The mediating roles of depression and demoralization daily hassles and behavioral inhibition as predictors of post-MI self-care: the distinct pathways of depression and demoralization.

Effective self-care after myocardial infarction (MI) is essential for secondary prevention, yet many individuals struggle to maintain recommended health behaviors. Daily hassles and psychological distress may interfere with self-care, but the roles of depressive symptoms and demoralization have not been sufficiently examined simultaneously. Although these forms of distress may co-occur, they reflect distinct psychological experiences. Depression is characterized by depressed mood, anhedonia, and related cognitive and motivational symptoms, whereas demoralization centers on perceived inability to cope, helplessness, and loss of meaning or purpose. This cross-sectional study examined the associations of daily hassles and behavioral inhibition (BI) with self-care behaviors after MI and tested whether depressive symptoms and demoralization statistically mediated these associations. Participants were 175 individuals who had experienced MI (mean age = 54.42 years, SD = 12.03; 58% male; 79% married) completed self-report questionnaires assessing self-care behaviors, daily hassles, BI, depressive symptoms, and demoralization. The mean time since MI was 12.08 months (SD = 4.26; range = 6-19 months). Structural equation modeling examined the hypothesized associations and indirect effects. Self-care behaviors were negatively associated with daily hassles, BI, depressive symptoms, and demoralization. Participants generally reported adequate dietary adherence and medication management but lower levels of physical activity. The model showed good fit to the data (CFI = .98, TLI = .95, RMSEA = .08). Depressive symptoms significantly mediated the associations of daily hassles and BI with self-care behaviors (indirect βs = -.09 to -.10, p < .05), while demoralization showed a significant indirect effect (indirect β = -.08, p < .05). Overall, depressive symptoms and demoralization showed distinct indirect associations with poorer post-MI self-care. The findings highlight the relevance of considering multiple dimensions of psychological distress in psychosocial approaches to secondary prevention.