Discussion
The results showed that anxiety and depression were the influencing factors of quality of life. Foreign scholars also pointed out that depression, anxiety and other emotions have a stronger impact on psychological level than physical function [40]. Patients with gynecological tumor do not understand the disease and treatment, leading to more anxiety. Anxiety can reduce the quality of life by affecting physical function [41,42]. For cancer patients, depression can aggravate the side effects of cancer treatment, affect the therapeutic effect, and even promote the recurrence and metastasis of tumor [43]. Therefore, anxiety and depression are risk factors of quality of life in patients with gynecological tumor. This study showed that hypertension had no effect on quality of life, which was different from previous studies [44], it may be caused by different populations or other unknown factors. However, hypertension and anxiety or hypertension and depression had additive interaction on the quality of life. The effect of two factors at the same time is greater than that of single factor. Carroll et al. found that the patients with anxiety and depression were significantly correlated with the incidence of hypertension [45]. Hamer et al. also found that anxiety and depression patients are more likely to cause varying degrees of blood pressure rise [46]. At present, many studies also suggested that hypertension itself may lead to anxiety and depression [47]. Research showed that in patients receiving anti-hypertensive treatment, 3/4 of them suffer from long-term illness, and most of them have anxiety and depression [48]. Hypertension will cause depression, anxiety, cognitive impairment, physical discomfort and sleep disorders. On the contrary, this psychological state will aggravate the condition of hypertension, resulting in a vicious circle between hypertension and anxiety, depression, which affected the prognosis of the disease, caused serious physical and mental consequences, and reduced the quality of life of patients.
In this study, anxiety and depression were negatively correlated with PSS, and PSS was positively correlated with quality of life, consistent with previous findings [49,50]. PSS moderates the effects of anxiety or depression on quality of life of patients. Social support can be used as an individual and internal resource to cope with and adapt to stress situations, enabling people to explain and deal with cancer, difficulties, hope and rehabilitation [29]. Studies have confirmed that social support was strongly positively correlated with the physiological and psychological aspects of long-term survival of cancer [51,52]. Hence, social support is an important factor to predict the quality of life of cancer patients [50]. The key factor of social support as a stress buffer is that the individual perceives that others will provide appropriate support, which will reduce the emotional and physiological reactions of individual stress. This can explain why the more social support patients feel during treatment, the more beneficial it is to improve depression and anxiety symptoms [53]. Study also showed that only when social support is needed can social support buffer the symptoms of anxiety and depression in cancer patients [54]. This can explain why lower social support is not obvious in alleviating the relationship between depression, anxiety and quality of life in our study. Social support is associated with reduced cancer-related stress and depression symptoms, positive psycho-social changes, and lower mortality [51,52,55]. Based on the above theory, it is concluded that when patients have depression or anxiety, social support has a positive effect on improving the quality of life, reducing the possibility of depression or anxiety, thus changing the relationship between depression or anxiety and quality of life.