Family support, stigma, and psychological detachment in hemodialysis patients: a cross-sectional mediation analysis.

BACKGROUND: Maintenance hemodialysis (MHD) patients face profound psychological challenges that impede their quality of life and treatment outcomes. Understanding the interplay between family support, illness-related stigma, fear of progression, and psychological detachment is crucial for developing effective psychosocial interventions. AIMS: This study aimed to investigate the relationships among family support, stigma, fear of disease progression (FoP), and psychological detachment in MHD patients, and to examine the mediating roles of stigma and FoP. METHODS: A cross-sectional study was conducted from November 2024 to January 2025. Using convenience sampling, 232 MHD patients were recruited from a hemodialysis center in China. Data were collected using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Impact Scale (SIS), Family APGAR Index, and the Psychological Detachment Scale for MHD. Mediation analysis was performed using the PROCESS macro (Model 6) with 5000 bootstrap samples. RESULTS: The mean score for psychological detachment was 193.10 ± 24.37. Family support was positively correlated with FoP (r = 0.16, p < 0.05) and negatively correlated with stigma (r = -0.21, p < 0.01) and psychological detachment (r = -0.22, p < 0.01). Stigma was positively correlated with psychological detachment (r = 0.59, p < 0.01). Mediation analysis revealed that stigma significantly mediated the relationship between family support and psychological detachment (indirect effect = -1.33, 95% CI [-2.30, -0.25]), indicating that higher family support was associated with lower stigma, which in turn was associated with lower psychological detachment. However, fear of progression did not mediate this relationship (indirect effect = 0.07, 95% CI [-0.05, 0.30]), nor did it function as a chain mediator with stigma (indirect effect = 0.05, 95% CI [-0.02, 0.13]). These findings suggest that stigma, but not fear of progression, is a key mechanism linking family support to psychological detachment in MHD patients. CONCLUSION: Psychological detachment in MHD patients is influenced by family support through the mediating mechanism of stigma, while fear of progression does not play a mediating role.Interventions aimed at enhancing family-centered care, reducing illness-related stigma, and addressing excessive fear of progression may improve patients’ psychological detachment and overall psychosocial well-being. CLINICAL TRIAL REGISTRATION: This study is a cross-sectional observational study, and clinical trial registration is not applicable.