Anxiety and Mindfulness in the Relationship Between Stress and Depression in Patients With Coronary Artery Disease: A Parallel Mediation Analysis
Yeoungsuk Song, Yoonmi Lee, Hong An Lim, Junghoon Lee
Nursing Open October 30, 2026 DOI: 10.1002/nop2.70992 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Correlational cross-sectional study Peer reviewed |
|---|---|
| Sample size | 112 |
| Population | Patients with coronary artery disease recruited from a general hospital in South Korea |
| Measures | Depression Anxiety Stress Scale-21 (DASS-21), Mindful Attention Awareness Scale (MAAS) |
| Topics | Anxiety Depression Meditation |
| Key findings | The total indirect effect of anxiety and mindfulness on the stress–depression relationship was significant (B = 0.37), driven mainly by a significant indirect effect through mindfulness (B = 0.26); the indirect effect through anxiety was not statistically significant (B = 0.11, 95% CI [-0.003, 0.268]). The authors suggest mindfulness may be an important factor linking stress and depression in coronary artery disease patients. |
Abstract
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.
Comparable studies
Other cross-sectional and survey studies on anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
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| Psychedelics and Mental Health: A Population Study Adult population in the United States | 2013 | Cross-sectional survey | n = 130,152 |
| The Role of Mindfulness and Psychological Flexibility in Somatization, Depression, Anxiety, and General Psychological Distress in a Nonclinical College Sample Ethnically diverse, nonclinical sample of college undergraduates (76% female) | 2011 | Observational cross-sectional survey | n = 494 |
| Ecstasy/MDMA attributed problems reported by novice, moderate and heavy recreational users Ecstasy users who participated in a WWW study of recreational drug use | 2002 | Cross-sectional survey | n = 282 |