Relation among hope, self-efficacy, and psychological distress in hemodialysis patients: a path analysis

Psychological distress is a major problem among hemodialysis patients. Certain prior studies suggest that psychological distress is negatively associated with hope and self-efficacy. The way hope and self-efficacy are linked with psychological distress, as well as the strength of these correlations in hemodialysis patients, may vary across cultures. Also, it is unclear whether self-efficacy mediates the relationship between hope and psychological distress. The purpose of this study was to look into the effects of hope, self-efficacy, and demographic characteristics on psychological distress, as well as to verify the mediating role of self-efficacy in the relationship between hope and psychological distress in a sample of Iranian hemodialysis patients.

This cross-sectional descriptive-analytical study was conducted in 2022. Total population sampling was used. The data collection tools were distributed to 345 eligible hemodialysis patients from six dialysis centers in Southern Khorasan province, Iran. Among them, 215 patients completed the questionnaires. Data were collected using a demographic questionnaire, the Chronic Kidney Disease Self-Efficacy instrument, the Kessler Psychological Distress Scale, and the Herth Hope Index. Data were analyzed using SPSS version 24 and AMOS version 22.

The final predictors of psychological distress were hope (β = -0.44, P < 0.001), self-efficacy (β = -0.29, P < 0.001), and duration of hemodialysis (β = -0.15, P = 0.003). These variables collectively predicted 46% of the variance of psychological distress. Path analysis with good model fit indices indicated the significant direct effect of hope on psychological distress (ß = - 0.47, P < 0.001), the significant direct effect of self-efficacy on psychological distress (ß = - 0.29, P < 0.001), the significant direct effect of hope on self-efficacy (ß = 0.49, P < 0.001), and the significant indirect effect of hope on psychological distress (ß = - 0.19, [95% CI = -0.32, -0.08], P < 0.001).

It is crucial to consider hope, self-efficacy, and the duration of hemodialysis when designing interventions aimed at reducing psychological distress in hemodialysis patients. According to this study, hope has a significant influence on reducing psychological distress by enhancing self-efficacy. Therefore, implementing programs that improve hope and self-efficacy simultaneously may reduce psychological distress in hemodialysis patients.