancer based on perceived stress mediated by emotional regulation has a good fit.


  1. Anderson P, Kedersha N, Ivanov P. Stress granules, P-bodies and cancer. Biochimica et Biophysica Acta (BBA)-Gene Regulatory Mechanisms. 2015;1849(7):861-70. 
  2. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. Journal of consulting and clinical psychology. 2017;85(4):397. 
  3. Chen H, Zhang W, Zhu G, Xie J, Chen X. Rethinking cancer nanotheranostics. Nature Reviews Materials. 2017;2(7):1-8. 
  4. Du J, Huang J, An Y, Xu W. The relationship between stress and negative emotion: The Mediating role of rumination. Clin Res. 2018;4(1):1-5. 
  5. Duffy MJ, Lamerz R, Haglund C, Nicolini A, Kalousová M, Holubec L, Sturgeon C. Tumor markers in colorectal cancer, gastric cancer and gastrointestinal stromal cancers: European group on tumor markers 2014 guidelines update. International journal of cancer. 2014;134(11):2513-22. 
  6. Forment JV, O'Connor MJ. Targeting the replication stress response in cancer. Pharmacology & therapeutics. 2018;188:155-67. 
  7. Graham DY. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer. World Journal of Gastroenterology: WJG. 2014;20(18):5191.
  8. Jeon BH, Choi M, Lee J, Noh SH. Relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy. Nursing & health sciences. 2016;18(1):23-9. 
  9. Katz LF, Heleniak C, Kawamura J, Jakubiak J. Emotion regulation, internalizing symptoms and somatic complaints in pediatric survivors of acute lymphoblastic leukemia. Psycho‐Oncology. 2015;24(11):1536-44.
  10. Lin L, Huang H, Liao W, Ma H, Liu J, Wang L, Huang N, Liao Y. MACC1 supports human gastric cancer growth under metabolic stress by enhancing the Warburg effect. Oncogene. 2015;34(21):2700-10. 
  11. Garnefski N, Kraaij V. Bully victimization and emotional problems in adolescents: Moderation by specific cognitive coping strategies?. Journal of Adolescence. 2014;37(7):1153-60.
  12. Song H, Fang F, Valdimarsdóttir U, Lu D, Andersson TM, Hultman C, Ye W, Lundell L, Johansson J, Nilsson M, Lindblad M. Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study. BMC cancer. 2017;17(1):2.
  13. Levy-Gigi E, Bonanno GA, Shapiro AR, Richter-Levin G, Kéri S, Sheppes G. Emotion regulatory flexibility sheds light on the elusive relationship between repeated traumatic exposure and posttraumatic stress disorder symptoms. Clinical psychological science. 2016;4(1):28-39.
  14. Lin Y, Jiang M, Chen W, Zhao T, Wei Y. Cancer and ER stress: Mutual crosstalk between autophagy, oxidative stress and inflammatory response. Biomedicine & Pharmacotherapy. 2019;118:109249. 
  15. Moon JY, Cho SK. Nobiletin induces protective autophagy accompanied by ER-stress mediated apoptosis in human gastric cancer SNU-16 cells. Molecules. 2016;21(7):914.
  16. Tarangelo A, Magtanong L, Bieging-Rolett KT, Li Y, Ye J, Attardi LD, Dixon SJ. p53 suppresses metabolic stress-induced ferroptosis in cancer cells. Cell reports. 2018;22(3):569-75.
  17. Wolz I. Emotions in Eating Disorders: The Interplay of Emotion Regulation and Inhibitory Control in Appetite and Eating Behaviour.2016.
  18. Zhang N, Li J, Wang H, Xiao L, Wei Y, He J, Wang G. The level of nesfatin-1 in a mouse gastric cancer model and its role in gastric cancer comorbid with depression. Shanghai archives of psychiatry. 2018;30(2):119.