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Ovarian cancer is one of the most common gynecological cancers in women. Its diagnosis and treatment often cause significant psychological distress, mainly reflected in depression and anxiety, which arise from multiple interacting factors. This study, grounded in Lazarus's Stress and Coping Model and from the perspective of set theory, aimed to investigate the correlates and configurational pathways of high and low levels of depression and anxiety symptoms in ovarian cancer patients by integrating stress sources, coping styles, and coping resources.

The study recruited ovarian cancer patients from a tertiary general hospital in Shenyang, China. The analysis included 169 ovarian cancer patients. The configurational factors included self-perceived burden (SPB), positive and negative coping styles, self-esteem, and general self-efficacy. Multiple linear regression and fuzzy-set qualitative comparative analysis (fsQCA) were used to explore the factors and configurational pathways related to depression and anxiety symptoms.

The fsQCA identified six configurational pathways linked to high and low levels of depression symptoms. Similarly, the fsQCA identified two configurations linked to high anxiety symptoms and four configurations related to low anxiety symptoms. Moreover, the configurations associated with low psychological symptoms did not stand in opposition to those associated with high psychological symptoms. Substitutability and complementarity were observed among the various elements in the configuration.

The study generated multiple configurational pathways for depression and anxiety symptoms in ovarian cancer patients by examining the combined effects of stress sources, coping styles, and coping resources. The configuration allows caregivers and medical staff to implement targeted measures to reduce burden perception and negative coping, enhance positive coping and self-esteem considering their substitutability and complementarity.