Although evidence exists on the harmful impacts of stigma on the mental well-being of cancer patients, studies examining the mechanisms through which this association occurs are lacking. We investigated how stigma impacts mental well-being among cancer patients through stress and how religiosity moderates this mediation. The study incorporated a cross-sectional design and the sample consisted of 210 cancer patients in Nigeria aged 18–80 years (males: n = 76, 36.2%; females: n = 134, 63.8%; mean age = 43.19 years, SD = 17.64 years), who completed relevant measures of stress, religiosity, stigma, and mental well-being. Results revealed that stress mediated the relationship between stigma and mental well-being, and religiosity moderated this mediation. Interventions should target stress reduction and leverage religiosity to mitigate the impact of stigma on mental well-being in cancer patients.
AdamuAMchunuGNaidooJR (2021) Women living with HIV in Nigeria: Predictive influence of hardiness on perceived stress. African Journal of AIDS Research20(1): 100–106.
2.
AgberotimiSFAkinsolaOSOguntayoR, et al. (2020). Interactions between socioeconomic status and mental health outcomes in the Nigerian context amid COVID-19 pandemic: A comparative study. Frontiers in Psychology11: 559819. https://doi.org/10.3389/fpsyg.2020.559819
3.
AgboPO (2024) ‘We shall triumph like the Jews’: Unveiling the implicit side of IPOB’s armed separatism in Southeast Nigeria. Security Journal37(3): 1144–1163.
4.
AhmadiF (2006) Culture, Religion and Spirituality in Coping: The Example of Cancer Patients in Sweden. Uppsala: Acta Universitatis Upsaliensis.
5.
AhujaKKBanerjeeDChaudharyK, et al. (2021) Fear, xenophobia and collectivism as predictors of well-being during coronavirus disease 2019: An empirical study from India. International Journal of Social Psychiatry67(1): 46–53.
6.
AldazBETreharneGJKnightRG, et al. (2017) Oncology healthcare professionals’ perspectives on the psychosocial support needs of cancer patients during oncology treatment. Journal of Health Psychology22(10): 1332–1344.
7.
Al EidNAAlqahtaniMMMarwaK, et al. (2020) Religiosity, psychological resilience, and mental health among breast cancer patients in Kingdom of Saudi Arabia. Breast Cancer Basic and Clinical Research14: 1178223420903054.
8.
AmamnsunuJE (2024) Healing and reconciliation: Applying trauma theory, social identity theory, and dialogical approaches to interfaith dialogue among Nigerian Christians and Muslims in Nigeria and the UK. Doctoral Dissertation, University of Wales Trinity Saint David.
9.
Amini-TehraniMZamanianHDaryaafzoonM, et al. (2021) Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model. Journal of Advanced Nursing77(8): 3412–3423.
10.
BaronRMKennyDA (1986) The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology51(6): 1173–1182.
11.
BulginDTanabePJeneretteC (2018) Stigma of sickle cell disease: A systematic review. Issues in Mental Health Nursing39(8): 675–686.
12.
ButtAShahzadMFLodhiRN, et al. (2025) Wellness under pandemic: A study of family support and religious commitment as antidotes to psychological distress under social disconnectedness policy in Pakistan. Current Psychology44: 2247–2316.
13.
CanadaALMurphyPESteinKD, et al. (2019) Trajectories of spiritual well-being in long-term survivors of cancer: A report from the American Cancer Society’s Studies of Cancer Survivors–I. Cancer125(10): 1726–1736.
14.
CannonAJDokucuMELoberizaFRJr (2022) Interplay between spirituality and religiosity on the physical and mental well-being of cancer survivors. Supportive Care in Cancer30(3): 1407–1417.
15.
CarmontSAMitchellGSeniorH, et al. (2018) Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care. BMJ Supportive & Palliative Care8(4): 385–399.
16.
CastilloSMSanta-Cruz-EspinozaH (2024) Stigma and mental health in patients with a cancer diagnosis. Enfermería Global73: 123.
17.
ChapmanBL (2016) Compassionate arts as a spiritual care technology for cancer patients interpreting the lived experience. Master’s thesis, University of Regina, University of Regina.
18.
ChenQ (2024) Neurobiological and anti-aging benefits of yoga: A comprehensive review of recent advances in non-pharmacological therapy. Experimental Gerontology196: 112550.
19.
