| Objective:To investigate the status quo of psychological distress of hemodialysis patients and the relationship between self-disclosure and psychological distress,and to explore the mediating effect of dyadic coping and intimate relationship on self-disclosure and psychological distress,For the future how to provide new way in clinical improvements in psychological distress in patients with new methods.Methods:From October 2022 to January 2023.A total of 237 HD patients were conveniently selected from a Grade Ⅲ hospital and three Grade Ⅱ hospitals in Shandong Province.The measurement tools included the general information questionnaire,Diseaserelated data questionnaire,The Kessler Psychological Distress Scale,Distress Disclosure Index Scale,Marriage Adjustment Scale,and Dyadic Coping Inventory.SPSS 27.0 was used for data entry,collation and analysis,including descriptive statistical analysis.independent sample T test,analysis of variance,brow-forstythe,Pearson correlation analysis and multiple linear regression analysis.The mediation effect was tested by the Bootstrap program in the Process plugin.Result:1.Status quo of hemodialysis patients with psychological distress,self-disclosure,intimate relationship and dyadic coping.The score of psychological distress in HD patients was(25.74±8.97).The score of selfdisclosure was(34.64±7.70),Intimacy relationship score was(88.37±26.50),The score of dyadic coping was(114.371±16.73).The scores of pressure communication was(25.18±5.08),support coping was(33.48±7.52),empowerment coping was(13.43±3.09),joint coping was(16.52±4.15)and negative coping was(25.75±4.31).2.Analysis of psychological distress,general demographic factors and disease-related factors in hemodialysis patients.There were significant differences in psychological distress scores of hemodialysis patients in education level,type of medical insurance,dialysis access,number of complications,monthly income and medical burden(P<0.05).There were no significant differences in gender,age,marriage age and residence(P>0.05).3.Correlation analysis of psychological distress,self-disclosure,intimate relationship and dyadic coping in hemodialysis patients.Pearson correlation analysis results showed that there was a significant negative correlation between psychological distress and self-disclosure,and with intimate relationship and with stress communication.There was a significant positive correlation between psychological distress and negative coping.There was a significant positive correlation between self-disclosure and intimate relationship,and with stress communication and with supportive coping.There was a significant negative correlation between self-disclosure and negative coping.There was a significant positive correlation between intimate relationship and stress communication,and with supportive coping,and with empowered coping,and with joint coping.There was a negative correlation between intimate relationship and negative coping.There was a significant positive correlation between stress communication and supportive coping,and with empowering coping,and with joint coping.There was a negative correlation between stress communication and negative coping(all P<0.01).4.Mediating effect of intimate relationship between self-disclosure and psychological distress in hemodialysis patientsThe results of multiple linear regression analysis showed that self-disclosure has a significant negative predictive effect on psychological distress.(β=-0.199,P<0.001).Selfdisclosure has a significant positive predictive effect on intimacy.(β=0.249,P<0.001).After adding intimate relationship,the absolute value of the regression coefficient of self-disclosure to psychological distress decreases,but it is still significant(β=-0.130,P<0.01),At the same time,intimacy still has a significant negative predictive effect on psychological distress.(β=0.276,P<0.001).Bootstrap test showed that the 95%CI of the mediating effect of intimate relationship was[-0.124,-0.023],excluding 0.The indirect effect of self-disclosure on psychological distress was-0.069(0.249*-0.276)and 34.67%(0.069/0.199).through the mediating effect of intimate relationship.5.Mediating effect of dyadic coping between self-disclosure and psychological distress in hemodialysis patientsThe results of multiple linear regression analysis showed that self-disclosure has a significant negative predictive effect on psychological distress.