Attachment Style and Depression in Colorectal Cancer Survivors: Mediating and Moderating Effects of Symptom Distress and Mindfulness.

OBJECTIVES: To examine the relationships among adult attachment styles, symptom distress, and depressive symptoms in colorectal cancer (CRC) survivors, and to explore whether mindfulness moderates these associations. SAMPLE AND SETTING: A cross-sectional study was conducted with 90 CRC survivors aged 20 years or older who had completed treatment within the past three months at a medical center in northern Taiwan. METHODS AND VARIABLES: Participants completed validated questionnaires measuring depressive symptoms (Beck Depression Inventory-II [BDI-II]), attachment style (Experience in Close Relationships Scale-Short Form), mindfulness (Five Facet Mindfulness Questionnaire), and CRC-specific symptom distress (European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-CRC Module). Data were analyzed using descriptive statistics, Pearson correlations, hierarchical regression, and the Hayes PROCESS macro. RESULTS: The mean BDI-II score was 4.96; 8% reported clinically significant depressive symptoms. Anxious attachment correlated with depression (r = 0.4, p < 0.001) and predicted depression in the initial regression model (beta = 0.5, p < 0.001). Avoidant attachment had an indirect effect through symptom distress (beta = 0.32, p = 0.002). Mindfulness moderated the anxious attachment-depression association (ΔR² = 0.03, p = 0.007), and acting with awareness moderated the avoidant attachment-depression association (ΔR² = 0.02, p = 0.02). IMPLICATIONS FOR NURSING: Findings suggest that routine assessment of attachment style and mindfulness traits may help identify CRC survivors at psychological risk. Incorporating mindfulness-based education into survivorship care may support emotional well-being.