ChoJSmithKChoiEK, et al. (2012) Public attitudes toward cancer and cancer patients: A national survey in Korea. Psycho-oncology21(10): 605–613.
20.
ChuBMarwahaKSanvictoresT, et al. (2024) Physiology, stress reaction. In StatPearls [Internet], 2025 January. Treasure Island (FL): StatPearls Publishing, https://www.ncbi.nlm.nih.gov/books/NBK541120/
21.
CohenJ (ed.) (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edn.New York, NY: Routledge.
22.
CohenSKamarckTMermelsteinR (1983) A global measure of perceived stress. Journal of Health and Social Behavior24: 385–396.
23.
CotocCN (2020) Self-stigma, trust in the oncologists and information seeking behaviors in breast cancer patients and survivors. Doctoral Dissertation, University of Illinois at Urbana-Champaign.
24.
DaysonCPainterJBennettE (2020) Social prescribing for patients of secondary mental health services: Emotional, psychological and social well-being outcomes. Journal of Public Mental Health19(4): 271–279.
25.
DougallALBaumA (2001) Stress, health, and illness. In: BaumARevensonTASingerJE (eds) Handbook of Health Psychology. Lawrence Erlbaum Associates, pp. 53–78.
26.
DukeEO (2014) Emerging religious marketplace in Nigeria: A quest for interpretation. Lwati: A Journal of Contemporary Research11(4): 47–63.
27.
DwivediM (2020) A perspective review on cancer – The deadliest disease. International Journal of Cancer Nursing1(1): 1–12.
28.
EdetanlenBEEkureEEIyorzorSO (2021) A study on the pattern of perceived stress among dental patients in a Nigerian tertiary hospital. Saudi Journal of Oral and Dental Research6(12): 543–547.
Endres-DigheSSucalditoADMcDowellR, et al. (2025) Mechanisms of resilience and coping to intersectional HIV prevention and drug-use stigma among people who inject drugs in rural Appalachian Ohio. Harm Reduction Journal22: 18.
31.
EsiakaDKNwakasiCNnameleVU, et al. (2023) Pathways to health outcomes after cancer diagnosis: A systematic review of cancer survivorship in Nigeria. Psychooncology32(7): 991–1000.
32.
EttridgeKABowdenJAChambersSK, et al. (2018) “Prostate cancer is far more hidden…”: Perceptions of stigma, social isolation and help-seeking among men with prostate cancer. European Journal of Cancer Care27(2): e12790.
33.
FerlayJErvikMLamF, et al. (2024) Lobal Cancer Observatory: Cancer Today (Version 1.1). Lyon: International Agency for Research on Cancer.
34.
FieldA (2018) Discovering statistics using IBM SPSS statistics (5th ed.). SAGE Publications.
35.
FreyMKChapman-DavisEGlynnSM, et al. (2021) Adapting and avoiding coping strategies for women with ovarian cancer during the COVID-19 pandemic. Gynecologic Oncology160(2): 492–498.
36.
FujisawaDUmezawaSFujimoriM, et al. (2020) Prevalence and associated factors of perceived cancer-related stigma in Japanese cancer survivors. Japanese journal of clinical oncology50(11): 1325–1329.
37.
GoffmanE (1963) Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall.
38.
HalámekFSvetlákMMalatincováT, et al. (2024) Enhancing patient well-being in oncology waiting rooms: A pilot field experiment on the emotional impact of virtual forest therapy. Frontiers in Psychology15: 1392397.
39.
HannKEJFreemanMFraserL, et al. (2017) Awareness, knowledge, perceptions, and attitudes towards genetic testing for cancer risk among ethnic minority groups: A systematic review. BMC Public Health17(1): 503.
40.
HatzenbuehlerMLPhelanJCLinkBG (2013) Stigma as a fundamental cause of population health inequalities. American Journal of Public Health103(5): 813–821.
41.
HayesAF (2018) Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs85(1): 4–40.
42.
HobfollSE (1989) Conservation of resources: A new attempt at conceptualizing stress. American Psychologist44(3): 513–524.
43.
HogeR (1972) A validated intrinsic religious motivation scale. Journal for the Scientific Study of Religion11(4): 369–376.
44.
HuangZYuTWuS, et al. (2021) Correlates of stigma for patients with cancer: A systematic review and meta-analysis. Supportive Care in Cancer29: 1195–1203.
