Objective To explore the mechanisms associated with symptom burden and depression in hepatocellular carcinoma patients after hepatectomy.

Methods A total of 230 hospitalized patients with hepatocellular carcinoma who were underwent hepatectomy for the first time were selected as study subjects. A self-administered General Information Questionnaire, MD Anderson Symptom Inventory, Patient Health Questionnaire, Connor-Davidson Resilience Scale, and Pittsburgh Sleep Quality Index were used to investigate sociodemographic, sociodemographic data, symptom burden, depression, psychological resilience, and sleep quality of postoperative hepatocellular carcinoma patients. Pearson correlation analysis was used to identify specific associations among variables. The mediating and moderating effects of psychological resilience and sleep quality between symptom burden and depression were analyzed using the Process.

Results Psychological resilience partially mediated the association between symptom burden and depression (β=-0.137, SE=0.084, 95%CI, -0.243 to -0.082), with the mediating effect accounting for 44.08% of the total effect, and the interaction term between symptom burden and sleep quality had predictive value for psychological resilience (β=-0.014, t=-6.209, P < 0.001).

Conclusion Postoperative symptom burden in hepatocellular carcinoma patients can play a role in depression through psychological resilience, where the effect of symptom burden on psychological resilience is moderated by sleep quality. Clinical staff should take reducing patients'postoperative symptom burden and improving psychological elasticity with sleep quality as important goals and develop appropriate nursing interventions to reduce the risk of depression in patients.