Coping strategies mediate the effects of stress on psychological distress in patients with end-stage renal disease: A structural equation modeling approach.

BACKGROUND AND PURPOSE: Patients with end-stage renal disease (ESRD) undergoing dialysis often experience substantial psychological and physiological stress, particularly during the coronavirus disease 2019 (COVID-19) pandemic. Coping strategies may influence how patients manage stress and related health outcomes. This study investigated the associations among coping strategies, perceived stress, anxiety, depressive symptoms, sleep quality, and quality of life (QoL) in ESRD patients, with a focus on the mediating role of coping strategies. MATERIALS AND METHODS: A cross-sectional study was conducted with 110 dialysis patients from two centers in southern Taiwan. Participants aged ≥20 years completed questionnaires assessing perceived stress, coping strategies, mental health, sleep quality, and QoL. Individuals with psychiatric conditions or a history of major depressive disorder were excluded. Structural equation modeling was used to examine direct and indirect relationships among perceived stress, coping strategies, and psychological outcomes. RESULTS: Among participants, 73.6% reported poor sleep quality, 45.5% had depressive symptoms, and 92% experienced anxiety. Poor sleep quality was associated with higher levels of anxiety and depressive symptoms. Active coping strategies were associated with better physical quality of life (PQoL), mental quality of life (MQoL), and lower depressive symptoms. In the structural equation model, coping strategies showed significant indirect effects in pathways linking perceived stress with sleep disturbances, psychological distress, PQoL and MQoL. CONCLUSION: Perceived stress and poor sleep quality were associated with greater psychological distress and poorer QoL. Coping strategies mediated specific associations among perceived stress, sleep disturbance, psychological distress, and physical and mental quality of life.