JavaidZKMahmoodKAliAA (2023) Mediating role of mindfulness between quality of life and workplace stress among working women. Journal of Workplace Behavior4(1): 68–80.
49.
KangDHParkNJMcArdleT (2012) Cancer-specific stress and mood disturbance: Implications for symptom perception, quality of life, and immune response in women shortly after diagnosis of breast cancer. International Scholarly Research Notices2012(1): 1–7.
50.
KoenigHGGeorgeLKPetersonBL (1998) Religiosity and remission of depression in medically ill older patients. American Journal of Psychiatry155(4): 536–542.
51.
KoenigHGSmileyMGonzalesJA (1988) Religion, Health, and Aging: A Review and Theoretical Integration, vol. 1000. Westport, CT: Greenwood Press.
52.
KranzDNiepelCBotesE, et al. (2023) Religiosity predicts unreasonable coping with COVID-19. Psychology of Religion and Spirituality15(1): 1–5.
53.
LagergrenPSchandlAAaronsonNK, et al. (2019) Cancer survivorship: An integral part of Europe’s research agenda. Molecular Oncology13(3): 624–635.
54.
LazarusSFolkmanS (1984) A comprehensive account of the transactional model of stress and its management. In: LazarusR SFolkmanS (eds) Stress Appraisal and Coping. New York, NY: Springer.
55.
LebelSCastonguayMMacknessG, et al. (2013) The psychosocial impact of stigma in people with head and neck or lung cancer. Psycho-oncology22(1): 140–152.
56.
LeeCCYangHWLiuCJ, et al. (2023) Unraveling the connections between gut microbiota, stress, and quality of life for holistic care in newly diagnosed breast cancer patients. Scientific Reports13(1): 17916.
57.
MacKinnonD (2012) Introduction to Statistical Mediation Analysis. New York, NY:Routledge.
58.
MajanoSBLyratzopoulosGde WitNJ, et al. (2022) Mental health morbidities and time to cancer diagnosis among adults with colon cancer in England. JAMA Network Open5(10): e2238569.
59.
ManiyarNSarodeSCThakkarS, et al. (2024) Contemporary perspective of spirituality and religiosity in head and neck cancer. Oral Oncology Reports10: 100389.
60.
MarrMDSilvaNMD (2024) Religion’s roles in community integration after homelessness: Supportive housing residents’ uses of spiritual practices amid trauma, discrimination, and stigma. Housing Studies39(2): 376–397.
61.
MassicotteVIversHSavardJ (2021) COVID-19 pandemic stressors and psychological symptoms in breast cancer patients. Current Oncology28(1): 294–300.
62.
MazorMPaulSMChesneyMA, et al. (2019) Perceived stress is associated with a higher symptom burden in cancer survivors. Cancer125(24): 4509–4515.
63.
MhlongoNZElufioyeOAAsuzuOF, et al. (2024) The role of HR in promoting mental health and well-being in healthcare settings: a comprehensive review. International Journal of Management and Entrepreneurship Research6(2): 380–391.
64.
MohammedhusseinMHajureMShifaJE, et al. (2020) Perceived stigma among patients with pulmonary tuberculosis at public health facilities in southwest Ethiopia: A cross-sectional study. PLoS One15(12): e0243433.
65.
MwobobiaJMKnettelBAHeadleyJ, et al. (2024) “Let him die. He caused it”: A qualitative study on cancer stigma in Tanzania. PLOS Global Public Health4(6): e0003283.
66.
NgGCMohamedSSulaimanAH, et al. (2017) Anxiety and depression in cancer patients: The association with religiosity and religious coping. Journal of Religion and Health56: 575–590.
67.
NwaforCIVandenhoeckA (2024) Exploring religion as a path to meaning: The role of “pastrotherapy” in supporting young people’s quest for a good life in Nigeria. Journal of Religion and Health63(3): 1967–1984.
68.
NwakasiCEsiakaDChineloN, et al. (2024) How will I live this life that I’m trying to save? Being a female breast cancer survivor in Nigeria. Ethnicity and Health29(2): 147–163.
69.
Obi-kegunaCNIgweEJUgwuJI, et al. (2024) Religious coping mediates the relationship between stigma and psychological distress among people living with HIV. Current Psychology43: 31386–31394.
70.
OnuDUIgweEJ (2024) Distress and health-related quality of life among people living with type 2 diabetes: An analysis of moderated mediation roles of mindfulness and social support. Journal of Health Psychology. Advance online publication. DOI: 10.1177/13591053241306559.
