JCOGP
Journal of Controversies in Obstetrics & Gynecology and Pediatrics

As of January 2023, our "Journal of Controversies Obstetrics & Gynecology and Pediatrics" has been published under the Medihealth Academy to publish all articles, reviews and case reports on Pediatrics, especially in the field of Obstetrics and Gynecology. In order to facilitate the citation of the articles, to take our place in internationally respected indexes and to reach a wider readership, we will pay attention to the fact that our article language is only English in terms of acceptance.

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Original Article
The association between intolerance of uncertainty and depression, anxiety, and stress among women with gynecological cancer in Turkiye: a cross-sectional study
Abstract
Aims: This study aimed to examine the association between intolerance of uncertainty (IU) and psychological distress (depression, anxiety, and stress) in women with gynecological cancer in Türkiye.
Methods: This cross-sectional study was conducted between February and July 2024, and included 139 women diagnosed with gynecological cancer at a university hospital in Ankara, Turkiye. Data were collected using a personal information form, the Intolerance of Uncertainty Scale-12, and the Depression, Anxiety, and Stress Scale-21. Statistical analyses included independent-samples t-tests, analysis of variance, Pearson correlations, and hierarchical linear regression.
Results: The mean depression, anxiety, and stress scores were 6.78 ± 5.47, 5.73 ± 4.12, and 7.91 ± 4.86, respectively. IU was positively correlated with depression (r = 0.437, p = 0.001), anxiety (r = 0.394, p = 0.001), and stress (r = 0.516, p = 0.001). Regression analyses showed that IU was independently associated with depression (ß = 0.389, p = 0.001), anxiety (ß = 0.377, p = 0.001), and stress (ß = 0.485, p = 0.001) after controlling for selected sociodemographic and clinical variables.
Conclusion: Higher intolerance of uncertainty was significantly associated with greater psychological distress in women with gynecological cancer. These findings suggest that psychosocial care may benefit from greater attention paid to uncertainty-related distress.

Keywords : Intolerance of uncertainty, gynecological cancer, depression, anxiety, stress

