QOL-21. Exploring the role of functionality appreciation in the relationship between death anxiety and depression among brain tumor patients

Abstract BACKGROUND Depression and death anxiety are prevalent concerns among brain tumor (BT) patients. Functionality appreciation, valuing the body for what it can do, has emerged as a potentially protective construct but remains underexplored outside of body image or eating disorder populations. This study examined the relationships among death anxiety, depression, and functionality appreciation in BT patients and tested whether functionality appreciation moderates the association between death anxiety and depression. METHOD A cross-sectional survey of 236 adults with primary BTs assessed death anxiety (Death and Dying Distress Scale), depressive symptoms (PHQ-9), and functionality appreciation (Functionality Appreciation Scale). Pearson correlations and a hierarchical regression were conducted to examine bivariate relationships and test moderation. RESULTS Death anxiety was positively associated with depression (r =.81, p <.001) and negatively associated with functionality appreciation (r = -.20, p =.002). Functionality appreciation was also negatively associated with depression (r = -.34, p <.001). A hierarchical regression revealed that death anxiety significantly predicted depression (β = 0.81, p <.001, R² =.66). Adding functionality appreciation improved the model (ΔR² =.03, ΔF = 23.09, p <.001), with higher functionality appreciation predicting lower depression (β = -0.18, p <.001). However, the interaction between death anxiety and functionality appreciation was non-significant (β = -0.05, p =.180), and did not improve the model (ΔR² =.002, p =.180). Sensitivity analyses suggested the study may have been underpowered to detect a small interaction effect. CONCLUSION Although functionality appreciation did not moderate the relationship between death anxiety and depression, it was independently associated with lower levels of both. These findings suggest functionality appreciation may act as a general protective factor for emotional well-being in BT patients. Future research should examine whether interventions that enhance functionality appreciation can reduce psychological distress and improve quality of life in this population.