Association of Spirituality and Family Support with Depression and Serum Serotonin Levels in Cervical Cancer Patients: a Cross-Sectional Study

Abstract

Introduction: Substantial physical, psychological, and social burden. Chemotherapy can trigger significant emotional distress, placing patients at increased risk of developing depression by underlying biological mechanisms. Serotonin, a key neurotransmitter involved in mood regulation, has been implicated in the pathophysiology of depression and may serve as a biological indicator linking cervical cancer–related stress and depressive symptoms.

Objectives: This study aimed to evaluate the association of spiritual aspects and family support with serum serotonin levels and depression status among cervical cancer patients following chemotherapy.

Methods: This cross-sectional study included cervical cancer patients who had completed two cycles of chemotherapy. Spirituality was assessed using the Daily Spiritual Experience Scale (DSES), family support was evaluated with the Family APGAR Score, and depression status was measured using the Zung Self-Rating Depression Scale (SDS). Serum serotonin levels were determined through laboratory analysis. Associations between variables were analyzed using Kruskal–Wallis and Chi-square tests, with statistical significance of p<0.05.

Results: Higher levels of spirituality were significantly associated with increased serum serotonin levels (p = 0.012) and lower depression severity (p = 0.001). Patients with healthy family function demonstrated significantly higher median serotonin levels compared with those with moderate or severe family dysfunction (p < 0.001). In addition, increasing depression severity was associated with progressively lower serotonin levels (p < 0.001).

Conclusions: Spirituality and family support are significantly associated with both biological (serotonin levels) and psychological (depression status) outcomes in cervical cancer patients after chemotherapy. These findings support a biopsychosocial–clinical approach to comprehensive cancer care.