The Effects Of Social Support,Perceived Stress And Coping Ability On Post-traumatic Growth Among Patients With Maintenance Hemodialysis

Objective: Maintenance Hemodialysis(MHD)therapy can not only cause anxiety,depression and other negative emotional experiences,but also lead to different degrees of post-traumatic growth.Therefore,this study will explore the status quo of post-traumatic growth in MHD patients,explore the association between social support,perceived stress,coping ability and post-traumatic growth in MHD patients,and further explore the effect of perceived stress and coping ability in the relationship between social support and posttraumatic growth in MHD patients.The study aims to provide ideas for improving the posttraumatic growth level of MHD patients,developing overall effective,scientific and feasible nursing,and strengthening targeted psychological intervention work.Methods: The questionnaire survey was conducted in 5 hemodialysis centers in Beijing from September to December 2019,and 750 MHD patients who met the standards participated in this survey.The questionnaire included the general questionnaire,perceived social support scale(PSSS),perceived stress scale(PSS-10)and the post-traumatic growth inventory(PTGI).641 questionnaires were effectively collected,with an effective rate of85.5%.One-way ANOVA and t-test statistical methods were used to compare the differences in demographic and disease-related characteristics of post-traumatic growth among MHD patients.Spearman correlation analysis was used to test the relationship between social support,perceived stress,coping ability and post-traumatic growth in MHD patients.Hierarchical regression analyses were used to exam the influencing factors of post-traumatic growth and the intensity of their effects,and to explore the mediating effect of perceived stress and coping ability.Bootstrap method was used to test the mediating effect of perceived stress and coping ability.Results: The average score of post-traumatic growth in MHD patients was 39.56 ± 23.38.Age,education level and dialysis age were the influencing factors of post-traumatic growth among MHD patients.The post-traumatic growth of MHD patients was positively correlated with social support and coping ability(P<0.01),and negatively correlated with perceived stress(P<0.01).After excluding the influence of control variables,social support was an important influencing factor of post-traumatic growth in MHD patients,and it explained 20.5% of the variation of post-traumatic growth.After adding perceived stress to the model,it explained 3.6% of the variance of the post-traumatic growth.The absolute value of standard regression coefficient of social support was decreased from0.463(P<0.01)in the second step to 0.423(P<0.01)in the third step.Thus,perceived stress could probably mediate the relationship between social support and post-traumatic growth.After adding coping ability as a mediating variable to the model,it explained 6.5% of the variation of post-traumatic growth.The absolute value of standard regression coefficient of social support decreased from 0.463 in the second step(P<0.01)to 0.422 in the third step(P<0.01).Thus,coping ability could probably mediate the relationship between social support and post-traumatic growth.In Bootstrap method results,the mediating effect of perceived stress was 0.039(P<0.01),and the 95% confidence interval was(0.021,0.062).The mediating effect of coping ability was 0.041(P<0.01),and the 95% confidence interval(0.019,0.065).Conclusion: The level of post-traumatic growth among MHD patients was relatively low.Age,education level and dialysis age could affect the post-traumatic growth level of MHD patients.Social support could enhance the post-traumatic growth of MHD patients.Patients with weak perceived stress ability or strong coping ability were in high level of post-traumatic growth.Social support could enhance the level of post-traumatic growth of MHD patients by alleviating their perceived stress and enhancing their coping ability.Therefore,family members,friends and medical staffs should give more care and support to MHD patients,relieve their psychological pressure and improve their coping ability,so as to improve their post-traumatic growth level.