Sense of Coherence and Defense Style Predict Sleep Difficulties in Early Non-metastatic Colorectal Cancer

Dig Dis Sci. 2016 Jan;61(1):273-82. doi: 10.1007/s10620-015-3843-1. Epub 2015 Aug 20.


Background: Sleep disturbances are common in cancer patients, but little is known about the complex interplay between the background psychological profile, coping with health stressors capacities and psychological distress in the formation of sleep difficulties in colorectal cancer.

Aims: To study the course and to identify psychological predictors of sleep difficulties in early non-metastatic colorectal cancer patients over a one-year period.

Methods: In this 1-year prospective study, we assessed in 84 early non-metastatic colorectal cancer patients the association of psychological distress (SCL-90-R), sense of coherence (SOC-29), and defense styles (Defense Style Questionnaire) with sleep difficulties (SCL-90-R) in multiple regression models. Eighty-two patients with breast cancer and 50 patients with cancer of unknown primary site served as disease controls, and 84 matched for age and sex alleged healthy individuals served as healthy controls.

Results: Colorectal cancer patients presented more sleep difficulties compared to healthy participants but fewer than patients with breast cancer and cancer of unknown primary site. Colorectal cancer patients' trouble falling asleep (p = 0.033) and wakening up early in the morning (p < 0.001) deteriorated over time. Sleep that was restless or disturbed was independently associated with low SOC (p = 0.046) and maladaptive defenses (p = 0.008). Anxiety symptoms (p < 0.001) predicted deterioration in trouble falling asleep, while depressive symptoms (p = 0.022) and self-sacrificing defense style (p = 0.049) predicted deterioration in wakening up early in the morning.

Conclusions: Psychological parameters and coping with health stressors capacities are independently associated with sleep difficulties in colorectal cancer patients, indicating the need for psychological interventions aiming at improving adjustment to the disease.

Keywords: Colorectal cancer; Ego mechanisms of defense; Personality; Psychological distress; Sense of coherence; Sleep.

MeSH terms

  • Aged
  • Case-Control Studies
  • Colorectal Neoplasms / complications*
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / physiopathology
  • Colorectal Neoplasms / psychology
  • Defense Mechanisms*
  • Female
  • Health Status
  • Humans
  • Male
  • Mental Health
  • Middle Aged
  • Prospective Studies
  • Quality of Life
  • Risk Assessment
  • Risk Factors
  • Sense of Coherence*
  • Sleep Wake Disorders / diagnosis
  • Sleep Wake Disorders / etiology*
  • Sleep Wake Disorders / physiopathology
  • Sleep Wake Disorders / psychology
  • Sleep*
  • Stress, Psychological / diagnosis
  • Stress, Psychological / etiology*
  • Stress, Psychological / physiopathology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires
  • Time Factors