Path analysis of mindfulness, positive affect, negative affect and cancer-related stress on death anxiety among cancer patients in Nigeria

Cancer is fundamentally a chronic disease that, beyond its physical consequences, can lead to heightened emotional distress and death anxiety. Mindfulness is a promising psychological resource capable of alleviating death anxiety among people living with a chronic disease. However, the underlying mechanisms through which mindfulness performs this function remains poorly understood. Dwelling on the Mindfulness-to-Meaning Theory, the current study examined the mediating role of positive affect, negative affect and cancer-related stress in the relationship between mindfulness and death anxiety. Using a cross-sectional design, 228 cancer outpatients (156 (68.4%) females, M age = 49.12, SD = 11.05), conveniently selected from Nnamdi Azikiwe university teaching hospital, Okofia, Anambra State, Nigeria, completed relevant self-report measures: Mindful Attention Awareness Scale (MAAS), Positive and Negative Affect Schedule (I-PANAS), Impact of Event Scale and Death Anxiety Inventory-Revised (DAI-R). Hayes PROCESS Macro for SPSS Model 4 was used for mediation analysis. After fully adjusting for key covariates, mindfulness was significantly associated with lower levels of death anxiety ( B = -0.24, p < .001, 95%CI: [-0.36, -0.13]) and indirectly through higher positive affect (Effect = -0.12, SE = 0.04, 95%CI: [-0.20, -0.03]), lower negative affect (Effect = -0.08, SE = 0.03, 95%CI: [-0.13, -0.02]) and lower cancer-related stress (Effect = -0.12, SE = 0.03, 95%CI: [-0.19 to -0.07]). Comparing the mediators, cancer-related stress exerted the greatest indirect effect on death anxiety, indicating that cancer patients with greater mindfulness skills may experience lowest levels of death anxiety through the pathway of lower levels of cancer-related stress. Mindfulness is significantly and negatively associated with death anxiety among cancer patients, with its effects largely explained through higher positive affect, lower negative affect and reduced cancer-related stress. This preliminary evidence suggest that mental health professionals and policy makers may target interventions that improves mindfulness skills and enhance adaptive emotional life to optimize health and wellbeing of cancer patients. Future studies using longitudinal or experimental design are encouraged to clarify directionality.