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1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10. 3322/caac.21834
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8. Johansen G, Lampic C, Flöter Rådestad A, Dahm-Kähler P, Rodriguez-Wallberg KA. Health-related quality of life, sexual function, psychological health, reproductive concerns and fertility outcome in young women treated with fertility-sparing surgery for ovarian tumors-a prospective longitudinal multicentre study. Gynecol Oncol. 2024;189:101-108. doi:10.1016/j.ygyno.2024.07.004
9. Shams M, Coman C, Fatone F, et al. The impact of gynecologic cancer on female sexuality in Europe and MENA (Middle East and North Africa): a literature review. Sex Med Rev. 2024;12(4):587-599. doi:10.1093/sxmrev/qeae039
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19. Uslu-Sahan F, Gulcan N. Supportive care needs in predicting the acceptance of illness among gynecological cancer patients undergoing therapy: a cross-sectional study. Support Care Cancer. 2023;32(1):61. doi:10.1007/s00520-023-08270-9
20. Var E, Nazik E. Supportive care needs of women with gynecologic cancer and factors affecting in Turkiye: a cross sectional study. Nurs Commun. 2024;8:e2024007. doi:10.53388/IN2024007
21. Polat F, Şenol DK. Examining the correlation between sexual and reproductive health stigmatization level and gender perception: a case of a university in Turkey-a descriptive cross-sectional study. Sao Paulo Med J. 2022;141(2):146-153. doi:10.1590/1516-3180.2022.0278.03062022
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24. Sarıçam H, Erguvan F, Akın A, Akça M. Belirsizliğe tahammülsüzlük ölçeği BTÖ-12 Türkçe formu geçerlik ve güvenirlik çalışması. Route Educ Soc Sci J. 2014;1(3):148-157.
25. Lovibond SH. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney: Psychol Found; 1995.
26. Sariçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. J Cogn Behav Psychother Res. 2018;7(1):19-30.
27. Di Mattei VE, Perego G, Taranto P, et al. Socio-demographic and psychological factors associated with quality of life of women undergoing chemotherapy treatment for gynecological cancer. Support Care Cancer. 2022;30(9):7333-7339. doi:10.1007/s00520-022-07162-8
28. Kakhniashvili T, Okribelashvili N, Kiladze I. Sociodemographic factors and depression in patients with breast cancer: a multicenter, cross-sectional study in Georgia. Breast Cancer (Auckl). 2025;19: 11782234251323775. doi:10.1177/11782234251323775
29. Shams M, Pardini S, Del Bianco P, Calabrese C, De Salvo GL, Novara C. The predictive role of intolerance of uncertainty and trait of worry in breast cancer patients: a prospective, observational, single-center clinical study. Front Psychol. 2023;14:1092060. doi:10.3389/fpsyg.2023. 1092060
30. Tosic Golubovic S, Binic I, Krtinic D, et al. Risk factors and predictive value of depression and anxiety in cervical cancer patients. Medicina (Kaunas). 2022;58(4):507. doi:10.3390/medicina58040507
31. Wilson EJ, Abbott MJ, Norton AR. The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: a systematic review and meta-analysis. J Anxiety Disord. 2023; 97:102729. doi:10.1016/j.janxdis.2023.102729
32. Sauer C, Haussmann A, Weissflog G. The effects of acceptance and commitment therapy (ACT) on psychological and physical outcomes among cancer patients and survivors: an umbrella review. J Context Behav Sci. 2024;33:100810. doi:10.1016/j.jcbs.2024.100810
1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10. 3322/caac.21834
2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820
3. International Agency for Research on Cancer. Global cancer observatory: cancer today, 2024. 2024. Available from: https://gco.iarc.who.int
4. Grassi L, Caruso R, Riba MB, et al. Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guidelines. ESMO Open. 2023; 8(2):101155. doi:10.1016/j.esmoop.2023.101155
5. Getie A, Ayalneh M, Bimerew M. Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses. BMC Psychiatry. 2025;25(1):156. doi:10.1186/s12888-025-06599-5
6. Uslu Sahan F, Yildirim S, Kasaltı T, Koc G. The relationship between spiritual care needs, psychological distress and quality of life in women with gynaecological cancer: a cross-sectional study. Indian J Palliat Care. 2025;31(3):227-234. doi:10.25259/IJPC_343_2024
7. Stroeken Y, Hendriks F, Beltman J, Ter Kuile M. Quality of life and psychological distress related to fertility and pregnancy in AYAs treated for gynecological cancer: a systematic review. Cancers (Basel). 2024; 16(20):3456. doi:10.3390/cancers16203456
8. Johansen G, Lampic C, Flöter Rådestad A, Dahm-Kähler P, Rodriguez-Wallberg KA. Health-related quality of life, sexual function, psychological health, reproductive concerns and fertility outcome in young women treated with fertility-sparing surgery for ovarian tumors-a prospective longitudinal multicentre study. Gynecol Oncol. 2024;189:101-108. doi:10.1016/j.ygyno.2024.07.004
9. Shams M, Coman C, Fatone F, et al. The impact of gynecologic cancer on female sexuality in Europe and MENA (Middle East and North Africa): a literature review. Sex Med Rev. 2024;12(4):587-599. doi:10.1093/sxmrev/qeae039
10. Riba MB, Donovan KA, Ahmed K, et al. NCCN Guidelines® insights: distress management, version 2.2023. J Natl Compr Canc Netw. 2023; 21(5):450-457. doi:10.6004/jnccn.2023.0026
