The Influence Mechanism Of Attachment Style On Demoralization And Post-Traumatic Growth In Maintenance Hemodialysis Patients

Objectives:The aims of the study were to investigate the status of demoralization and post-traumatic growth(PTG)of maintenance hemodialysis(MHD)patients,and to explore the parallel mediating role of positive and negative self-compassion in the relationship between attachment styles and demoralization and PTG.Methods:Totally 301 patients with maintenance hemodialysis were enrolled through convenience sampling to complete the Socio-demographic Questionnaire,Demoralization Scale Mandarin Version(DS-MV),Posttraumatic Growth Inventory(PTGI),Experiences in Close Relationships Scale-Modified Short Form(ECR-16)and Self-Compassion Scale(SCS).These Questionnaires were used to measure the status of socio-demographic characteristics,demoralization,post-traumatic growth,attachment style,positive self-compassion and negative self-compassion in MHD patients.Data were analyzed using SPSS 25.0 and AMOS 23.0.Statistical methods included:descriptive analysis,t-test,ANOVA,hierarchical linear regression,Pearson correlation analysis,and structural equation modeling.Results:1.Socio-demographic and disease characteristics of MHD patientsAmong 301 MHD patients,there were 176 males(58.4%)and 125 females(41.5%).The age of MHD patients mainly ranged from 46 to 64 years old(48.5%),with an average age of 51.98 and 14.31 years old.Married patients accounted for 79.1%,patients with bachelor’s degree or above accounted for 25.9%,and employed patients accounted for 30.6%.Among the patients in the sample,the duration of dialysis ranged from 4 months to 20.8 years,with an average of 4.55 years,the majority of patients with primary disease types of diabetic nephropathy(29.9%)and hypertensive nephropathy(32.6%),and patients with kidney transplantation experience accounted for 6.4%。2.The status of demoralization and PTG of MHD patientsThe mean score of demoralization was 37.52(SD=13.32).The prevalence of high level of demoralization were 20.6%.Moderate demoralization was found in 62.5%of MHD patients.The overall mean score of PTG in MHD patients was 58.94(SD=12.28).3.Influencing of socio-demographic and disease data on demoralization scores in MHD patientsUnivariate analysis showed that demoralization scores of the patients were significantly different in marital status(t=-3.88,P<0.001).The scores of demoralization were significantly different in family financial burden(F＝25.64,P<0.001),employment status(t=-3.79,P<0.001),and kidney transplantation experience(t=-2.05,P=0.041).The demoralization status of patients was negatively correlated with age(r=-0.28,P<0.001)and positively correlated with the number of complications(r=0.21,P<0.001).4.Influencing of socio-demographic and disease data on post-traumatic growth scores in MHD patientsUnivariate analysis showed that PTG scores of the patients were significantly different in marital status(t=-3.62,P<0.001),family economic status(F=13.05,P<0.001),educational level(F=3.80,P<0.05),employment status(t=-3.27,P<0.001)and the number of complications(r=-0.19,P<0.01).5.The influencing factors of demoralization and post-traumatic growth in MHD patientsHierarchical linear regression showed that family economic burden(β=0.096,P<0.01),kidney transplantation experience(β=0.071,P<0.05),the number of complications(β=0.085,P<0.05),attachment anxiety(β=0.180,P<0.001)and negative self-compassion(β=0.518,P<0.001)had significant positive predictive effects on demoralization of maintenance hemodialysis patients.Positive self-compassion(β=-0.184,P<0.001)has a significant negative predictive effect on demoralization in MHD patients.Hierarchical linear regression showed that positive self-compassion(β=0.391,P<0.001)had significant positive predictive effects on PTG of maintenance hemodialysis patients.The number of complications(β=-0.143,P<0.01)has a significant negative predictive effect on demoralization in maintenance hemodialysis.6.The influence mechanism of attachment style,positive self-compassion and negative self-compassion on demoralization and post-traumatic growth in MHD patientsThe results of structural equation model analysis showed that the direct effect of attachment anxiety on the demoralization of patients with maintenance hemodialysis was not significant,but the indirect effect was significant.Negative self-compassion played a complete mediating role in the relationship between attachment anxiety and demoralization of patients with maintenance hemodialysis.The direct effect of attachment anxiety on post-traumatic growth of patients with maintenance hemodialysis was insignificant,but the indirect effect was significant.Positive self-compassion played a complete mediating role in the relationship between attachment anxiety and demoralization of patients with maintenance hemodialysis.Conclusions:1.The demoralization and post-traumatic growth of patients with maintenance hemodialysis were at moderate levels.2.Attachment anxiety and negative self-compassion were the risk factors of demoralization in patients with maintenance hemodialysis,while positive self-compassion is the protective factor of demoralization.Attachment anxiety is a risk factor of post-traumatic growth in patients with maintenance hemodialysis,and positive self-compassion is a protective factor of post-traumatic growth.3.Negative self-compassion played a complete mediating role in the relationship between attachment anxiety and demoralization in patients with maintenance hemodialysis,while positive self-compassion played a complete mediating role in the relationship between attachment anxiety and post-traumatic growth in patients with maintenance hemodialysis.