The impact of illness perception on the quality of life in initial peritoneal dialysis patients: the mediating role of activation, depression, and medication adherence

Posted on 21 Aug 2025 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.175576515.59235874/v1 — This is a preprint and has not been peer-reviewed. Data may be preliminary. The impact of illness perception on the quality of life in initial peritoneal dialysis patients: the mediating role of activation, depression, and medication adherence Yujun Zhou1, Yanling Huang1, and Jianying Li 1 1Sun Yat-sen University First Affiliated Hospital Department of Nephrology August 21, 2025 Abstract Objective Patients who suffering the initial period of dialysis were prone to heavy physical and psychological burden due to excessive illness perception and low patient activation level, which ultimately impacting the quality of life of PD patients. Therefore, this study aimed to clear the mediating relationships between illness perception and quality of life in initial peritoneal dialysis patients. Method This study was a cross-sectional survey. 201 initial peritoneal dialysis patients were included which from three hospitals in Guangdong Province from January 2022 to December 2023. Variables included illness perception (Brief Illness Perception Questionnaire, BIPQ), patient activation (Patient Activation Measure-13, PAM-13), depression (Patient Health Questionnaire-2, PHQ-2), medication adherence (Morisky Medication Adherence Scale-4, MMAS-4), and quality of life (the Medical outcomes study 12-item short-form health survey, SF-12). Structural equation modeling with bootstrapping was employed for mediation analysis. Results Illness perception negatively correlated with quality of life (r = -0.645, p < 0.01), patient activation (r = -0.165, p < 0.05), and medication adherence (r = -0.212, p < 0.01), and positively correlated with depression (r = 0.460, p < 0.01). The structural equation model results showed good model fit that CMIN/DF = 1.310, RMSEA = 0.039, GFI = 0.991, AGFI = 0.955, CFI = 0.997, NFI = 0.989, TLI = 0.990. The path results showed that the total direct effect of illness perception on quality of life was -0.429, accounting for 59.83% of the total effect. Patient activation and depression played a chain mediating role in the path from illness perception to quality of life, with an effect size of -0.288, accounting for 40.17% of the total effect. Medication adherence did not demonstrate significant mediation effects. Conclusion The patient activation and depression were the mediating variables between illness perception and quality of life in initial peritoneal dialysis patients. Enhancing patient activation levels and alleviating depression symptoms will improve quality of life in initial peritoneal dialysis patients. Hosted file 0812MANUSCRIPT-midiating adherence(without authors).doc available at https://authorea.com/ users/958319/articles/1327136-the-impact-of-illness-perception-on-the-quality-of-life- in-initial-peritoneal-dialysis-patients-the-mediating-role-of-activation-depression-and- medication-adherence 1