Body image dissatisfaction and lower self-esteem as major predictors of poor sleep quality in gynecological cancer patients after surgery: cross-sectional study

BMC Womens Health. 2021 Jun 3;21(1):229. doi: 10.1186/s12905-021-01375-5.


Background: Sleep quality is among the indicators associated with the quality of life of patients with cancer. A multitude of factors may affect patient sleep quality and are considered as associated predictive factors. The aim of this study was to examine the predictors of poor sleep quality in Moroccan women with gynecological cancer after radical surgery.

Methods: A cross-sectional study was carried out at the Oncology Department of the Ibn Rochd University Hospital, Casablanca (Morocco), on women who had undergone radical surgery for gynecological cancer (n = 100; mean age: 50.94 years). To assess sleep quality, symptoms of depression and anxiety, self-esteem and body image, the following translated and validated Arabic versions of the tools were used: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Rosenberg's Self-Esteem Scale and Body Image Scale. To determine predictors of sleep quality, multiple linear and hierarchical regressions were used.

Results: 78% of participants were considered poor sleepers, most of them exhibited very poor subjective quality (53%), longer sleep onset latency (55%), short period of sleep (42%) and low rate of usual sleep efficiency (47%). 79% of these patients did not use sleep medication and 28% were in poor shape during the day. Waking up in the middle of the night or early in the morning and getting up to use the bathroom were the main reasons for poor sleep quality. Higher PSQI scores were positively correlated with higher scores of anxiety, depression, body image dissatisfaction and with lower self-esteem (p < 0.001). The medical coverage system, body image dissatisfaction and low self-esteem predicted poor sleep quality. After controlling for the socio-demographic variables (age and medical coverage system), higher body image dissatisfaction and lower self-esteem significantly predicted lower sleep quality.

Conclusion: Body image dissatisfaction and lower self-esteem were positively linked to sleep disturbance in women with gynecological cancer after undergone radical surgery. These two predictors require systematic evaluation and adequate management to prevent sleep disorders and mental distress as well as improving the quality of life of these patients.

Keywords: Body image; Gynecological cancer; Self-esteem; Sleep quality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Dissatisfaction*
  • Body Image
  • Cross-Sectional Studies
  • Depression / etiology
  • Female
  • Humans
  • Middle Aged
  • Morocco
  • Neoplasms*
  • Patient Satisfaction
  • Quality of Life
  • Self Concept
  • Sleep
  • Sleep Wake Disorders* / etiology
  • Surveys and Questionnaires