11. Amiri S. The prevalence of anxiety symptoms/disorders in cancer patients: a meta-analysis. Front Psychiatry. 2024;15:1422540. doi:10. 3389/fpsyt.2024.1422540
12. Ghamari D, Dehghanbanadaki H, Khateri S, et al. The prevalence of depression and anxiety in women with ovarian cancer: an updated systematic review and meta-analysis of cross-sectional studies. Asian Pac J Cancer Prev. 2023;24(10):3315-3325. doi:10.31557/APJCP.2023.24. 10.3315
13. Qiu T, Zhang T, Zhang Y, Qiu X. Prevalence rates of depression, anxiety, and suicidal ideation in patients with ovarian cancer: a systematic review from 1977 to 2024. Int J Psychiatry Med. 2025;912174251350465. doi:10.1177/00912174251350465
14. Carleton RN, Norton MAPJ, Asmundson GJG. Fearing the unknown: a short version of the Intolerance of Uncertainty Scale. J Anxiety Disord. 2007;21(1):105-117. doi:10.1016/j.janxdis.2006.03.014
15. Shen Z, Zhang L, Shi S, Ruan C, Dan L, Li C. The relationship between uncertainty and fear of disease progression among newly diagnosed cancer patients: the mediating role of intolerance of uncertainty. BMC Psychiatry. 2024;24(1):756. doi:10.1186/s12888-024-06201-4
16. Yang Y, Tan A, Sardesai SD, et al. Effect of intolerance of uncertainty on perceived cognitive function among breast cancer patients before chemotherapy. Cancers (Basel). 2025;17(11):1884. doi:10.3390/cancers 17111884
17. Yang Y, Lin Y, Kim B, Gorka SM, Von Ah D. Intolerance of uncertainty and its association with cancer-related symptoms: a scoping review. Cancer Nurs. 2025. doi:10.1097/NCC.0000000000001462
18. Song J, Cho E, Cho IK, et al. Mediating effect of intolerance of uncertainty and cancer-related dysfunctional beliefs about sleep on psychological symptoms and fear of progression among cancer patients. Psychiatry Investig. 2023;20(10):912-920. doi:10.30773/pi.2023.0127
19. Uslu-Sahan F, Gulcan N. Supportive care needs in predicting the acceptance of illness among gynecological cancer patients undergoing therapy: a cross-sectional study. Support Care Cancer. 2023;32(1):61. doi:10.1007/s00520-023-08270-9
20. Var E, Nazik E. Supportive care needs of women with gynecologic cancer and factors affecting in Turkiye: a cross sectional study. Nurs Commun. 2024;8:e2024007. doi:10.53388/IN2024007
21. Polat F, Şenol DK. Examining the correlation between sexual and reproductive health stigmatization level and gender perception: a case of a university in Turkey-a descriptive cross-sectional study. Sao Paulo Med J. 2022;141(2):146-153. doi:10.1590/1516-3180.2022.0278.03062022
22. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12): 1495-1499. doi:10.1016/j.ijsu.2014.07.014
23. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191. doi:10. 3758/BF03193146
24. Sarıçam H, Erguvan F, Akın A, Akça M. Belirsizliğe tahammülsüzlük ölçeği BTÖ-12 Türkçe formu geçerlik ve güvenirlik çalışması. Route Educ Soc Sci J. 2014;1(3):148-157.
25. Lovibond SH. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney: Psychol Found; 1995.
26. Sariçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. J Cogn Behav Psychother Res. 2018;7(1):19-30.
27. Di Mattei VE, Perego G, Taranto P, et al. Socio-demographic and psychological factors associated with quality of life of women undergoing chemotherapy treatment for gynecological cancer. Support Care Cancer. 2022;30(9):7333-7339. doi:10.1007/s00520-022-07162-8
28. Kakhniashvili T, Okribelashvili N, Kiladze I. Sociodemographic factors and depression in patients with breast cancer: a multicenter, cross-sectional study in Georgia. Breast Cancer (Auckl). 2025;19: 11782234251323775. doi:10.1177/11782234251323775
29. Shams M, Pardini S, Del Bianco P, Calabrese C, De Salvo GL, Novara C. The predictive role of intolerance of uncertainty and trait of worry in breast cancer patients: a prospective, observational, single-center clinical study. Front Psychol. 2023;14:1092060. doi:10.3389/fpsyg.2023. 1092060
30. Tosic Golubovic S, Binic I, Krtinic D, et al. Risk factors and predictive value of depression and anxiety in cervical cancer patients. Medicina (Kaunas). 2022;58(4):507. doi:10.3390/medicina58040507
31. Wilson EJ, Abbott MJ, Norton AR. The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: a systematic review and meta-analysis. J Anxiety Disord. 2023; 97:102729. doi:10.1016/j.janxdis.2023.102729
32. Sauer C, Haussmann A, Weissflog G. The effects of acceptance and commitment therapy (ACT) on psychological and physical outcomes among cancer patients and survivors: an umbrella review. J Context Behav Sci. 2024;33:100810. doi:10.1016/j.jcbs.2024.100810
Article available in :
Volume 4, Issue 2, 2026
Page : 36-42
https://doi.org/10.51271/JCOGP-0071
Article Information
Received : 09 Şub 2026
Accepted : 22 Nis 2026
Published : 30 Nis 2026
Corresponding Author :

Fatma Uslu Sahan: Department of Obstetrics and Gynecologic Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkiye

[email protected]
Citation : Şahingöz Alpargan M, Uslu Şahan F, Karadurmuş N Ayidaga T. The association between intolerance of uncertainty and depression, anxiety, and stress among women with gynecological cancer in Turkiye: a cross-sectional study. J Controv Obstetr Gynecol Ped. 2026;4(2):36-42. doi:10.51271/JCOGP-0071

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