(β=-0.199,P<0.001).Selfdisclosure has a significant positive prediction on the positive dimension of binary coping(pressure communication)(β=0.196,P<0.001);After adding stress communication,The absolute value of the regression coefficient of self-disclosure to psychological distress decreases,but it is still significant(β=-0.153,P<0.001),At the same time,pressure communication still has a significant negative predictive effect on psychological distress.(β=0.237,P<0.001).Bootstrap test showed that the 95%CI of the mediating effect of stress communication was[-0.092,-0.011],excluding 0.The indirect effect of self-disclosure of HD patients on psychological distress through stress communication was-0.046(0.196*-0.237),and the mediating effect size was 23.12%(0.046/0.199).Self-disclosure has a significant positive predictive effect on the negative dimension of binary coping(negative coping)(β=-0.216,P<0.001).After the addition of negative coping,The regression coefficient of self-disclosure to psychological distress decreased,but it was still significant.(β=-0.141,P<0.01),At the same time,negative coping still has a significant positive predictive effect on psychological distress.(β=0.271,P<0.001).The 95%confidence interval of Bootstrap test on the mediating effect of pressure communication is[-0.096,0.023],excluding 0.The indirect effect of negative coping on psychological distress in hemodialysis patients was-0.059(-0.216*0.271)and the intermediate effect size was 29.65%(0.059/0.199).6.Analysis of the chain mediating effects of dyadic coping and intimate relationship on self-disclosure and psychological distress in hemodialysis patientsPsychological distress as a dependent variable,self-disclosure as independent variables,and Stress communication and intimate relationship were all taken as the mediating variables to construct a multiple mediation model.Process plug-in was used to test the mediation model 6.The results showed that the predictive effect of self-disclosure on psychological distress through stress communication was-0.026(0.196*-0.133).The Bootstrap test showed that the 95%CI of mediating effect of close relationship was[-0.060,-0.001],excluding 0,indicating the existence of mediating effect.The predictive effect of self-disclosure on psychological distress through intimate relationship was-0.033(0.154*-0.213).The 95%CI of the mediation effect of intimate relationship tested by Bootstrap was[-0.070,-0.004],excluding 0,indicating the existence of the mediation effect.The indirect prediction effect of selfdisclosure on psychological distress through the multiple mediating effects of stress communication and intimate relationship was-0.020(0.196*0.487*-0.213).The 95%CI of the mediation effect of Bootstrap test was[-0.047,-0.004],excluding 0,indicating the existence of chain mediation effect.Psychological distress as a dependent variable,self-disclosure as independent variables,and negative coping and intimate relationship were all taken as the mediating variables to construct a multiple mediation model.Process plug-in was used to test the mediation model 6.The results showed that the predictive effect of self-disclosure through negative coping with psychological distress was-0.050(0.216*-0.232).,The Bootstrap test showed that the 95%CI of mediating effect of close relationship was[-0.084,-0.020],excluding 0 indicating the existence of mediating effect.he predictive effect of self-disclosure on psychological distress through intimate relationship was-0.051(0.214*-0.238).The 95%CI of the mediating effect of intimate relationship tested by Bootstrap was[-0.099,-0.014],excluding 0,indicating the existence of the mediating effect.The indirect prediction effect of self-disclosure on psychological distress through the multiple mediating effects of intimate relationship and negative coping was-0.008(-0.216*-0.163*-0.238).The 95%CI of the mediation effect of Bootstrap test was[-0.019,-0.001],excluding 0,indicating the existence of chain mediation effect,And negative coping and intimacy played a complete mediating role in the relationship between self-disclosure and psychological distress.Conclusion:1.The level of psychological distress of hemodialysis patients is at a medium level,but the number of patients with psychological distress is relatively large.It suggests that medical staff should pay attention to the psychological distress of hemodialysis patients.2.It is suggested that individualized intervention programs can be given to patients according to these influencing factors in clinical work to improve their psychological status and promote their health outcomes.3.It is suggested that medical workers can improve the psychological condition of patients by improving the level of self-disclosure,improving the level of intimate relationship and improving the level of dual coping. |
PDF Full Text Request