The relationship between alexithymia, emotion regulation, psychological resilience, and self-management behaviors in kidney transplant recipients: a multicenter structural equation modeling study.

BACKGROUND: Effective self-management behaviors can improve outcomes in kidney transplant recipients. Although existing evidence has shown that alexithymia is negatively associated with self-management behaviors, the underlying mechanisms remain unclear. This study aimed to explore the relationships among the alexithymia, emotion regulation, psychological resilience and self-management behaviors in kidney transplant recipients. METHODS: This multicenter cross-sectional study recruited kidney transplant recipients who attended follow-up visits at three major tertiary hospitals in northern and southern China between January and March 2026. A general demographic questionnaire, the Perth Alexithymia Questionnaire, the Emotion Regulation Questionnaire, the Kidney Transplant Psychological Resilience Scale, and the Kidney Transplant Self-Management Scale were used for data collection. The relationships among alexithymia, emotion regulation, psychological resilience, and self-management were examined using correlation analysis, linear regression, and structural equation modeling. RESULTS: A total of 299 kidney transplant recipients were included in the analysis. The structural equation model demonstrated a good fit to the data (CFI = 0.949 - 0.955; RMSEA = 0.077 - 0.085). Alexithymia was directly associated with self-management in two parallel structural equation models (direct effect = -0.129 in the cognitive reappraisal model; -0.119 in the expressive suppression model). Emotion regulation strategies, including cognitive reappraisal and expressive suppression, mediated the association between alexithymia and self-management (indirect effect = -0.030 and -0.041, respectively). Furthermore, a chain mediating pathway through emotion regulation strategies and psychological resilience was identified (indirect effect = -0.028 and -0.067, respectively). CONCLUSION: Alexithymia is both directly and indirectly associated with poorer self-management behaviors in kidney transplant recipients, with emotion regulation strategies and psychological resilience serving as significant mediators. These findings provide preliminary directions for optimizing personalized self-management support following kidney transplantation.