Abstract

Objective: Biological and psychological factors contribute to coronary artery disease (CAD). The purpose of this study was to investigate the relationship between spiritual well-being and CAD severity and determine the mediating effects of anger rumination and worry on this relationship. Design: Descriptive, cross-sectional survey. Setting: Afshar Hospital in Yazd, Iran. Method: Participants were 327 patients with CAD (138 women, 189 men). Spiritual well-being, anger rumination, worry and CAD severity were measured using demographic and medical information questionnaires, the Spiritual Well-Being Scale, the Anger Rumination Scale, the Penn State Worry Questionnaire and Gensini method. Mediation analysis was conducted using the PROCESS macro. Results: CAD severity was negatively correlated with spiritual well-being (r = –.62, p < .01) and positively correlated with anger rumination (r = .58, p < .01) and worry (r = .33, p < .01). The relationship between spiritual well-being and CAD severity was mediated by anger rumination. The direct effect of spiritual well-being on CAD severity was statistically significant (β = –.06, 95% confidence interval [CI] [–.09, –.04]). We find a significant indirect effect of spiritual well-being on CAD severity through anger rumination (β = –.03, 95% CI [–.05, –.02]). Conclusion: These results highlight the potential benefits of spiritual well-being for patients with CAD to help them reduce anger rumination and, consequently, CAD severity.