Oribatid mites like lichens-feeding preferences among three Cladonia species with different chemistry.

Coronary Heart Disease (CHD) is characterized by coronary artery stenosis, occlusion, or functional abnormalities leading to myocardial ischemia or infarction [, ], and remains a major public health challenge in China with substantial health and economic burdens [, ]. Percutaneous Coronary Intervention (PCI) is a widely adopted minimally invasive treatment for CHD, effectively improving myocardial perfusion due to its safety and rapid efficacy []. Despite technological advancements, postoperative complications and concerns about restenosis often contribute to negative psychological states in patients, including anxiety, depression, and low self-esteem [–]—factors that may hinder recovery and reduce quality of life []. With the shift toward positive psychology in CHD research [], self-esteem—defined as a core evaluation of an individual’s self-worth—has emerged as a critical determinant of illness adaptation, aligning with Lazarus and Folkman’s stress-coping framework. According to this theoretical model, an individual’s appraisal of stressors (e.g., illness-related uncertainty, functional limitations post-PCI) and subsequent coping strategies are shaped by personal resources, among which self-esteem serves as a key psychological asset []. High self-esteem enhances individuals’ ability to engage in adaptive coping (e.g., seeking social support, adhering to medical recommendations) by fostering a sense of control and resilience, thereby supporting physical and mental health outcomes. In contrast, low self-esteem is associated with maladaptive coping patterns (e.g., avoidance, helplessness), social withdrawal, and compromised quality of life, as individuals may perceive illness-related stressors as overwhelming []. In CHD patients, lower self-esteem levels have been linked to impaired treatment adherence, reduced stress resilience, and adverse disease prognosis [–], underscoring its regulatory role in mediating the stress-response process and influencing disease progression and recovery. However, existing literature predominantly positions self-esteem as a predictive variable for prognosis, with limited research investigating it as an outcome variable shaped by contextual and individual factors. Specifically, studies on self-esteem among post-PCI patients remain scarce, and the mechanisms through which factors such as rural residence (e.g., associated with reduced access to psychosocial resources, greater illness-related stigma) or educational level (e.g., influencing health literacy and stress appraisal) impact self-esteem remain underexplored. Guided by Lazarus and Folkman’s stress-coping framework [, ], this cross-sectional study aims to systematically assess self-esteem status in CHD patients following PCI and identify its influencing factors. By elucidating how individual (e.g., age, educational level) and contextual (e.g., place of residence, income) factors interact to shape self-esteem via stress appraisal and coping processes, this study seeks to provide empirical evidence for the development of targeted psychological nursing interventions to improve patient outcomes and quality of life. The conceptual pathways underlying these relationships, based on the stress-coping framework, are illustrated in Fig. .