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

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.

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.

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.

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).

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.