维持性血液透析患者配偶亲密关系与二元应对在其自我表露与恐惧疾病进展间的中介效应OA

Objective To explore the relationship between self-disclosure and fear of progression in spouses of maintenance hemodialysis(MHD)patients,and to further analyze the chain mediating effect of intimacy and dyadic coping on this relationship.Methods From May 2023 to December 2024,307 spouses who accompanied MHD patients for medical treatment at Ji'an Central People's Hospital were selected by convenience sampling.They were investigated using the Distress Disclosure Index(DDI),Marital Adjustment Test(MAT),Dyadic Coping Inventory(DCI)and Fear of Progression Questionnaire Short Form/Partner Version(FoP-Q-SF/P).Results Correlation analysis showed that DDI scores were positively correlated with MAT and DCI scores,but negatively correlated with FoP-Q-SF/P scores;MAT scores were positively correlated with DCI scores,but negatively correlated with FoP-Q-SF/P scores;DDI scores were negatively correlated with FoP-Q-SF/P scores(P<0.05 for all).The structural equation model revealed that intimacy and dyadic coping exhibited a partial mediating effect on the relationship between self-disclosure and fear of progression,with indirect effects of-0.339 and-0.083,accounting for 60.64%and 14.85%of the total effect,respectively;additionally,intimacy and dyadic coping exhibited a chain mediating effect on the relationship between self-disclosure and fear of progression,with an indirect effect of-0.066,accounting for 11.81%of the total effect.Both partial and chain mediating effects were statistically significant(P<0.05).Conclusion Healthcare providers may develop interventions centered on"promoting self-disclosure",with"optimizing intimacy and dyadic coping"as the key pathway.On the one hand,healthcare providers may directly encourage spouses of patients to make self-disclosure;on the other hand,they may take targeted nursing interventions to improve spousal intimacy and coping strategies,thereby reducing their fear of progression through multiple pathways.