The mediating role of rumination between fear of disease progression and sleep disturbance in melanoma patients: a dual-perspective analysis based on person-centered and variable-centered approaches

Abstract

Background: Previous studies have confirmed that melanoma patients often experience intense fear of disease progression, with a significantly higher incidence of sleep disorders compared to the general population. However, the relationship between these two factors and the underlying psychological mechanisms remain unclear. To address the gaps in previous research, the present study employs a dual-methodological approach, incorporating both person-centered and variable-centered strategies, to comprehensively examine the association and heterogeneity between fear of disease progression and sleep disturbances among melanoma patients. Methods: A cross-sectional survey design was implemented, utilizing convenience sampling to enlist a total of 501 melanoma patients from three tertiary-level hospitals located in Sichuan Province, China. Data collection took place between May and July 2025. Results: Findings from the variable-centered analysis indicated that fear of disease progression not only exerted a direct positive association with the occurrence of sleep disturbances but also mediated this relationship through the amplifying effect of rumination. The person-centered analysis delineated three distinct subgroups of patients. Among these, the subgroup characterized by medium fear of disease progression – high rumination demonstrated markedly higher levels of sleep disturbance in comparison to the other two groups. This suggests that individuals who experience both medium fear of disease progression and high rumination are particularly susceptible to severe sleep-related issues. Conclusion: The results of this study underscore the critical role of rumination as a key psychological mechanism that mediates the impact of fear of disease progression on sleep quality among melanoma patients. From a clinical and psychological intervention standpoint, implementing cognitive-behavioral strategies aimed at reducing rumination within this high-risk subgroup may serve as an effective approach to mitigate fear levels and enhance overall sleep quality.