Assessing the Relationship between Self-Efficacy and Mental Health Amongst Patients Undergoing Hematopoietic Stem Cell Transplant

Background: Cancer patients undergoing hematopoietic stem cell transplant (HSCT) vary in their confidence in managing practical and emotional challenges caused by this toxic treatment (i.e., self-efficacy). While greater self-efficacy has been associated with better HSCT symptom management, its association with patients’ mental health is unclear. The present study was conducted to assess whether higher self-efficacy is associated with better mental health outcomes throughout HSCT.

Methods: Participants were 348 HSCT patients enrolled in a trial testing a psychosocial writing intervention (expressive helping). They completed a 17-item cancer self-efficacy scale at baseline and were categorized into self-efficacy quartiles based on their score: “high efficacy" (top quartile; n=95) and “low efficacy” (bottom quartile; n=90). Demographics that varied significantly between groups according to Fisher’s exact tests were included in a multivariate regression analysis that tested the association between self-efficacy and selected mental health outcomes at three timepoints: pre-infusion (baseline), during hospitalization, and 1-2 months post-discharge. Outcomes studied included anxiety (GAD-7), depressive symptoms (CESD), fatigue (FACIT-F), overall mental health (PROMIS Global-7), symptom severity (MDASI), cancer specific anxiety (IES), and social isolation (PROMIS Social Isolation Scale). Regression models controlled for the baseline value of the outcome being evaluated to account for baseline individual differences. Analyses were completed in R Studio (Ver: 2024.04.0+735) and used R script (Version 4.4.1). All p-values reported below are corrected for multiple hypothesis testing.

Results: Participants’ mean age was 57.95 (SD=12.61), 56% were male, 75% identified as White, and 50% had a 4-year college degree. Over half (54%) of participants had received an autologous transplant. Multiple Myeloma was the most common diagnosis (46%), followed by Acute Leukemias (AML, ALL) (15%), Non-Hodgkin's Lymphoma (10%), and Myelodysplastic Syndrome (10%).

Participants with low self-efficacy had lower annual household income (p=0.037) and worse baseline Karnofsky performance status (p=0.026) than those with high self-efficacy, so these factors were included as covariates in all regression models. The 2 self-efficacy groups did not differ in age, gender, race, relationship status, education, employment status, insurance status, diagnosis, transplant type (Auto vs. Allo), HSCT comorbidity index, or GVHD status.

The regression analyses revealed that participants with higher self-efficacy had greater overall mental health at baseline (B=12.03, SD=3.4, p<0.001); this association was not found in any other time point.

High self-efficacy was also associated with lower baseline anxiety (B=-5.74, SD=2.1, p=0.006) and lower anxiety during hospitalization (B=-7.12, SD=3.5, p=0.04), but this association did not extend to post-discharge.

High self-efficacy was also associated with lower depressive symptoms at baseline (B=-9.63, SD=3.6, p=0.008) and during hospitalization (B=-27.33, SD=9.0, p=0.003), but not at post-discharge.

Finally, high self-efficacy was associated with lower post-discharge social isolation (B=-10.06, SD=3.2, p=0.00231).

Self-efficacy was not associated with fatigue, cancer-specific anxiety, or symptom severity at any timepoint.

Conclusion: Higher self-efficacy prior to HSCT infusion is prospectively associated with improvements in subsequent mental health across various domains. These findings suggest that self-efficacy—a patient's confidence that they can manage practical and emotional HSCT challenges—may play a role in a patient’s transplant experience, highlighting the need for further research on interventions to improve self-efficacy before HSCT.