The Mediating Effects of Anxiety and Depression on the Relationship Between Mindfulness Levels and Sleep Quality in Acute Leukemia Patients: A Cross-Sectional Study.

OBJECTIVES

The purpose of this study was to explore the relationships between mindfulness, sleep quality, anxiety, and depression in adult leukemia patients, and to test whether anxiety and depression play a mediating role between mindfulness level and sleep quality.

METHODS

This study was a cross-sectional study, conducted in China from June 2023 to December 2024. A total of 200 patients diagnosed with acute leukemia (AL) were surveyed. Data collection utilized the Mindful Attention Awareness Scale, Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale. Statistical analyses employed SPSS 27.0 for descriptive and inferential statistics, and AMOS 24 for mediation analysis.

RESULTS

The mean scores for mindfulness levels, sleep quality, anxiety, and depression were (63.90 ± 14.40), (7.88 ± 3.94), (5.77 ± 3.89), and (5.55 ± 3.99), respectively. Notably, the mindfulness level exhibited a significant negative correlation with the PSQI score, as well as with the levels of anxiety and depression (r = -0.436, -0.348, -0.179, respectively; all P < .01). Moreover, the PSQI scores were positively correlated with both anxiety and depression (r = 0.471, 0.395, respectively; P < .01), and anxiety and depression were positively correlated with each other (r = 0.671, P < .01). Regarding the impact on sleep quality, the direct effect value of mindfulness was -0.179, while the indirect effect values of anxiety and depression were -0.174 and -0.082, respectively. These indirect effects accounted for 40.00% and 18.85% of the total effect, respectively.

CONCLUSIONS

The results of this study suggest that the mindfulness levels, sleep quality, and the states of anxiety and depression among AL patients all require improvement. Mindfulness was shown to directly affect patients' sleep quality and can also exert an indirect influence through the pathways of anxiety and depression.

IMPLICATIONS FOR NURSING PRACTICE: In clinical practice, in addition to taking measures to alleviate the emotional distress experienced by these patients, enhancing their level of mindfulness emerges as a viable and promising approach to significantly improve their sleep quality. Nurses should integrate mindfulness-based interventions into the daily care routine of AL patients, providing structured programs to help patients cultivate mindfulness skills. Additionally, establishing a regular assessment mechanism for patients' mindfulness levels, anxiety, depression, and sleep quality can enable nurses to adjust care plans in a timely manner, ensuring that interventions are personalized and effective in promoting patients' psychological well-being and sleep quality.