OBJECTIVE: To investigate the factors influencing the fear of recurrence among craniopharyngioma (CP) patients. METHODS: A total of 152 CP patients from Mianyang Central Hospital were recruited for this survey. The patients completed validated self-report questionnaires, including the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Hospital Anxiety and Depressed Scale (HADS), Social Support Rating Scale (SSRS), and Simplified Coping Style Questionnaire (SCSQ). RESULTS: The average post-surgery FoP-Q-SF score in CP patients was 36.29±5.22 points, with 71.1% of patients scoring above the clinical significance level (cut-off score ≥34). FoP-Q-SF scores differed significantly by type of resection, gender, and tumor size (P<
0.001), with lower recurrence fear in patients undergoing total resection, female patients, and those with tumors <
2.4 cm. Social support (P<
0.001) and positive coping (P<
0.001) were associated with a significant reduction in the fear of recurrence, while negative coping was associated with an increased fear of recurrence (P<
0.001). Additionally, gender (P<
0.001) and tumor size (P<
0.001) also showed significant effects on fear of recurrence. The interaction between depression and gender significantly affected fear of recurrence (P<
0.001), with female FoP-Q-SF scores increasing as HADS-depression scores rose, while the opposite trend was observed for male patients. CONCLUSION: The interaction between gender and depressive mood significantly modulates the fear of recurrence, suggesting that gender differences should be considered in clinical interventions. Social support and positive coping play a positive role in alleviating fear of recurrence, while negative coping may exacerbate the fear. Strengthening psychological assessment and support during postoperative care is recommended.