Factors pertaining to religion and spirituality have been linked with well-being and adequate coping. Few studies have investigated negative aspects of religious coping, such as spiritual struggle.

Based on multidisciplinary literature and previous findings, our study's objectives are to estimate the parallel psychophysiological pathways from pre-operative distress to post-operative depression in patients undergoing open heart surgery.

The study's aims are to examine the association in depression, anxiety, and how coping, spiritual struggle and interleukin-6 play a role in patients following open heart surgery.

Plasma samples for interleukin-6 (IL-6) were obtained before open heart surgery. Patients’ history and demographic information obtained through interviews 2 days before surgery. Follow up interview for mental health and religious were conducted before and after surgery.

The results showed that a link between spiritual struggle and IL-6 mediated the indirect effects of pre-operative anxiety on post-operative depression. Anxiety had positive indirect effects on post-operative hostility. Further, hope played a protective mediating role to moderate the undesirable influences of the spiritual struggle-IL-6 link and maladaptive coping on post-operative mental health attributes.

Our study estimated important psychophysiological pathways from pre-operative distress to post-operative maladjustment. To our knowledge, this model is the first analysis to demonstrate the significant mediating effect of the spiritual-IL-6 link, alongside that of positive religious copping and other maladaptive coping, in this population.