71.
OnuDUNnadozieEEObi-KegunaCN, et al. (2024) Exploring the impact of stigma on health-related quality of life among individuals with sickle cell disease: A moderated mediation analysis of distress and social support. Psychology Health & Medicine. 1–20. Advance online publication. DOI: 10.1080/13548506.2024.2447009.
72.
OnyedibeMCChidebeRCWAndersenBL, et al. (2025) Age modulates, religious coping mediates: The role of attitude to self in cancer patients’ quality of life. Frontiers in Psychology16: 1558236.
73.
OnyekaTCOnuJUAgomDA (2023) Psychosocial aspects of adult cancer patients: A scoping review of sub-Saharan Africa. Psycho-oncology32(1): 86–106.
74.
OnyigbuoC (2016) Exploring health-seeking behaviours among Nigerians in the UK: Towards improved healthcare utilisation. Doctoral Dissertation, Middlesex University.
75.
ParkGKimJ (2021) Depressive symptoms among cancer patients: Variation by gender, cancer type, and social engagement. Research in Nursing and Health44(5): 811–821.
76.
PhamNTLeeJJPhamNH, et al. (2021) The prevalence of perceived stigma and self-blame and their associations with depression, emotional well-being and social well-being among advanced cancer patients: Evidence from the APPROACH cross-sectional study in Vietnam. BioMed Central (BMC) Palliative Care20(1): 9.
77.
RaiSSSyurinaEVPetersRMH, et al. (2020) Non-communicable diseases-related stigma: A mixed-methods systematic review. International Journal of Environmental Research and Public Health17(18): 6657.
78.
ReutterKKBigattiSM (2014) Religiosity and spirituality as resiliency resources: Moderation, mediation, or moderated mediation?Journal for the Scientific Study of Religion53(1): 56–72.
79.
ReynoldsLMHarrisL (2021) Stigma in the face of cancer disfigurement: A systematic review and research agenda. European Journal of Cancer Care30(1): e13327.
80.
RockwoodNJHayesAF (2017) MLmed: An SPSS macro for multilevel mediation and conditional process analysis. In: Poster presented at the annual meeting of the Association of Psychological Science (APS), Boston, MA.
81.
RohaniCAbediHAOmranipourR, et al. (2015) Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: A prospective study with comparative design. Health and Quality of Life Outcomes13(1): 14.
82.
RuckerDDPreacherKJTormalaZL, et al. (2011) Mediation analysis in social psychology: Current practices and new recommendations. Social and Personality Psychology Compass5(6): 359–371.
83.
RuedaSMitraSChenS, et al. (2016) Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. BMJ Open6(7): e011453.
84.
Salamanca-BalenNQiuMMerluzziTV (2023) COVID-19 pandemic stress, tolerance of uncertainty and well-being for persons with and without cancer. Psychology and Health38(10): 1402–1419.
85.
SalsmanJMPustejovskyJEJimHS, et al. (2015) A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer. Cancer121(21): 3769–3778.
86.
SaticiBSaricaliMSaticiSA, et al. (2022) Intolerance of uncertainty and mental wellbeing: Serial mediation by rumination and fear of COVID-19. International Journal of Mental Health and Addiction20(5): 2731–2742.
87.
SeibCPorter-SteeleJNgS-K, et al. (2018) Life stress and symptoms of anxiety and depression in women after cancer: The mediating effect of stress appraisal and coping. Psychooncology27(10): 1787–2357.
88.
SharpLCarsinAETimmonsA (2013) Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology22(4): 745–755.
89.
SheehanLCorriganP (2020) Stigma of disease and its impact on health. In: HarknessSJ (ed.) The Wiley Encyclopedia of Health Psychology. NJ: Wiley, pp.57–65.
90.
SholihinMHardivizonHWantoD, et al. (2022) The effect of religiosity on life satisfaction: A meta-analysis. HTS Teologiese Studies/Theological Studies78(4): 7172.
91.
SinghVSinghV (2020) Effects of stress in psychological health and its management. Journal of Law6(1): 5–71.
92.
SmallLAHuynhAKParchmentTM (2022) The association between self-esteem, stigma, and mental health among South African youth living with HIV: The need for integrated HIV care services. AIDS Care34(1): 86–94.
93.
