Psychological phenotypes of sense of coherence: How illness perception mediates distress differently across patient subgroups with hematologic malignancies

BACKGROUND: Sense of coherence (SOC) plays a critical role in how patients with hematologic malignancies cope with disease-related stress. However, the heterogeneity of SOC and its mechanisms influencing anxiety and depression remain unclear. This study aimed to identify latent SOC profiles and to examine the mediating role of illness perception in the SOC-anxiety and depression relationship. METHODS: A cross-sectional study was conducted among 486 inpatients with hematologic malignancies. SOC, illness perception, and symptoms of anxiety and depression were assessed using the SOC-13, the BIPQ-8, and the PHQ-4. Descriptive analyses, Logistic regression, latent profile analysis, network analysis, and mediation analyses were performed to examine SOC profile classification, illness perception with anxiety-depression associations, and their underlying mechanisms. RESULTS: Latent profile analysis identified three SOC subgroups: Low SOC-Psychologically Vulnerable (26.8%), Moderate SOC-High Control Low Understanding (42.2%), and High SOC-Resilient Adaptive (31.1%), with age, residence, diagnosis, chronic disease, and social support as significant predictors of profile membership. Network analysis revealed that tension/anxiety (D1) and low mood (D3) were central symptoms across SOC profiles, while emotional representation (P8) consistently emerged as a key bridge node linking illness perception with emotional distress. Mediation analysis further showed that illness perception significantly mediated the SOC-anxiety and depression link, with the strongest effect observed in Profile 2, weaker in Profile 1, and non-significant in Profile 3. CONCLUSIONS: SOC shows heterogeneous profiles with distinct structures. Illness perception partially mediates the SOC-anxiety/depression link, moderated by SOC profiles, highlighting the need for tailored psychological interventions.