Objective: This study examined how Jewish and Arab women in Israel, with varying levels of religiosity, cope with metastatic breast cancer, specifically investigating the relationships between loneliness, depression, anxiety, and quality of life, and exploring the moderating roles of religiosity and spirituality.
Methods: A mixed-method approach was employed, including a quantitative longitudinal component and a qualitative component consisting of in-depth interviews with a subset of the participants. The quantitative analysis involved 100 women who completed validated scales assessing loneliness (UCLA), religiosity and spirituality (SBI, FACIT-Sp), depression (PROMIS-D-SF), anxiety (PROMIS-A-SF), and quality of life (FACT-B).
Results: Loneliness correlated positively with depression (r = 0.63, p < .01), anxiety (r = 0.50, p < .01), and negatively with quality of life (r = -0.55, p < .01). Cluster analysis identified four groups: (1) low loneliness–low religiosity, (2) high loneliness–low religiosity, (3) low loneliness–high religiosity, and (4) high loneliness–high religiosity, demonstrating significant differences in depression (F(3) = 18.96, p < .001), anxiety (F(3) = 10.61, p < .001), and quality of life (F(3) = 10.81, p < .001). Post-hoc analyses indicated lower depression levels in the highly lonely but highly religious group (cluster 4) compared to the highly lonely and less religious group (cluster 2). Qualitative interviews with Arab and ultra-Orthodox Jewish women highlighted belief in God as a critical resource alleviating distress and loneliness.
Conclusions: High loneliness increases depression and anxiety and reduces quality of life among women with metastatic breast cancer. Religiosity and spirituality mitigate depression specifically under conditions of high loneliness. These quantitative findings, enriched by qualitative insights, underscore the importance of integrating religious and spiritual resources into psychosocial oncology care, particularly in culturally and religiously diverse populations.