SnijdersRAHBromLTheunissenM, et al. (2023) Update on prevalence of pain in patients with cancer 2022: A systematic literature review and meta-analysis. Cancers15(3): 591.
94.
Stergiou-KitaMPritloveCKirshB (2016) The “Big C”—Stigma, cancer, and workplace discrimination. Journal of Cancer Survivorship10: 1035–1050.
95.
Stergiou-KitaMQieXYauHK, et al. (2017) Stigma and work discrimination among cancer survivors: A scoping review and recommendations [Stigmatisation et discrimination au travail des survivants du cancer: Examen de la portée et recommandations]. Canadian Journal of Occupational Therapy84(3): 178–188.
96.
SushmithaS J SMathiasT (2023) Stress, a great impact on mental health. Asian Journal of Nursing Education and Research13(3): 232–237.
97.
SwihartDLYarrarapuSNSMartinRL (2023) Cultural religious competence in clinical practice. In StatPearls [Internet], 2025 January. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK493216/
98.
TennantRHillerLFishwickR, et al. (2007) The Warwick-Edinburgh mental well-being scale (WEMWBS): Development and UK validation. Health and Quality of Life Outcomes5(1): 63–13.
99.
The Lancet (2018) GLOBOCAN 2018: Counting the toll of cancer. Lancet392(10152): 985.
100.
The National Comprehensive Cancer Network (2020) Finding Comfort in Spirituality. Plymouth Meeting, PA: National Comprehensive Cancer Network.
101.
TurliucMNCandelOS (2022) The relationship between psychological capital and mental health during the covid-19 pandemic: A longitudinal mediation model. Journal of Health Psychology27(8): 1913–1925.
102.
UrtigaLMPCLinsGANSlongoA, et al. (2022) Spirituality and religiosity: Influence on cancer therapy and well-being. Revista Bioética30(4): 883–891.
103.
ValikhaniAAhmadniaFKarimiA, et al. (2019) The relationship between dispositional gratitude and quality of life: The mediating role of perceived stress and mental health. Personality and Individual Differences141: 40–46.
104.
ValikhaniAKashaniVORahmanianM, et al. (2020) Examining the mediating role of perceived stress in the relationship between mindfulness and quality of life and mental health: Testing the mindfulness stress buffering model. Anxiety, Stress, and Coping33(3): 311–325.
105.
VucicVRadovanovicSRadevicS, et al. (2021) Mental health assessment of cancer patients: Prevalence and predictive factors of depression and anxiety. Iranian Journal of Public Health50(10): 2017–2027.
106.
VuHM (2020) Relationship between work-life balance, religiosity and employee engagement: A proposed moderated mediation model. The Journal of Asian Finance, Economics and Business7(10): 339–345.
107.
WarrenA (2023) The relationship between perceived stigma and perceived stress in cognitive decline: A survey of persons with mild cognitive impairment and their caregivers. Frontiers in Psychology14: 1293284.
108.
WilliamsonTJOstroffJSHaqueN, et al. (2020) Dispositional shame and guilt as predictors of depressive symptoms and anxiety among adults with lung cancer: The mediational role of internalized stigma. Stigma and Health5(4): 425–433.
109.
YangHBrandJSFangF, et al. (2017) Time-dependent risk of depression, anxiety, and stress-related disorders in patients with invasive and in situ breast cancer. International Journal of Cancer140(4): 841–852.
110.
YilmazMDissizGDemirF, et al. (2017) Reliability and validity study of a tool to measure cancer stigma: Patient version. Asia-Pacific Journal of Oncology Nursing4(2): 155–161.
111.
YilmazMDissizGUsluogluAK, et al. (2020) Cancer-related stigma and depression in cancer patients in a middle-income country. Asia-Pacific Journal of Oncology Nursing7(1): 95–102.
112.
ZarzyckaBSliwakJKrokD, et al. (2019) Religious comfort and anxiety in women with cancer: The mediating role of hope and moderating role of religious struggle. Psychooncology28(9): 1829–1835.
113.
ZhangYCuiCWangY, et al. (2020) Effects of stigma, hope and social support on quality of life among Chinese patients diagnosed with oral cancer: A cross-sectional study. Health and Quality of Life Outcomes18: 112–118.
114.
ZhouESPenedoFJLewisJE, et al. (2010) Perceived stress mediates the effects of social support on health-related quality of life among men treated for localized prostate cancer. Journal of Psychosomatic Research69(6): 587–590.
