Psychological resilience mediates the impact of anxiety and insomnia on health-related quality of life in maintenance dialysis patients

Abstract

Abstract This study examined the associations of anxiety, insomnia, and psychological resilience with health-related quality of life (HRQoL) among maintenance dialysis patients and explored potential mediating roles. In this cross-sectional study, 207 adult patients undergoing maintenance dialysis were recruited. HRQoL was assessed using the Short Form-36 Health Survey (SF-36), generating Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Anxiety, insomnia, and psychological resilience were measured using the Generalized Anxiety Disorder-7 (GAD-7), Athens Insomnia Scale (AIS), and 25-item Connor–Davidson Resilience Scale (CD-RISC-25), respectively. Multivariable linear regression and bootstrap-based mediation analyses were conducted. Furthermore, subgroup analyses were conducted to examine the robustness of the results. Higher anxiety and insomnia scores were independently associated with lower PCS and MCS, whereas resilience was positively associated with both components. Each one-point increase in anxiety score was associated with a 1.61-point decrease in PCS and a 1.15-point decrease in MCS; corresponding decreases for insomnia were 1.01 and 0.91 points. Psychological resilience partially mediated the association between anxiety and HRQoL (23.46% for PCS; 30.37% for MCS), but no significant mediation was observed for insomnia. Subgroup analyses showed consistent associations for insomnia, while the anxiety–HRQoL relationship was modified by smoking status and diabetes. Anxiety and insomnia are independently associated with impaired HRQoL in dialysis patients. Psychological resilience partially explains the adverse impact of anxiety, but not insomnia, suggesting distinct patterns of association and potential targets for tailored psychosocial interventions.