Anxiety and Mindfulness in the Relationship Between Stress and Depression in Patients With Coronary Artery Disease: A Parallel Mediation Analysis

AIM: To examine the indirect effect of anxiety and mindfulness on the relationship between stress and depression in patients with coronary artery disease. DESIGN: A correlational, cross-sectional design was used. METHODS: Participants of this study comprised 112 patients with coronary artery disease recruited from a general hospital in South Korea between January and September 2021. The Korean versions of the Depression Anxiety Stress Scale-21 and Mindful Attention Awareness Scale were used. Data were analysed using parallel multiple mediation analysis (PROCESS macro Model 4). RESULTS: Stress, anxiety, mindfulness and depression were significantly correlated. The total indirect effect through anxiety and mindfulness on the relationship between stress and depression was significant (B = 0.37, 95% CI [0.200, 0.592]). The specific indirect effect through mindfulness was significant (B = 0.26, 95% CI [0.122, 0.423]), whereas the indirect effect through anxiety was not statistically significant (B = 0.11, 95% CI [-0.003, 0.268]). CONCLUSION: Mindfulness may be an important psychological factor associated with the relationship between stress and depression in patients with coronary artery disease. Further research is needed to clarify the role of anxiety in this relationship. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Mindfulness-based approaches may be considered as complementary strategies for managing psychological distress and depressive symptoms in patients with coronary artery disease. Anxiety should also be assessed as part of comprehensive psychological care.