Influencing factors and path analysis of posttraumatic growth in patients with autoimmune diseases

Guided by the Transactional Model of Stress and Coping, this study aimed to construct a structural equation model of posttraumatic growth in patients with autoimmune diseases. Through path analysis, the associative pathways among key factors, including fear of disease progression, social support, illness perception, and coping modes, were examined.

A cross-sectional study was conducted. A total of 317 patients with autoimmune diseases were recruited from the rheumatology and immunology departments of three tertiary grade A hospitals in Anhui Province, China, between January 2025 and February 2026 using a convenience sampling method. Participants were assessed using a general information questionnaire, the Posttraumatic Growth Inventory (PTGI), the Fear of Progression Questionnaire (FoP-Q), the Perceived Social Support Scale (PSSS), the Medical Coping Modes Questionnaire (MCMQ), the Brief Illness Perception Questionnaire (BIPQ), and a Visual Analog Scale (VAS) for disease activity. Data were analyzed using SPSS 26.0 for correlation and regression analyses. Structural equation modeling was performed using Amos 26.0, and the bias-corrected bootstrap method was employed to test mediating effects.

A total of 288 patients completed the survey. The total score of posttraumatic growth was 52.20 ± 13.87. The structural equation model demonstrated a good fit to the data (χ²/df = 2.736, CFI = 0.935, TLI = 0.928, RMSEA = 0.063) and accounted for 49.3% of the variance in posttraumatic growth. Fear of disease progression was directly positively associated with posttraumatic growth (β = 0.290, 95% CI: 0.191-0.392), accounting for 68.7% of its total effect. Mediation analysis revealed three statistically significant mediating pathways: (1) fear of disease progression → social support → posttraumatic growth (indirect effect = 0.054, 95% CI: 0.015-0.107, P = 0.006), accounting for 12.80% of the total effect; (2) fear of disease progression → patient-reported disease activity → posttraumatic growth (indirect effect = 0.048, 95% CI: 0.015-0.099, P = 0.003), accounting for 11.37%; and (3) fear of disease progression → avoidance coping → posttraumatic growth (indirect effect = 0.037, 95% CI: 0.011-0.080, P = 0.004), accounting for 8.77%. The mediating effects of fear of disease progression via resignation coping and illness perception were not statistically significant (P > 0.05). These findings suggest that fear of disease progression is positively associated with posttraumatic growth and may be indirectly associated through a facilitative pathway via social support as well as inhibitory pathways via patient-reported disease activity and avoidance coping.

Fear of disease progression is positively associated with posttraumatic growth in patients with autoimmune diseases. In clinical practice, attending to patients' level of fear of disease progression, strengthening social support systems, guiding reduction of avoidance coping, and alleviating negative illness perception are all associated with promoting patients' posttraumatic growth and positive psychological adaptation. Given the cross-sectional design of this study, the above associations should be understood as covarying relationships among variables rather than causal effects.